Promoting health worldwide

Family planning: Women in developing and emerging countries should be able to take control of their own lives. Working with partners, Bayer aims through the provision of more health information and education to reduce the risks associated with unplanned pregnancies and unsafe terminations. Here, Dr. Nicodemus McKinnen advises his patient Mitchel Marwena about family planning at the Family Health Center in Nairobi, Kenya.

In the 21st century, the world will be strongly shaped by the effects of population growth in developing countries and emerging markets and by demographic change in numerous industrialized countries. Developing countries in particular are home to increasing numbers of people who lack access to the necessary pharmaceutical products and medical care. That is why Bayer is extending its reach beyond established western health care systems. “Innovation is the key to our commercial success and at the same time the basis of our social commitment,” says Dr. Jörg Reinhardt, Chief Executive Officer of Bayer HealthCare AG. “That’s why we invest significantly each year in the research into and the development of new active ingredients and treatments. We want all people to share in this progress – regardless of their income or where they live.” In developing countries, needs are considerable, but access to pharmaceuticals is made difficult through low incomes and a lack of infrastructure in the health care sector. As part of its “Access to Medicine (ATM)” strategy, Bayer HealthCare is cooperating with a number of private and state organizations. In its “Family Planning” and “Neglected Diseases” lighthouse projects, the company is enabling access to health care and education – including for the poorest of the poor. In emerging markets where economic development is further advanced, Bayer HealthCare is offering its preparations at reduced prices within its patient access programs. In industrialized countries and countries with medium incomes the company has established patient aid programs to be able to offer the necessary therapies also to those people who are not covered by health insurance or who cannot afford treatment.

Opinion

“Bayer and the WHO have been partners since 2004 in the fight against Chagas disease. Bayer‘s continuing support in donating high-quality medicines and providing financial support for distribution, logistics and for national health care programs will greatly help to reduce the extent of Chagas disease in countries where the burden on health and society is greatest.“

Dr. Hiroki Nakatani, Assistant Director-General at the World Health Organization (WHO), responsible for issues concerning HIV/AIDS, tuberculosis, malaria and neglected tropical diseases

Combating poverty through family planning

According to estimates of the World Health Organization (WHO) [ 19 ], of the good 210 million pregnancies recorded each year, around 38 percent are unplanned and 20 percent are terminated. Particularly in developing and emerging countries with high mortality rates for mothers and children, women often do not have any possibility of protecting themselves against unwanted pregnancies, which in turn increases the risk of falling even deeper into poverty. Poverty is one of the biggest obstacles when it comes to gaining access to health care. Half a million women, above all in poorer countries, still die during pregnancy or childbirth each year.

Bayer is the world market leader in contraceptives and has many years of experience in this area. The company has been active in family planning programs for over 40 years. For example, we are involved in joint projects with USAID [ 20 ] (United States Agency for International Development) and non-governmental organizations such as the UNFPA (United Nations Population Fund) [ 21 ]. In 2011 Bayer HealthCare provided these and other organizations with around 119 million cycles of oral contraceptives, more than 4 million injection ampoules and 1.6 million contraceptive implants at a preferential price. These were then sold by the organizations under favorable terms or given away free of charge in countries in Africa, Asia and Latin America. In cooperation with USAID, Bayer HealthCare has established the Contraceptive Security Initiative, which has so far been launched in Ethiopia, Uganda and Tanzania – with other African countries to follow through 2013. This initiative is geared towards selling modern oral contraceptives through local pharmacies at a cheaper price. This way, the up-and-coming middle classes in these countries have the opportunity to take on financial responsibility for their own family planning (for more information, see the table “Bayer lighthouse projects”).

Our work also focuses on improving knowledge of family planning in developing countries. Bayer is cooperating on the “Youth2Youth” sex education program with the German Foundation for World Population (DSW) in Uganda [ 22 ]. More information is available in the online report [ 23 ].

Our “Family Planning” lighthouse project addresses three of the eight Millennium Development Goals of the United Nations (UN): strengthening equal opportunities, reducing child mortality and improving health care for mothers. This commitment to education programs relates to the UN Declaration, which calls for a substantial increase in health information and education to reduce the risk of HIV infections and other sexually transmitted diseases and of unplanned pregnancies and to cut the number of unsafe terminations.

