Alliances for health

Self-determined family planning is still a taboo subject in many developing and emerging countries. Many women have unplanned pregnancies, often at a very young age. According to the World Health Organization (WHO), 1,500 women die every day as a result of complications during pregnancy and childbirth. 10,000 children worldwide die every day during their first few months of life, 99 percent of them in developing countries. As part of its Sustainability Program, Bayer intends its lighthouse project "Family Planning" to make a substantial contribution to helping women to plan their lives themselves. A fundamental aspect of family planning is access to contraceptives. Working with partners such as the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF), Bayer hopes that the provision of more health information and education will reduce the risks associated with unplanned pregnancies and unsafe termination of pregnancy.

The Group’s commitment is a contribution towards achieving the Millennium Development Goals of the United Nations (UN). These goals, which should be achieved by 2015, commit the global community to reducing child mortality, improving maternal health and supporting gender equality. But the challenges are considerable. The WHO estimates that of the 210 million or so pregnancies which occur in the world every year, around 38 percent are unplanned and 20 percent are terminated. That’s more than 40 million terminations annually, most of them in developing countries.

The “Family Planning” lighthouse project draws on the many years of experience that Bayer HealthCare (BHC) has with contraception. “But our objective is not only to bring reliable, low-risk methods of contraception onto the market,” explains Dr. Ulrich Köstlin, a member of the Bayer Pharma AG Board of Management and of the Bayer HealthCare Executive Committee. “We are also aware how important it is to provide comprehensive information about the benefits and risks of contraceptives and on how to use them correctly. Another factor is that the price of contraceptives is a challenge in many countries. Bayer therefore also takes into account the low purchasing power in developing countries in particular.” The prices of contraceptives must be adjusted to patients’ income, and are an essential factor in giving patients access to medical care.

In September 2009, BHC concluded a model cooperation agreement with the United States Agency for International Development (USAID). In this agreement, the company undertakes to market an oral contraceptive at a reduced price in a number of developing countries in Africa so that women with a low income can afford the original product. This initiative will begin with the oral contraceptive Microgynon® Fe in Ethiopia, followed by Tanzania and Uganda. Eight further African countries will be included by 2012.

This is the first time that a government organization has cooperated with a manufacturer to make available a low-price oral contraceptive to women in Ethiopia. “We will work with USAID in this region to create conditions under which patients can be educated, the product can be distributed, and health care professionals can be trained,” says Klaus Brill, Head of the Corporate Commercial Relations function. We will be launching numerous family planning programs with the aim of doubling our current joint activities in this field by 2012. For example, we will be providing up to 110 million monthly cycles of oral contraceptives annually so that eight million women in developing countries can use reliable contraception every year.

According to WHO statistics, around 16 million children are born every year to mothers WHO are between 15 and 19 years of age. More than 90 percent of these mothers live in developing or emerging countries. In these countries, there is very often a lack of knowledge on sexuality and contraception methods and the topic is frequently seen as taboo. Yet knowledge, education and explanation are vital elements in empowering women to determine their own lives and make their own family planning decisions. Bayer HealthCare’s family planning program therefore also pursues another approach: we support comprehensive sex education. This includes the topic of HIV/AIDS, particularly in Africa. Our goal is to help children and adolescents to make a conscious decision to use contraception and to stop the spread of sexually transmitted diseases.

Bayer is participating in a project organized by the German Foundation for World Population (DSW), which runs sexual and reproductive health education programs in developing countries. The programs encourage young people to pass on their knowledge to their peers. “We approach the young people who visit the youth clubs which we have set up, and then spend five days teaching them to cope with sexuality, to use condoms, and to protect themselves against HIV/AIDS,” explains Silke Rauschenbach from DSW. “They put their new knowledge into practice using creative methods such as games, songs and little theater performances in schools and village communities.” This approach also takes cultural differences into account. “The only way we can reach people here is through creativity. If we talk to them directly, they just walk away,” explains DSW employee David Kafambe.

