We Wouldn’t Mind If You Died of AIDS and Hepatitis C

aids flagRussia has an HIV epidemic. According to the Federal Aids Prevention Center, approximately a million Russians are infected. A third of them also have hepatitis C. At best, only hundreds of these patients receive state-of-the-art treatment. Image by Yaroslava Chingayev, special to Vedomosti

Officials Want to Replace Current Hepatitis C Treatment with Outmoded Therapy
Industry and Trade Ministry Supplied Money for Manufacture of Drugs
Irina Sinitsyna and Olga Sukhoveiko
Vedomosti
December 13, 2018

The Russian Health Ministry plans to significantly reduce procurements of the most effective treatment for viral hepatitis C, combined interferon-free treatment, thus reducing the availability of the drugs for patients infected with HIV in combination with hepatitis B and hepatitis C. Instead, the ministry has proposed putting these patients on interferon therapy. Maria Onufriyeva, director of Community of People Living with HIV, an interregional grassroots organization, has written about the matter to Health Minister Veronika Svkortsova. Ms. Onufriyeva has also sent a letter to Valery Alexeyev, director of the Honest Procurements Project at the Russian People’s Front (ONF). Vedomosti has seen copies of the letters. Ms. Onufriyeva confirmed she sent them. A spokesperson for Mr. Alexeyev said he received the letter. The Health Ministry has not responded to her query.

In November, Minister Skvortsova said that over 714,000 Russians were infected with HIV. According to the Federal Aids Prevention Center, whose figures Ms. Onufriyeva cites, there are 978,443 Russians infected with HIV. A third of them also have hepatitis C.

In late October, the Health Ministry published the final list and amounts of drugs it would be procuring in 2019 and providing to HIV patients, including HIV patients who also have hepatitis B and hepatitis C, writes Ms. Onufriyeva. (Vedomosti has seen a copy of this list.) In particular, the Health Ministry wants to reduce procument of dasabuvir by 750%, meaning one hundred patients would have access to the drug, while this year 748 people could count of getting it, according to the Community’s calculations.

In monetary terms, this would mean a drop in expenditures on the drug from 431.6 million rubles [approx. 5.7 million euros] to 57.9 million rubles [767, 754 euros].

The Health Ministry plans to switch to narlaprevir, intended for the treatment of hepatitis C in combination with other antiviral drugs. In 2018, as the Community has discovered, and as is borne out by information accessed on the federal procurements website, narlaprevir was not purchased by the Russian governmennt. In 2019, the Health Ministry could spend 139 million rubles [approx. 1.8 million euros] on procuring the drug in order to treat 430 people, the Community argues.

Dasabuvir is the most up-to-date antiviral drug. According to the Community, it can cure 98% of hepatitis C patients in twelve weeks.

This figure was confirmed by Vadim Pokrovsky, director of the Federal AIDS Prevention Center.

In Russia, HIV patients who also have hepatitis C have been treated with dasabuvir in combination with ombitasvir/paritaprevir/ritonavir, manufactured under the brand name Viekira Pak by the American company AbbVie. Dasabuvir was placed on the official Russian list of vital and essential drugs for this year. Two years ago, Alexey Repik’s R-Pharm and AbbVie agreed to partly localize manufacture of the drug at R-Pharm’s plant in Kostroma. As R-Pharm reported then, the deal covered repackaging of the drug and quality control. According to AbbVie, Viekira Pak is distributed in Russia by R-Pharm and Euroservice.

Ms. Onufriyeva writes that interferon therapy is much less effective in treating chronic hepatitis C patients with HIV. The treatment significantly reduces quality of life, since it requires weekly injections.

Mr. Pokrovsky explained the difference. Interferon treatment has almost no effect on the virus itself. It stimulates the body’s immune response, but it has numerous side effects, from impotence to mental disturbances. The treatment lasts a year.

Due to the length of the treatment, Ms. Onufriyeva said, it was between 52% and 133% more expensive than interferon-free treatment.

Tableted by R-Pharma, narlaprevir has to be taken together with ritonavir, pegylated (long-acting) interferon, and ribavirin, as indicated in the instructions.

