new internationalist
issue 165 - November 1986

Health Action International
A profile of the action network that holds the pharmaceutical
industry accountable, by Andy Chetley.

Founded in 1981 as an 'antibody' to the ill-treatment of consumers by multinational drug companies, in five years Health Action International has grown from a core of about a dozen active organizations largely based in Europe, to a global network of more than 50 consumer, development and public interest groups in some 40 countries.

From its inception, business publications and the industry itself have carefully monitored HAI's activities. The former chairman of the US Pharmaceutical Manufacturers Association described the groups in HAI as 'formidable foes ... skillful in achieving high levels of publicity.' He warned in 1982 that the industry needed to put more thought and effort into countering HAI attacks intelligently.

'The vigorous campaign by the activists has had some discernible effect,' conceded Dr Arnold of the International Federation of Pharmaceutical Manufacturers Associations, even though he described HAI's 'militant consumerism' as being led by 'liberal idealists with an unself-critical conviction that only they are right.'

Also in 1984 Scrip, the pharmaceutical industry's trade publication, brought out a book analysing the activists. It concluded that 'activists have nothing to lose, therefore they cannot lose; therefore industry cannot win.' If only it were that easy.

Earlier this year, the International Organizations Monitoring Service - an intelligence-gathering service specialising in charting possible regulatory problems for transnational corporations - warned its clients: 'The activists were an insignificant political force just five years ago. Judging from their growth and the support for them, they are here to stay and will be a much more serious international force in the future. It would be unwise to expect that the international activists will fade away.'

The credibility of HAI might simply be in the eyes of their corporate beholders. But it has made vigorous efforts to publicise the problems of inappropriate medicines. As a network rather than a formal organization, all the participating groups have their own independence and are free to work in their own country in the best way to:

• further the safe, rational and economic use of pharmaceuticals worldwide;
  
• convince the industry to produce drugs which meet real medical need, have significant therapeutic value, are acceptably safe and offer satisfactory value for money;
• promote the full implementation of the WHO Action Programme on Essential Drugs;
  
• look for non-medical solutions to health problems caused by conditions of poverty.

At the same time, groups pool their expertise and co-operate internationally on specific events or strategies. Indeed the very lack of organisation within the network can be a strength. A myriad of responses can make it difficult for the pharmaceutical industry to predict what is coming next.

At its inception, following the success of the International Baby Food Action Network in having an international code of marketing of breast-milk substitutes adopted by the World Health Assembly in 1981, a code of marketing behaviour for pharmaceutical firms too, was a priority of HAI.

Seeing the writing on the wall, the corporations prepared their own voluntary code of behaviour. The strategy was self-evident: to head off effective regulation. HAI described the voluntary code as 'worthless' and drafted their own - much tougher - version. After a year or so of promoting the code at World Health Organization and UNCTAD meetings, HAI eased back. They recognized that it was unlikely that any UN agency would be prepared to adopt a pharmaceutical code, given the belligerent mood of the US. As every UN organisation's principal funder, the Americans walk the corridors with a big stick. Cutbacks in financial contributions have been threatened at the hint of WHO regulation of private enterprise. American policing activities have been particularly aggressive as so many of the top pharmaceutical corporations are US-based, and have significant lobbying clout on Capitol Hill. Nonetheless, HAI groups have moved forward on other fronts.

Several individual drugs have been targeted as being either non-essential or unnecessarily hazardous. Strong HAI campaigns have been mounted which attacked the use of anti-diarrhoeal products containing clioquinol - a substance which led to large-scale nerve disorders in Japan. It has brought an agreement by Ciba Geigy to withdraw its cioquinol products. Another energetic campaign has focused on the so-called 'appetite stimulants', often promoted as a treatment for malnutrition in children. As a result, the two major companies - Merck Sharp & Dohme and Sandoz - have recently agreed to change their promotional material for these products.

In the last year HAI has focussed less on individual drugs and more on the whole concept of a drugs market out of control. In mid-1986, HAI launched its Problem Drugs pack which claims that some 70 per cent of the products on the market are unnecessary, hazardous or irrational and should be removed. The pack has already been seen by many people 'as essential source material and will remain so for some time to come, since (the pharmaceutical) industry has no alternative package.'

