Sewol ferry disaster panel sitting idle; cheap hepatitis treatment needed

A South Korean protester is helped after being sprayed by a water cannon as they try to march toward the presidential house during a rally demanding a fully independent inquiry into the 2014 Sewol ferry disaster in Seoul.
A South Korean protester is helped after being sprayed by a water cannon as they try to march toward the presidential house during a rally demanding a fully independent inquiry into the 2014 Sewol ferry disaster in Seoul.PHOTO: AFP

1. Sewol disaster committee still idle

In its editorial on July 28, 2015, The Korea Herald says the special committee investigating the Sewol ferry disaster has done nothing for four months.

South Korean protestors clash with riot police as they try to march toward the presidential house during a rally demanding a fully independent inquiry into the 2014 Sewol ferry disaster in Seoul on May 1, 2015     PHOTO: AFP

Fifteen months have passed since the Sewol ferry disaster shook the nation, and many Koreans may have recovered from the initial shock of one of the worst maritime calamities. But this does not mean that they could ease up on what they suffered and what they committed themselves to when the tragic accident overtook the entire nation.

So it is utterly disturbing to hear that the special committee named to investigate what caused the ferry to sink and find what we should do to prevent such a disaster has been idle for more than four months.

The committee was launched in March, 11 months after the ferry sank with more than 300 people, many of them high school students on a field trip, under the Special Sewol Act.

But over the four months of its operation, it has done virtually nothing. Instead of organizing a team of qualified staff and getting it to start its job, the panel has engaged itself in disputes and internal feuding over peripheral issues.

The committee's chairman, Lee Seok Tae, and the bereaved families of the Sewol victims hampered otherwise smooth operations of the panel by insisting on a change to a government decree that set aside a key investigation post to a government official. The post is a mid-level one, but the opposition suspected it could lead to government intervention in the probe.

Lee eventually changed his position, requesting the government fill the post in question and two other key positions. But damage has already been done to his leadership, as seen by the voluntary resignation of vice chairman Cho Dae Hwan.

The biggest problem is that the committee is under the control of those with ideological bias. For instance, it has recently hired about 30 civilian staff, but most openings went to those from left-wing groups - like progressive bar association, civic and labor groups.

The special act gives the investigation committee one year to finish its work, which can be extended once by six months. It can get another three months to complete its final report. But even if all this is considered, there is not enough time.

What's urgent is that the committee makes sure it is entirely independent not only of political power and ideology but also of bereaved families of victims, some of whom are tied up with left-wing groups.

2. Hepatitis treatment

In its editorial on July 28, 2015, the Dawn said the new treatment for hepatitis C must be made cheap and easily available.

An automated machine works on purification of potential hepatitis C virus drug candidate at the Gilead Sciences Inc. lab in Foster City, California, U.S.     PHOTO: BLOOMBERG

Hepatitis C is a major global killer. Worldwide, the disease affects between 150 to 185 million people. Hepatitis C-related deaths number between 350,000 and 500,000 annually. A guesstimate for Pakistan suggests 10-15 million affected, with 28,000 cases added to this number every year. Yet its treatment is prohibitively expensive, with the injection-based interferon treatment costing about US$18,000 (S$24,579) for a 48-week course in the US, thus pricing out patients in low- and middle-income countries.

Nevertheless, some countries such as Egypt, where 10-14pc of the population is infected with hepatitis C, have managed to secure a deal for the country's patients with multinational pharmaceuticals. As a result, the cost of treatment went down to about US$2,000 and benefitted 220,000 patients, according to an article on the Open Society Foundations website. Thailand has gone a step further by bringing the treatment of hepatitis C within the ambit of universal health coverage.

Pakistan, on the other hand, despite having a huge population of hepatitis C sufferers, has not paid sufficient attention to the challenge. However, it appears there has been a belated outbreak of good sense from government quarters on this front recently. This has coincided with advances in the treatment of hepatitis C with new orally-based direct-acting medicine coming into the market.

Since 2013, Gilead Science, a US pharmaceutical giant, has led the effort by producing a new line of oral drugs with far fewer side effects than those associated with the previously injection-based interferon treatment. The treatment is slowly spreading beyond its US base where it is still exorbitantly priced between US$63,000 and US$84,000. Like interferon, the cost of the new treatment is again beyond the capacity of patients in the low- and middle-income countries. However, Gilead has entered into agreement with 11 generic drug makers around the world to provide the new treatment at a lower cost in 91 countries.