In 2012, R-Pharma acquired a license for the production and sale of narlaprevir from Merck & Co. It tried to refine the drug with support from a federal targeted program administered by the Russian Industry and Trade Ministry. Trade publication Vademecum wrote that R-Pharm invested 700 million rubles in narlaprevir. The Industry and Trade Ministry would allocate 120 million rubles on clinical trials, Sergei Tsyb, head of the ministry’s Department for Chemical Engineering and Bioengineering, promised in 2012.

A R-Pharm spokesperson confirmed receipt of the funds.

R-Pharm registered narlaprevir in 2016. In the spring of 2017, during a meeting with the business community, President Putin promised R-Pharm’s director general Vasily Ignatiev that the government would allocate funds to procure the company’s drugs for hepatitis C patients.

“I will also keep this in mind when allocating resources for healthcare in 2018 and the following years, in 2019 and 2020. It will be necessary, of course, to use what you have developed,” Putin said.

Mr. Pokrovsky is certain the Health Ministry’s decision to reduce procurements of interferon-free drugs could have been influenced by Russian manufacturers wanting to compensate their costs at the state’s expense.

The R-Pharm spokesperson insisted that the company, like other manufactures, received a request from the Health Ministry to quote its prices for narlaprevir and dasabuvir.

“Our price offers for the drugs were the same as last year’s,” he said.

In total, according to the Community’s calculations, in 2019, the Health Ministry can spend 473.5 million rubles [approx. 6.3 million euros] on the procurement of drugs for treating chronic hepatitis C, as opposed to 1.1 billion rubles [approx. 14.6 million euros] last year.

In November, Vademecum wrote that, in 2019, the Health Ministry would also reduce its overall procurement of antiretroviral drugs under its program for providing drugs to people infected with HIV, including patients who were infected with HIV in combination with the hepatitis B and C viruses. However, although it would spend far less money, it planned to expand coverage to a mere sixty percent of those needing treatment.

Ms. Onufriyeva has asked the Health Ministry to consider increasing procurements and moving away from the chronic hepatitis C drugs scheduled for purchase in 2019 and towards drugs that have proven effective. The latter should be supplied to patients with HIV plus viral hepatitis C, including those suffering from advanced liver fibrosis and cirrhosis.

She has asked Mr. Alexeyev to assist her in protecting the interests of patients by sending inquiries to the Health Ministry, asking them to explain the reasons for the cuts in procurements and the selection of outmoded drugs. She also asked him to verify whether the Health Ministry’s actions were in compliance with antitrust laws.

She told Vedomosti she had not received replies to her letters.

vich

“How the Numbers of HIV-Infected Patients Have Changed, 2013–2018.” The red columns indicate total numbers of patients; the orange columns, first-time infections. Figures are given in thousands of people. Source: Rosstat. Courtesy of Vedomosti

Mr. Alexeyev explained the delay in replying. The letter contained a good deal of specialized and medical information, and it was under review by independent experts working for the Russian People Front’s Honest Procurements Project.

“The Russian People’s Front has drawn attention to problems with the list of essential and vital drugs, and their procurements, and this letter is the latest alarm,” he said.

According to Mr. Alexeyev, the Russian People’s Front has been reviewing the Health Ministry’s procedure for including medicines on the list and had already been in touch with the government.

hep b and c

“How the Numbers of Hepatitis Patients Have Changed, 2013–2018.” The dark blue bars indicate first-time cases of chronic hepatitis B; the light blue bars, first-time cases of chronic hepatitis C. Figures are given in thousands of people. Source: Rospotrebnadzor. Courtesy of Vedomosti

If the grassroots organization Community of People Living with HIV believes the industry regulator acted in a way that violated specific regulations on procurements or antitrust statutes, it can file a complaint with the Federal Anti-Monopoly Service (FAS) in the manner prescribed by law, said Maxim Degtyarev, deputy head of the Department for Oversight of the Social Sector and Trade at FAS. For the time being, however, FAS had no grounds to perform an inspection.

The Industry and Trade Ministry did not respond to our request for information.

Elena Filimonova contributed to this article.

Translated by the Russian Reader

(Don’t) Pay Your Rates

DSCN4253A Petersburg housing services worker risking life and limb to clear snow off the roof of a tenement building in the city’s downtown. Photo by the Russian Reader

Russians Are Increasingly Not Paying for Their Flats
Growing Debts for Housing Services and Utilities Reflect Obvious Social Ills
Pavel Aptekar
Vedomosti
February 21, 2018

The increase in housing and utilities rates, occuring alongside a protracted downslide in personal income, has produced an abrupt upturn in debts for housing services and utilities, and collections of arrears in court, especially among low-income segments of the Russian populace.