Effective means of tackling tropical diseases

Another UN Millennium Development Goal is to tackle serious tropical diseases. Bayer concentrates primarily on neglected tropical diseases, working closely with the WHO in this regard. As part of this cooperation, we provide medicines to treat the life-threatening infectious diseases Chagas in Latin America and African sleeping sickness – Germanin™ for the treatment of the early stages of African sleeping sickness and Lampit™ both as a combination therapy with another drug for the advanced stages of African sleeping sickness and as a single-entity therapy to treat Chagas disease. The active ingredients in both drugs have been on the WHO’s Essential Drug List for many years.

Bayer is the only producer of the Lampit™ active ingredient nifurtimox. Since 2004 we have been supporting the WHO in the fight against Chagas disease by providing the requisite drugs free of charge. The contract with the WHO, which was extended ahead of schedule in March 2011 through 2017, sets aside an annual donation of one million Lampit™ tablets from 2012, which is double the existing commitment. This is supplemented by an annual donation of US$300,000 that Bayer provides for logistics and the distribution of nifurtimox to treat Chagas disease. The fight against African sleeping sickness is also proving successful. The number of cases for both forms of the disease is in continual decline, with the chance of eliminating the disease entirely growing strongly.

Bayer HealthCare is also committed to tackling tuberculosis, a highly drug-resistant disease in tropical regions in particular. As a partner in the Global Alliance for TB Drug Development, we are involved in the development of a therapy that reduces the duration of treatment from six to four months. This therapy incorporates the Bayer active ingredient moxifloxacin. The WHO has been provided with the drug containing the active ingredient moxifloxacin since 2011 – before approval of the indication – to treat multi-resistant tuberculosis (MDR-TB) in national programs, e.g. initially in China in 2011.

Our Bayer CropScience subgroup has long been involved, above all, in the fight against vector-borne infectious diseases such as malaria and dengue fever. One approach designed to counteract the threat of malaria is a new type of mosquito net that combines the strength of polypropylene with the softness of a multifilament fiber. It also incorporates the WHO-recommended active ingredient deltamethrin against insects. This ingredient is then gradually released to continuously deliver its insecticidal action. The concluding report of the Pesticide Evaluation Scheme of the World Health Organization (WHOPES) [ 25 ] confirmed that the Bayer LifeNet™ mosquito nets [ 24 ] exhibit a superior action against insects that transmit malaria. LifeNet™ therefore surpasses by far the minimum requirements of WHOPES which state, for example, that a net must remain effective after 20 washes. The longer-lasting action of a durable net represents an important step on the way towards sustainable vector control. More information can be found on the internet [ 26 ].

Access to innovative medicine

The call for access to medicine affects not only developing and emerging countries but also countries without state-run health insurance systems, such as the United States. Here, too, many people cannot afford certain effective medicines when they come at a higher cost as a result of the high associated research outlay.

For markets like these, Bayer has developed a differential pricing system based on the general level of income, with the medicines being distributed for sale via local partners. This way, for example, a total of 40,366 patients in the United States benefited in 2011 from our patient access programs, including 17,068 from our multiple sclerosis drug Betaseron™/Betaferon™, 39 from Kogenate™ for the treatment of hemophilia, and 2,975 from the anticancer drug Nexavar™. Similar programs have been up and running since 2007 in China and, since 2008, in other countries in southern and southeast Asia, Brazil and selected countries in southeastern Europe.

Programs like these not only provide patients with access to forms of treatment they could otherwise not afford – they also help Bayer to open up new markets.

We intend to further expand Bayer’s commitment in this area in the future. To ensure the long-term success of our programs, our concepts within the ATM strategy must be commercially viable, they must offer answers to urgent social issues and they must comply with the principles of research-driven pharmaceutical manufacturers. In line with the joint declaration – the “Principal Focus and Actions of the Research-Based Pharmaceutical Industry in Contributing to Global Health” – all member companies of the International Pharmaceutical Association are committed to supporting the Millennium Development Goals. The formation of global partnerships plays an essential role in this regard.

Bayer is also active in the public health sector, e.g. with its “Go West” [ 27 ] program in China that was launched in 2007 in cooperation with the Chinese Health Ministry to support the continuing education of physicians in rural and district hospitals in the undersupplied western part of the country.