Above all, the global nature of HAI means that information flows quickly around the network, - providing an international challenge to an international problem.

Profiles of some participants

NM Offices: Emmsstraat 9, 2595 EG The Hague, The Netherlands (responsible for overall co-ordination and lobbying efforts) and P0 Box 1045, 10630 Penang, Malaysia (operates an information clearing house and publishes a regular newsletter, HAI News). Both HAI offices are with the International organization at Consumers Unions one of the founders of HAI. IOCU has a membership of some 130 consumer organizations from 51 countries many of which are also actively involved in HAI. Another founding organization is BUKO, the Federal congress of Development Action Groups, August Bebel Str. 62, D-4600 Bielefeld 1, Fed. Rep. of Germany. Linking more than 200 development action groups in West Germany, BUKO has been active since 1960 on pharmaceuticals, and for the past year has been concentrating its efforts on the German company, Hoechst, one of the three biggest pharmaceutical companies in the world.

In the UK Social Audit (PO Box 111, London NW1 8XG), Oxfam (274 Banbury Road, Oxford 0X2 7DZ) and War on Want (Three Castles House, 1 London Bridge Road, London SE1 95G) have all been involved in HAI activities, Social Audit has produced several good publications on medicines and co-ordinated the global campaign on appetite stimulants, Similarly Oxfam has produced several publications, and has been actively involved in efforts with the EEC to introduce export control on hazardous pharmaceuticals, War on Want has been instrumental in producing information about Bangladesh's Drug Policy.

In Australia. the Aumtnhian Consumers Association (57 Carrington Road, Marrickville NSW 2204) has become increasingly involved in HAI's activities. Another useful Australian-based organization, although not strictly a participant in the HAI network, is the Medical Lobby for Appropriate Marketing (MLAM, 33 Renaissance Arcade, Adelaide SA 5000). MLAM is a network of mainly health professionals in over 30 countries which encourages companies to provide adequate information about drugs through regular monthly letters to pharmaceutical corporations pointing out problems with their existing marketing and advertising and suggesting improvements. The UK branch can be contacted at 232 St Margarets Road, Bradford, West Yorks, BD7 2BU.

In Aotearoa (NZ) the NZ Coalition for Trade & Development (PO Box 11345, Wellington) has produced some information materials on pharmaceuticals,

In Canada. HAI Canada (c/o united Church House, 85 St Clair Ave E, 6th fI., Toronto, Ontario, M4T 1 M8), is the co-ordinating network involving nearly 20 consumer, professional, development, church, women's health and other public interest groups. It has produced many useful publications, including information on women and drugs.

In the US, the National Women's Health Network 145 Sutton Place South, New York, NY 100221, The committees for Responsible Investment of the Medical Mission Sisters (338 West St. Hyde Park, Mass, 021361 and the Interfaith Centre on Corporate Responsibility (475 Riverside Drive, Room 666, New York, NY 10115) have all been active on pharmaceuticals, with particular emphasis on the role of US companies.

Worth reading on...
PHARMACEUTICALS & WORLD HEALTH

Bitter Pills - Medicines and the Third World poor, by Dianna Meirose, 1982, Oxfam. Getting a little dated, but still a classic. Essential reading.

Essential Drugs and Developing Countries, by Evaluation and Planning Centre for Health Care, 1985, London School of Hygiene & Tropical Medicine. Useful, up-to-date review and comprehensive bibliography.

Prescription for Death -The drugging of the Third World, by Milton Silverman, Philip Lee and Mia Lydecker, 1982, UnIversity of California Press. Just one of a host of good North American publications on the issue.

Another Development in Pharmaceuticals, Special Issue of Development Dialogue 1985:2. Some good articles, particularly by Charles Medaware and Mira Shiva

The Unmasking of Medicine - A searching look at health care today, by Ian Kennedy, 1983, Paladin. Stimulating. Should be required reading of every health professional. Strong intelligent analysis. British orientated

Transnational Corporation in the Pharmaceutical industry of Develeping Countries, 1984, United Nations Centre on Trananational Corporations Studded with statistical information.