The Russian Supreme Court has published statistics on the collection of debts for housing services and utilities. In 2014, 2.1 million such cases were ajudicated by the courts. In 2017, the figure was 5.4 million cases, and the total amount of recoverable debt had doubled, from ₽60 billion to ₽120 billion—taking into account, however, the debts of legal entities that paid for heating irregularly. Nevertheless, these figures reflect both an alarming trend—utilities payments have increasingly become a burden for disadvantaged parts of the populace—and the unwillingness of the rich to pay the bills for flats they have purchased as investments.

Generally, the collection of payments for utilities and housing services proceeds calmly. According to the Institute for Urban Economics, 95–97% of apartment residents pay their bills on time, but an individual’s timeliness in paying their bills depends on their income, as well as the climate and budget priorities of the Russian region where they live. According to Rosstat, household expenses on utilities and housing services per family member rose between 2014 and 2016 from ₽1,511 to ₽1,816, i.e., by 20.2%. The share of total household expenses spent on utilities and housing services rose during the same period from 10.3% to 11.3%.

For the sake of budget savings, many regions have reduced subsidies on housing and utilities, which has seriously increased the amount of money spent on these services by local populations, says economist Natalya Zubarevich. For example, housing and utilities account for 25.8% of paid services in Kursk Region, while in neighboring Oryol Region the figure is 41.1%. In Khabarovsk Territory, housing and utitilies expenses make up 26.7% of the cost of all services, while in Amur Region, which has a comparable climate, the figure is 45.8%.

In 2016, housing and utilities expenses accounted for 15.2% of all expenses among the ten percent of Russian families with the lowest incomes, and 14.8% of all expenses among the ten percent of families who were less poor. People who have to scrimp on everything are often forced not to pay for housing and utilities simply in order to survive. However, according to Mikhail Men, Minister for Construction and Housing, some of the arrears are owed by the proprietors of apartments bought as investments, who do not want to pay the bills for vacant flats.

According to Rosstat, the total amount of money owed by the Russian populace for housing and utilities in 2014 was ₽111 billion; in 2015, it was ₽135.8 billion. Subsequently, the debts have grown more quickly. In October 2016, Andrei Chibis, Deputy Minister for Construction and Housing, informed TASS News Agency they had reached ₽270 billion, and in July 2017, Men cited the figure of ₽645 billion [approx. €9.2 billion].

This increase reflects an obvious social ill. Housing and utitilies fees are billed by private companies, who turn not only to the courts to collect unpaid bills but also to the services of illegal debt collectors. Such circumstances could engender serious conflicts, especially in small towns with poor populations.

Translated by the Russian Reader. See my numerous previous posts on the problem of debt in Russia.

MP Oleg Shein: Astrakhan Region Headed for Social Catastrophe

Russian MP Oleg Shein. Photo courtesy of Wikipedia
Russian MP Oleg Shein in 2009. Photo courtesy of Wikipedia

MP: Astrakhan Region Headed for Deep Social Catastrophe
Rosbalt
November 18, 2016

Astrakhan is among the regions undergoing a social catastrophe, argues MP Oleg Shein, who sits on the State Duma’s Committee for Labor, Social Policy, and Veterans Affairs. As the MP told our correspondent, both federal and regional authorities are to blame for the situation.

“Astrakhan Region is currently undergoing a fiscal disaster due to the fact the regional budget has collapsed. This year, it has been slashed by 15%, from 38 to 33 billion rubles. Next year, the regional authorities have proposed cutting the budget by another eight billion rubles. Accordingly, the budget will have shrunk by about 40% in two years. Already this year, financial aid to the poor has been completely eliminated, and subsidies for parents paying fees to kindergartens have been canceled, causing kindergarten fees to increase by one and half times. The upper grades have been eliminated in a number of schools. Schools have gone from eleven grades to nine grades, and this has caused overcrowded classes in the remaining schools. Payroll has been reduced by 7% for public sector employees: doctors, teachers, and cultural workers. Actually, 7% is the average figure; large numbers of people have had their salaries cut much more considerably. So the region really is headed downhill, and the regional government sees no ways of heading off the disaster,” said Shein.

