LILONGWE-(MaraviPost)-One of the country’s Civil society organisations on Friday urged the Malawian government to implement intellectual property laws as a means of ensuring affordable cervical cancer treatment.
The call comes as Malawi joins with others nations in commemorating World Intellectual Property Day which falls on April 26, yearly.
The civil society organisations is calling government to address the challenges to accessing cervical cancer medicines in Malawi.
Many patients are unable to access quality services due to delays in the implementation of the law.
For instance, At the age of 36, Alile (Not real name) has been living with cervical cancer for almost two years.
She receives chemotherapy every three weeks at a clinic in Malawi’s capital, Lilongwe, 100km west of her home in Salima.
The treatment she receives, she says, is helping her to feel better, but she understands that she has a long way to go.
Rosemary (Not real name) , another cervical cancer patient at the same clinic, is quieter, more serious, seemingly stoic.
Diagnosed in 2014, she is now 40 years old, and spends weeks at a time with her sister in Lilongwe while she receives her treatment.
“I believe that chemotherapy can fix this disease,” she says. “I hope that one day I am going to be fine.”
Alile and Rosemary are among a very small percentage of women who are being treated for cervical cancer at all in Malawi. Millions of others simply go undiagnosed and untreated. The result is a devastating number of preventable deaths.
Cervical cancer, which refers to the growth of abnormal cells in the cervix, accounts for over 40% of female cancers in Malawi from age 15 and above.
Current estimates indicate that, every year, 4,163 women are diagnosed with cervical cancer in the country and 2,879 die from it.
According to a 2016 Ministry of Health policy brief, Malawi has the highest rate of cervical cancer in the world.
It is almost always detected when it is already too advanced to be operated on.
Since cervical cancer is particularly life threatening for people with HIV, it is especially dangerous among Malawi’s HIVpositive population, which is one of the largest globally.
Barriers to access to treatment
“Both Alile and Rosemary are on palliative care,” says Mary, the medical officer treating them.
“Our resources and options are limited. With the funding the clinic gets, it is impossible to maintain a consistent supply of the cancer and supporting drugs we need, and we often have to change their treatment regime.
Consistency is very important for effectiveness; change should only take place if patients are not responding to the drugs prescribed or if there are severe side effects.”
Cervical cancer patients are typically treated with medicines that include Carboplatin, Cisplatin, Docetaxel and Paclitaxel.
Access to these medicines, however, is regularly affected by procurement problems, and stock-outs in Malawi are frequent.
Although there are newer drugs on the market, their prohibitively high cost further reduces their access by poor Malawians, who only have access to public health facilities.
At this stage, even consistent access to older drugs would be beneficial. One of the best treatment options is the concurrent use of both chemo and radiation.
“But when it comes to radiotherapy, Malawi has the expertise but lacks the infrastructure,” says Mary. “We simply don’t have access to the technology.”
While the medical community is hoping that the new cancer centre being built in Lilongwe will bring such resources, it will not be able to cope with the number of patients who need this care.
Prevention is better than treatment
Dealing with cervical cancer requires a dual-pronged approach: the administration of the human papillomavirus (HPV) vaccine, which has been used globally as a cervical cancer prophylactic for several years, and adequate screening. This has not been implemented effectively in Malawi.
“Although the HPV vaccine Cervarix has been available in Malawi’s private hospitals since 2011, most Malawians cannot afford this out-of-pocket expense,” says Maud Mwakasungula, the executive director of Malawi’s Women’s Coalition Against Cancer (WOCACA).
“In January 2019, a project to vaccinate young girls that was first piloted in 2014 was rolled out nationally. Unfortunately, demand could not be met due to an insufficient supply of the vaccine globally at the time.”
Malawi’s screening process is also problematic, hindered by the costs involved, poor communication and cultural misconceptions.
Discrimination also plays a role, especially among sex workers, says the Centre for Human Rights Education, Advice and Assistance (CHREAA).
“While we encourage sex workers to go for cervical cancer screening,” says CHREAA executive director Victor Mhango,
“it is not easy for them to acquire the medical help they need as they face a great deal of stigma in hospitals.”
“Without consistent public awareness campaigns, adequate prevention and screening initiatives, the number of cases of cervical cancer will continue to rise,” says Mwakasungula.
And without access to medicines and treatment, these cases are likely to be fatal.
Reforming legislation to ensure access to medicines
The barriers to accessing cancer diagnosis and treatment are manifold and complex, and are part of larger, systemic medical, political and legislative problems.
“In particular, the impact of intellectual property (IP) rights, policies and laws in facilitating access to medicines is often overlooked by both government and civil society,” says Chikosa Banda, senior law lecturer at the University of Malawi and an IP expert.
“These regulations, however, are critical to ensuring that patients are able to source and afford the medicines they need.” Banda explains that Malawi has revised its Patents Act and has recently installed a national IP policy to incorporate international trade flexibilities.
These flexibilities are provided for in the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
They allow WTO member states such as Malawi to continue to import affordable medicines and, someday, hopefully manufacturer their own.
Although these legislative changes are promising, the government of Malawi has to implement them as part of their procurement systems in order for them to be effective.
“Providing access to cervical cancer medicines in Malawi is going to take radical healthcare reforms, together with enhanced public awareness campaigns, improved screening measures, and capacity-building endeavours across all relevant sectors,” says Banda.
This World Intellectual Property Day, civil society organisations stand in solidarity with the government of Malawi and encourage its leaders to put laws into practice to ensure long-lasting change.
Therefore this World Intellectual Property Day is an opportunity to highlight the role that IP rights (patents, trademarks, industrial designs, copyright) play in encouraging innovation and creativity.
As a balanced IP system recognizes and rewards inventors and creators for their work and ensures that society benefits from their creativity and ingenuity.
An environment in which innovation and creativity thrive and which is diverse and inclusive, improves our chances of addressing the major challenges facing humanity, driving human progress, and making our lives healthier, safer, and more comfortable.