Small Medicine

By: Lara Sewers

The Clinton foundation gave Kenya a blank check to purchase medicine for children with HIV this week. This is perhaps a start to address the issue of lack of adequate medication for children in the developing world, especially those who are HIV positive. In Kenya alone, the cost of drug treatment for HIV positive children is around 2 billion dollars annually; without including the costs of administration, medical assistance, and educational campaigns. Kenya has around 120,000 children infected with the virus. Only a fraction of those, are able to receive any treatment at all.

Despite the large number of children infected with the HIV virus and other illnesses adequate medicine is largely unavailable in the developing world mostly because they are substantially more expensive than adult medicine. Costs of adult medicine are less given the competitiveness in the market that has led to lower prices overall. Few drug manufacturers in the children’s market have prevented this same decrease in prices for children’s medication and consequently have rendered treatment out of reach for millions of children around the world.

According to the World Health Organization, about 60 essential medicines are still not available in formulations appropriate for children consumption. Children with HIV have to take at least 12 pills per day and most of them in tablets with terrible taste and which are hard to swallow for small children. The WHO is inviting member governments to contribute to a fund that would initiate the development of a children’s drug fund in hopes of promoting the availability of appropriate drugs and to highlight the need to pay more attention to children’s needs overall.

Developing children’s medication is a complicated business. Children metabolize drugs in a different way than adults and the cost of developing adequate medication is three times more than that for adult medication. Still, acknowledging this difficulty, the WHO has identified a number of medications already in the market that are adequate to treat a number of illnesses from malaria, tuberculosis, to HIV but are still not made readily available to children in need. This is despite the fact that 40% of malaria cases affect children.

The lack of attention paid to children’s health needs is not a problem exclusive to the developing world. Even in Europe less than half of the medication routinely administered to children has been approved for their use. This is especially true for drug treatment for diseases that are less common. Some rich countries have taken initiative and have started to take children’s needs into account when certifying new drugs for the market. America’s Best Pharmaceuticals for Children Act, passed in 2002, requires the Food and Drug administration to take into account children’s medical needs when certifying drugs. However, this is only one of many initiatives needed to boost the production of children’s medication worldwide. The WHO’s new initiative seeks to set aside funding to aid the research and development of new medications fit for child treatment in recognition of the pressing need for children’s drugs but also in an underlying effort to place more attention on their rights.

Private firms, more concerned about liability for marketing new drugs, especially in the absence of adequate children’s testing that requires informed consent (which is especially hard to get), are deterred from entering the market and doing the adequate research. The WHO hopes that by investing public funds into the research necessary, private corporations will be shamed into doing the same and governments will create a more conducive atmosphere for these activities.

For more information:

The Economist print edition, When a spoonful of sugar won’t do, (Dec. 8, 2007).

AllAfrica.com, Kenya: Country Gets Blank Cheque to Treat HIV+ Children, (Dec. 12, 2007).