 […]

“The regional authorities—and there is some truth to this—explain what is happening by referring to the loss of tax revenues from the oil industry. Several years ago, the State Duma—or rather, the United Russia party—freed Lukoil from paying taxes on its oil rigs in the Caspian Sea. This year as well, United Russia has voted to transfer the profits from oil production in the Caspian, the income tax revenue, from the regional budget to the federal budget. The regional authorities were really counting on the money, but they have ended up with nothing.  But there is a second reason: their completely devil-may-care approach to drafting the regional budget and the loss of the local tax base. Sometimes, the regional government has literally abetted hostile takeovers of local companies, as, for example, happened to the local company Bassol, which supplies 60% of the salt to the Russian market and now pays taxes outside of Astrakhan Region. Paradoxically, the regional government welcomed this,” said Shein.

The MP said that despite its socio-economic difficulties, Astrakhan Region was also marked by high levels of corruption and the waste of money on mega projects like a musical theater and so on.

According to a rating compiled by the sociology department at the Russian Federation Government Financial University, Astrakhan was among the Russian cities with populations of 500,000 or more where the lowest indices for quality of life had been recorded. According to Astrakhanstat, during the period from January 2016 to August 2016, the real disposable income of Astrakhan Region residents was 89.4% of what it had been during the same period last year.

Translated by the Russian Reader. Thanks to Valentin Urusov for the heads-up

The Penguins Can Fend for Themselves

vechorka-penguin

“There will be no global warming. Russian expedition continues to uncover the secrets of Antarctica.” Front page of the March 13, 2015, edition of Vechernyi Petersburg newspaper.

Earlier today, my comrade Louis Proyect posted a link on his Facebook wall to a Reuters article on the crazy extent of official and grassroots climate change skepticism and ignorance in the world’s biggest country. Here is a short excerpt:

Wildfires crackled across Siberia this summer, turning skies ochre and sending up enough smoke from burning pines to blot out satellite views of the 400-mile-long Lake Baikal.

To many climate scientists, the worsening fires are a consequence of Siberia getting hotter, the carbon unleashed from its burning forests and tundra only adding to man-made fossil fuel emissions. Siberia’s wildfire season has lengthened in recent years and the 2015 blazes were among the biggest yet, caking the lake, the “Pearl of Siberia”, in ash and scorching the surrounding permafrost.

But the Russian public heard little mention of climate change, because media coverage across state-controlled television stations and print media all but ignored it. On national TV, the villains were locals who routinely but carelessly burn off tall grasses every year, and the sometimes incompetent crews struggling to put the fires out.

While Western media have examined the role of rising temperatures and drought in this year’s record wildfires in North America, Russian media continue to pay little attention to an issue that animates so much of the world.

The indifference reflects widespread public doubt that human activities play a significant role in global warming, a tone set by President Vladimir Putin, who has offered only vague and modest pledges of emissions cuts ahead of December’s U.N. climate summit in Paris.

Russia’s official view appears to have changed little since 2003, when Putin told an international climate conference that warmer temperatures would mean Russians “spend less on fur coats” while “agricultural specialists say our grain production will increase, and thank God for that”.

The president believes that “there is no global warming, that this is a fraud to restrain the industrial development of several countries including Russia,” says Stanislav Belkovsky, a political analyst and critic of Putin. “That is why this subject is not topical for the majority of the Russian mass media and society in general.”

_________

This reminded me of a dismal interview I had read this past spring in Vechernyi Petersburg, a now-defunct local rag. (The front page of that particular issue of “Vechorka” is depicted at the top of this post.) I had thought about translating it at the time, but since I prefer to push stories that, however bleak, have a positive hook (meaning they feature an underdog or underdogs fighting the powers that be, whatever the odds), I thought better of it.

Now, however, that the official line seems to be run the country into the dirt as quickly as possible, I am kicking out the jams (at least, tonight). After all, somebody out there might be wondering why a country that should have everything going for it in terms of human and natural resources is trying so hard to become a failed state. Interviews like the one that follows—with a gentleman not only purporting to be a scientist, but a scientist charged with running the Russian Antarctic Expedition—might give you a clue.