Awareness of the fact that the “first time” can have far-reaching consequences if contraception is not used is sadly also lacking in the industrialized countries. Some 25 percent of young women in the 14 to 24 age-bracket worldwide are not sufficiently well informed. This is why Bayer HealthCare also plays a part in World Contraception Day (WCD), celebrated every year on September 26. Initiated by 10 international organizations involved in sexual health, WCD creates a global platform for activities, initiatives and awareness campaigns. The global website at www.your-life.com is part of this education initiative.

Bayer HealthCare is involved in a further project which aims to increase awareness of the wide range of contraceptives available and to provide information on long-term contraception and sterilization. The RESPOND project (Responding to the Need for Family Planning through Expanded Contraceptive Choices and Program Services) launched by the non-governmental organization Engender Health in June 2009 is receiving support from Bayer HealthCare in the form of training material. It provides information on long-term contraception and sterilization for developing countries.

Self-determined family planning is a central aspect of maternal health and the development of entire societies. IPPF sees itself as a voice for women “which is dedicated to making the best methods of family planning available not only in privileged countries but to all women worldwide,” Dr. Kelly Culwell explains. In African countries, in particular, there is a major need for improved family planning activities. “But in many parts of the continent we face political, logistical and often cultural difficulties.”

The organization also champions engaging local communities in order to promote family planning, especially in developing and emerging countries. Reliable protection with contraceptives can only be ensured if they are used correctly. This means carrying out education and communication activities appropriate for the cultural context and in local languages. As IPPF is a federation of local organizations operating in 171 countries, the organization is able to utilize their knowledge, experience and trust gained with local communities to plan the appropriate family planning interventions. The need for improved family planning is not limited to developing countries. “We also need to invest more in more effective methods and more education in developed countries as well,” Culwell adds.

IPPF welcomes Bayer HealthCare’s global and wide-ranging commitment to family planning. Culwell is positive about the project currently being run in Uganda by Bayer HealthCare in collaboration with DSW. “The key to success here is that the sponsors are working locally with trustworthy peers.”

Bayer HealthCare complies with the highest quality standards, a commitment that also extends to the medicines which it supplies to developing and emerging countries. For its contraceptive pills Microgynon® and Microlut® and the contraceptive implant Jadelle® Bayer HealthCare has attained the prequalification status awarded by the World Health Organization (WHO). Through this, the WHO confirms that the preparations and their manufacture meet international standards in terms of efficacy, compatibility, quality etc. Bayer HealthCare is the first manufacturer of contraceptive products to be prequalified by the WHO.

The world’s poorest people often suffer from diseases which are neglected by medical research. Against this background, Bayer HealthCare has designated a further lighthouse project to focus on tropical and neglected diseases. According to the WHO, more than 3.3 billion people, or in other words about half the world’s population, are threatened by diseases such as African sleeping sickness, Chagas disease, malaria and tuberculosis. These conditions place a lasting burden on entire families or village communities.

Bayer HealthCare participates in aid programs to provide drugs for the treatment of these diseases which are included in the list of essential medicines drawn up by the World Health Organization (WHO).

To tackle African sleeping sickness, the company has been supplying 10,000 ampoules annually containing the active substance suramin for single-entity therapy of an early stage of the disease since 2003. In 2009, the company additionally started supplying, at no charge, 400,000 tablets per year of its drug Lampit®; the active substance nifurtimox treats the advanced stage of African sleeping sickness. Since 2009, a further compound has been used in a combination therapy which opens up new perspectives in the treatment of late stages of the disease. The WHO included this combination therapy in the list of essential medicines in 2009.

Chagas disease, which is an infection transmitted in Latin America by a biting parasitic bug, claims around 14,000 lives every year. Bayer HealthCare has been collaborating with the WHO since 2002, annually supplying tablets of nifurtimox at no charge. In 2007, this cooperation agreement on the supply of 2.5 million tablets of Lampit® and support to the tune of US$1.5 million for training and distribution was extended for a further five years. “Our collaboration with the WHO is particularly important to US because it provides US with a specific way of reaching the people who are affected by these diseases,” Köstlin explains. Our donations of Lampit® and Germanin® to help control Chagas disease and African sleeping sickness are routed exclusively through the WHO. Bayer’s Donation Directive stipulates compliance with the WHO’s Guidelines for Drug Donations. 

