Brazil was one of the first countries to adopt significant health policies to better attend people with HIV. The integrated analysis of the high cost of medicines, public health, and access to medicines comprises an extremely complex task, and Productive Development Partnerships (PDP) was the mechanism used by the Brazilian government, with a view to technological development and training of national production complex. The PDP of atazanavir was formalized in late 2011, and the agreement includes the transfer of technology, manufacturing, and distribution of the drug. The PDP emerges as a solution found by the government to minimize the Ministry of Health drug spending and encourage the local production. However, one should not ignore that there are risks associated with regulatory barriers and problems in negotiations with the holders of technology. Thus, this chapter presents a case study of the successes the management information of the productive development partnerships in Brazil as a collaborative tool for global health.
TopIntroduction
One of the challenges for public health in Brazil comprises the introduction of new policies and strategies that encourage innovation and development of the pharmaceutical sector in the country. Brazil was a pioneer in adopting policies to guarantee universal and free access to medicines against AIDS, important instrument for strengthening the national policy on access to medicines.
Acquired Immunodeficiency Syndrome (AIDS) is a pandemic disease and according to the global statistical panorama presented by UNAIDS, in 2020, 37.6 million people in the world were living with HIV and of these 27.4 million had access to antiretroviral therapy. Worldwide, there were 1.5 million new HIV infections diagnosed in 2020, a reduced number when compared to the 2.8 million registered in 1998 (UNAIDS, 2021).
In Brazil, from the beginning of the epidemic in 1980 until June 2020, 1,011,617 cases of AIDS were detected. Over the past five years, annual records show an average of 39,000 new cases. Since 2012, there has been a decrease in the AIDS detection rate in Brazil, with an average of 17.8 cases per 100,000 inhabitants in 2019, representing a decrease of 18.7%. Although there has been a reduction in AIDS cases throughout the country, especially in recent years, it is worth noting that part of this reduction may be related to the identification of data transfer problems between SUS management spheres, which can lead to a difference in the total number of cases among the municipal, state, and federal HIV/AIDS databases (Brasil, 2020).
In 2014, the publication of the Clinical Protocols and Therapeutic Guidelines (PCDT – Brazilian term) in the format of a protocol for HIV/AIDS and for other opportunistic or related diseases granted Brazil another vanguard step in the response to the epidemic, by becoming the first country in development and the third in the world to recommend immediate initiation of antiretroviral therapy (ART) for all people living with HIV/AIDS (PLHIV), regardless of CD4 count (Silveira, Corrêa, Barroso & Figueiredo, 2016). According to the Department of Chronic Diseases and Sexually Transmitted Infections (DCCI), the total percentage of individuals eligible for ART who started treatment within one month after taking the first CD4, reached the value of 64% in 2020 (Ministry of Health, 2020a).
In 2020, the federal government's investment was close to 1 billion and 840 thousand reais in serving the population with medicines for the treatment of people with HIV/AIDS and other sexually transmitted diseases, which represented 0.06% of all expenditures of the year (Portal da Transparência, 2020). An extremely attractive market for the pharmaceutical industry, and, therefore, one of the fields of greatest investment in research and development (R&D) and protection through patents on antiretroviral drugs (ARVs).
The integrated analysis of the high cost of medicines, public health and accessibility to medicines is an extremely complex task and, from the perspective of health policies, it appears that, despite the progress achieved in Brazil in recent decades, the commitment to ensure accessibility universal access to medicines and the right to health does not reflect our reality. Brazilian autonomy in the production of inputs, medicines and vaccines is still far away. Even so, national production, including public production, remains essential for the health system and for the Brazilian population (Chaves, GC, Moraes, EL & Castro, CGSO de, 2021; Possas, C., Scapini, R. & Simão, M., 2013).