The lethargic Drugs Regulatory Authority of Pakistan (DRAP) has at last woken up to the growing hepatitis C crisis by giving the go-ahead to the new drug under the brand name of Sovaldi produced by Gilead. The medicine is being marketed by a local pharmaceutical company reportedly at Rs32,000 for one month's treatment. Although still not cheap by most standards, the price is nevertheless being touted as a big pro-patient concession, having been reduced by 40pc from the originally determined price of Rs55,000 for one month's treatment.

In order to drive the point home, parallels are being drawn with Egypt where the new drug is reported to be available at a much higher price. The reality, however, is quite different. Egypt furnishes an example of a success story where the government has negotiated a good deal with multinational pharmaceutical companies to provide drugs at reduced prices to hepatitis C sufferers. Further, the Egyptian government has subsidised the treatment on a systematic basis. As in the case of interferon treatment, the Egyptian government has negotiated a long-term deal with Gilead to provide the new oral treatment at a reduced cost ranging from US$900-US$1,900 for four to 12 weeks' treatment which is far cheaper than in Pakistan. In addition, unlike Pakistan, the Egyptian government has set up a health exchange where hepatitis patients can register for treatment at further subsidised rates. The online registration system has already attracted huge numbers.

In contrast, DRAP has granted sole monopoly to market Gilead's new line of oral drugs to one local company. The price charged is higher with the result that most patients are priced out. Moreover, the new drugs are available only through a slow, cumbersome and restrictive registration process. As a result, the number of patients who have so far benefitted from the new treatment only runs into a few thousand. In addition, the market exclusivity keeps the price artificially high, further restricting access to the medicine. This has become especially significant since another local pharmaceutical company has undertaken to provide the new medicine at a much reduced price of Rs11,000 per month.

Therefore if the government wants to make good on its promise of providing cheap and prompt treatment to hepatitis sufferers, it must change its current strategy. It must open up the market to more companies by granting them licences for generic production of the new drugs. For this to happen, however, the generic producers need to make sure that the generics produced are of the same quality as the original. Lastly, if there is one global lesson from the hepatitis control programme, it is that where governments committed to public health have acted decisively, they have managed to obtain deals from multinational drug companies that are advantageous to patients rather than give sole monopoly to private companies to market the new treatments as is the case in Pakistan.

The writer is a development consultant and policy analyst.

3. Big cities the effort of government and residents

In its editorial on July 28, 2015, the Kathmandu Post says urban development requires combined efforts of government and residents.

The total numbers of municipalities has risen to 191 from 58, of which 131 Village Development Committees were declared to be municipalities in the previous fiscal year in Nepal.     PHOTO: REUTERS

According to the UN, more than half the population of the world currently lives in urban areas, of which 53 per cent reside in Asia. Although Nepal is one of the least urbanised countries in Asia, it is also among the rapidly urbanising nations. According to the Economic Survey 2014/15 conducted by the Ministry of Finance, the average urbanisation growth rate in Nepal in the last ten years has been 3.43 per cent, due to various reasons such as migration and changes in the geography, and demographics. The total numbers of municipalities has risen to 191 from 58, of which 131 Village Development Committees were declared to be municipalities in the previous fiscal year. Until 2011, 19 per cent of the total population of Nepal resided in municipalities. Now, 38.26 per cent of the Nepalis live in urban areas.

The Economic survey as well as National Urban Development Strategy 2015, prepared by the Ministry of Urban Development, has raised concerns over the unplanned urbanisation that is taking place all over the country. It has been reported that urban environmental problems are reaching critical levels, as insufficiency in urban infrastructure is hampering the creation of basic facilities required in urban areas, such as access to drinking water, transport networks, sanitation facilities, open spaces and waste management. The government has been thus taking initiatives to plan proper urban settlements and the Urban Development Strategy, which is a 15-year plan for urbanisation in the country, is an example of that.

But inadequate planning on the part of the government is not the only reason for unplanned urbanisation. More often that not, the government has been unable to implement its policies, exacerbating the problem of haphazard urbanisation. For example, Nepal had building codes in place to guide the construction of houses even before the Great Earthquake. Yet, failure to strictly implement those codes on the government's part and house owners' blatant violation of the codes led, in many cases, to faulty construction. Therefore, urban residents are also responsible for haphazard urbanisation.

Properly planned urbanisation cannot be achieved only through the government's efforts; the public also needs to be supportive of such policies. This can be achieved by making the public more aware of why planned urbanisation is required and how unplanned urbanisation is going to harm them. People need to take responsibility for their actions and fulfil their part in making cities more liveable. For instance, by following traffic rules, refraining from littering on the streets and public spaces, adhering to building codes while constructing houses, city dwellers can make a significant difference. The government can improve the infrastructure and make the proper policies, but unless people follow the rules and do their part, government's efforts will go in vain.