Tuberculosis is another “neglected disease.” Around nine million new cases of active tuberculosis (TB) are reported every year. The WHO estimates that two million people die of the disease annually. Bayer HealthCare is working with the TB Alliance (Global Alliance for TB Drug Development) on the clinical development of a therapy option involving combination therapy with moxifloxacin, a drug substance produced by Bayer, which could reduce the duration of tuberculosis treatment from the present six months to four months. This would represent a substantial improvement for affected patients, who often stop taking the protracted and thus expensive treatment before it is completed. If their studies are successful, Bayer HealthCare and the TB Alliance will work towards making moxifloxacin available to tuberculosis patients at affordable prices, especially in developing countries which have a heavy burden of disease. In addition, we joined the “Critical Path to TB Drug Regimens” (CPTR) initiative in March 2010. This collaboration between industry, the authorities and NGOs is intended to accelerate the clinical development of TB therapies and to achieve faster regulatory approval of combination therapies.

Figures from the WHO show that some 3.3 billion people, or half the world’s population, are at risk of developing malaria. Around 250 million people contract the infection every year, and almost a million die as a result. Climate change is expected to hasten the spread of tropical diseases such as malaria and dengue fever into regions which have not been affected by these parasites in the past. Researchers at Bayer CropScience were the first to find a way of incorporating the active substance deltamethrin, which the WHO recommends as protection against mosquitoes, into polypropylene fibers. The outcome of this work is a new textile fiber which can be used to make impregnated mosquito nets which are softer, stronger and stay effective for longer. The product, which goes by the brand name LifeNet™, is a long-lasting insecticidal net (LLIN) which is scheduled to REACH the market in the next few years.

In 2009, Bayer CropScience concluded a forward-looking cooperation agreement with the Innovative Vector Control Consortium (IVCC) in Liverpool, United Kingdom. The objective of this project, which is initially planned to run for three years, is to discover new compounds effective against mosquitoes and other insects which are disease vectors. These compounds will be marketed as public health products (PHP) with the aim of protecting the health of the population. Bayer CropScience is contributing to this project its many years of experience and a comprehensive spectrum of substances and screening technologies. Bayer is opening its substance library – one of the most extensive in the world – for the first time as part of this collaboration.

Successful innovative therapies and drug products are already available for many of the diseases which are becoming more prevalent especially in emerging countries. However, many patients in these countries have no access to these products and treatments. The first access program for Nexavar®, a cancer treatment from Bayer HealthCare, was started in China in 2007. The drug is approved in the E.U. for the therapy of kidney and liver-cell carcinoma. The program gives cancer patients access to therapy with Nexavar® and covers the cost of the drug either for a limited period of time or for the full duration of therapy.

The program is now being extended to other countries, including India.

We will continue to pursue our strategy of “alliances for sustainable health care” and review the possibility of implementing it for other business units and regions. This includes the issues of market access and pricing concepts. The existing Bayer Social Healthcare Programs will remain a core activity here. In the future Bayer will maintain its innovative and research efforts, and will continue to enter alliances to intensify global partnerships and provide medicines for these projects. Bayer HealthCare’s commitment is a contribution towards achieving the Millennium Development Goals announced by the United Nations.

Malaria is one of the most dangerous tropical diseases. According to the who, more than 880,000 people around the world die of malaria each year. Areas in Africa south of the Sahara are particularly badly affected by this disease. Here, a child dies every 30 seconds as a result of the Plasmodium parasite, which is transferred by the bite of the Anopheles mosquito. Drugs that can be taken by adults have become less effective due to resistance. Impregnated mosquito nets offer excellent protection, particularly for very young children.