Bayer lighthouse projects for health care
Family Planning	Implemented measures	Results in 2011
Introduce original products oral contraceptives) at prices in line with the local market in 11 African countries jointly with USAID by 2013	Project: Contraceptive Security Initiative (CSI): Ethiopia (Dec. 2010), Uganda (Sept. 2011) and Tanzania (Nov. 2011), with another eight countries to follow by 2013 (contract with USAID to run until 2014 – roll-out scheduled for completion in 2012)	Measurements are based on CYP* (Couple Years of Protection) Example for oral contraceptives: 1 CYP = around 14 cycle packs; total CYPs: 8,157; all CYPs are calculated using the MSI Impact Calculator (Version 1.2) Ethiopia (2011): outlets supplied*: 1,351; cycles provided: 103,690; CYPs: 7,406 Uganda (2011): outlets supplied: 140; cycles provided: 7,429; CYPs: 530 Tanzania (2011): outlets supplied: 47; cycles provided: 3,097; CYPs: 221
Increase annual provision of oral contraceptives to 119 million cycles jointly with partners (e.g. USAID, UNFPA, IPPF)	Bulk delivery of oral contraceptives, injections and implants for family planning programs in developing countries in agreement with partners	Figures for 2011: Hormone implant: 1.61 million; CYPs: 5.64 million Oral contraceptives: 118.56 million; CYPs: 8.47 million Injections: 4.53 million; CYPs: 1.13 million Total CYPs in 2011: 15.24 million All CYPs are calculated using the MSI Impact Calculator (Version 1.2) Target defined in 2009 and met in 2010; the level was sustained in 2011
Neglected Diseases	Implemented measures	Results in 2011
Support the WHO • in tackling Chagas and • in treating African sleeping sickness	Extension of cooperation with the WHO in the fight against Chagas and doubling of the provision of nifurtimox for Chagas treatment from 500,000 to 1 million tablets per year from 2012 to 2017, a total of 5 million tablets and US$1.5 million during the entire period	Figures for Chagas: 2011: Number of nifurtimox tablets distributed according to the WHO: 488,100 worldwide Patients treated with nifurtimox: 1,212
	Annual provision of 400,000 tablets containing nifurtimox to the WHO for the nifurtimox/eflornithine combination therapy of African sleeping sickness from 2009 to 2012 Plans to extend the contract Bayer participation in the Bill & Melinda Gates Foundation’s initiative “London Declaration on NTDs (Neglected Tropical Diseases)” on January 30, 2012 for the elimination of neglected tropical diseases by 2020	African sleeping sickness: A combination therapy involving drugs containing the active ingredients nifurtimox and eflornithine for the treatment of this disease has been placed on the WHO’s Essential Drug List 2011: 403,700 tablets containing nifurtimox distributed by the WHO 4,500 patients treated The report on the WHO’s control and monitoring program on African sleeping sickness from 2011 indicates that: The number of cases for both forms of the disease has declined steadily The combination therapy of eflornithine and nifurtimox has made an important contribution to this decline The chances of eliminating the sickness are high
Conduct research into shortening the duration of tuberculosis therapy together with the Global Alliance for TB Drug Development		Patient recruitment for the ReMOXTB**** study concluded mid-January 2012
New cooperation with the WHO in tackling TB	Cooperation between Bayer, the WHO and the Stop Tuberculosis (TB) Partnership to tackle multi-resistant tuberculosis	Bayer made 620,000 tablets of the antibiotic moxifloxacin available in 2011 to treat TB in China
* CYP = Couple Years of Protection. CYP is the number of couples who used the provided contraceptives for a year. MSI Impact Calculator: Marie Stopes International (MSI) is one of the biggest international organizations committed to the support of family planning and reproductive health. The Impact Calculator is a method for controlling the influence of, for example, family planning programs. More information is available at http://www.mariestopes.org/ * Outlet: pharmacies or drug-dispensing outlets **** ReMOXTB = rapid evaluation of moxifloxacin in the treatment of sputum smear positive tuberculosis. (This study investigates a short, fast therapy involving moxifloxacin for the treatment of tuberculosis.)

Promoting health worldwide

Opinion

Combating poverty through family planning

Effective means of tackling tropical diseases

Access to innovative medicine

Bayer Group

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