TO DENY pre-exposure prophylaxis (PrEP) to people at high risk of acquiring HIV ought to be unconscionable, but yesterday’s welcome Court of Appeal decision has implications for NHS England.
The figures make sense, especially in the long run, with 103,700 individuals currently living with HIV in the UK and each one likely to take medication costing up to £360,000 during their life.
Offering PrEP — the anti-retroviral drug Truvada — to high-risk groups could cost £20 million a year but is likely to slash infection rates in these groups by up to 90 per cent.
NHS England has waited on the result of this case before agreeing to commission PrEP, based on an interpretation of whether PrEP is essentially preventative and thus the responsibility of local authorities or a treatment proper to the NHS.
People at risk of HIV and their families will question the wisdom of such a lengthy and expensive legal rigmarole while patients are suffering.
They will welcome the court ruling in favour of the case made by the National Aids Trust and the Local Government Association.
However, this is yet another squabble about restricting availability of essential treatment for NHS patients on cost grounds.
Patients are caught between the Tory government’s obsession with cutting expenditure on health and pharmaceutical companies’ drive to maximise profits.
The court was correct to recommend finding a better mechanism for sorting out these conflicts than taking them through the court system and lining the pockets of costly barristers and solicitors with taxpayers’ money.
NHS England has undertaken to contact the drug manufacturer asking for reconsideration of the exorbitant price charged for Truvada and to examine the scope for possible broader use of generic medications.
This ought to raise the profile once more of demands to bring the pharmaceuticals industry into public ownership and prevent big pharma from holding the NHS to ransom.
While our NHS remains publicly funded and free at the point of use, the public service model introduced by Nye Bevan in the postwar Labour government is constantly under threat.
The revelation that Richard Branson’s Virgin conglomerate is to take over provision of social care in Bath and North East Somerset exemplifies the private sector’s constant campaign to penetrate health services and social care and transform public funds into private profits.
Bevan himself warned over 60 years ago in his book In Place of Fear that public enterprise should produce medical supplies for the NHS to prevent big business profiteering.
Pharmaceutical companies do not share the ethos of the NHS or of those who rely on our public health system.
Their priority is to develop or modify “new” preparations that can deliver high returns.
The recent Ebola crisis in West Africa laid bare the failure of big pharma to develop an effective vaccine because there was no “business case” to justify it.
The spread of Ebola to Europe and North America provided the impetus to make that “business case.”
Profitability cannot continue as the main motivation for the small group of pharmaceutical companies that dominate the entire globe.
Big pharma always stresses the huge cost of researching and developing new medications, testing, manufacturing and distributing them, but the reality is that R&D accounts for just 10 per cent of revenue, with marketing taking up an exorbitant share.
Our health service is being eaten alive by private capital. It’s time to return to NHS principles and challenge the big pharma profiteers.