________

Global warming is a topic that bears no relation to reality
Valery Lukin, head of the Russian Antarctic Expedition, says Antarctica still holds many secrets
Sergei Prudnikov
March 13, 2015
Vechernyi Peterburg

The summer season of the Sixtieth Antarctic Expedition is coming to an end. The scientific research vessel Akademik Fyodorov is now making the rounds of the stations, supplying them with food, fuel, and materials for the coming eight or nine months. In early March, the ship left Progress Station. Its next stops are Molodyozhnaya Station, Novolazarevskaya Station, and Bellingshausen Station. In April, the Akademik Fyodorov will sail for the shores of South America, and on May 15, it will return to Petersburg. In anticipation of the completion of the latest stage of work, Vechernyi Peterburg met with Valery Lukin, head of the Russian Antarctic Expedition (RAE).

Valery Vladimirovich, what are the results of the 2014–2015 season? 

I must say right off the bat that employees of thirty-one organizations, representing ten federal agenices, are involved in the RAE. They include Roshydromet, Rosrybolovstvo (Federal Agency for Fishery), Roscosmos (Russian Federal Space Agency), Rosatom, the Ministry of Defense, and so. Work is underway on sixty-four projects, and each of them is significant. Nevertheless, I would note the drilling of a second borehole into the subglacial Lake Vostok and laying the foundations for installing new ground-based monitoring equipment for the GLONASS satellite navigation system. Interesting work has been done in the oasis of dry valleys,near the American McMurdo Station on the shore of the Ross Sea. They contain the most ancient varieties of permafrost on earth, thirty to forty million years old. Such polar caps exist in similar conditions on Mars. This gives us a unique opportunity for developing the technology to sample this material in the future. I should also note that the Russian Federal Ministry of Culture has implemented several of its own projects in Antarctica for the first time. One of them is the creation of the latest (the third) in a series of virtual branches of the Russian Museum for RAE personnel. The first was unveiled on board the Akademik Fyodorov; the second, at Novolazarevskaya Station; the latest, at Bellingshausen Station.

One of the priorities in Antarctica is the study of climate change. Why is it important? And how do things stand with global warming?

Indeed, it is extremely important. After all, what is the ice of Antarctica? It is compacted precipitation. By carrying out isotopic studies on it, we can track changes in temperature on earth, as well as the levels of methane and carbon dioxide that were in the atmosphere many years ago. Based on the research done on the ice core at Vostok Station, we have assembled a picture of climate change over the last 420,000 years. This included four complete climatic cycles: glaciation and warming with an average period of 100,00 years. We are now in an interglacial period, between peaks of cooling. But it is unclear how long this period will continue and whether it has reached its maximum. No one knows where we are headed. As for global warming, in my opinion, it is only a topic for speculation that is advantageous to businessmen, politicians, and journalists, and which bears no relation to reality.

But what about the movement of glaciers, which are, allegedly, melting furiously?

Glaciers are always moving. Near the Geographic South Pole, at Amundsen-Scott South Pole Station, they move at a speed of 11.5 meters a year. Near Vostok Station, they move at a speed of two meters a year. This is ordinary aerography: new ice forms, old ice flows. Now if it stopped moving, that would be something worthy of immediate attention. In the 1960s, Sovet scientists and their colleagues from Dresden took measurements of the glacier on a 100-kilometer segment of the track from Mirny Station to Vostok Station. Forty-four years later, the measurements were repeated. The ice had grown by forty-two meters! What melting are we talking about here?! As for speculation around a topic, let me remind you that, twenty years ago, all the media suddenly wrote about the growing hole in the ozone layer over Antarctica and the catastrophe it threatened. It was the owner of the large chemical company DuPont who had raised the issue. It was he who paid scientists to study the phenomenon. The scientists concluded that the reduction of the ozone layer had to do with Freon entering the upper atmosphere. Ultimately, this substance was banned. But Mr. DuPont created a new substance, Freon-141, which, by the way, is two and a half times more expensive than the “old” Freon. The problem of the hole in the ozone layer did not go away. But it has been forgotten: people with a stake in the matter performed the task assigned to them. The same thing is sure to happen with the topic of global warming.

Antarctica is an icy, barren continent. What is the practical benefit of researching it?

National security. The economic effects. Strengthening international prestige. With regard to safety, we are talking about ground support in the Southern Hemisphere for our space program. In Soviet times, this problem was solved by a special space fleet. A whole series of craft was built. Then they were scrapped. Using radar stations located in southern Russian, we can look into near-Earth space no farther than thirty degrees latitude south. If we talk about the economic effect, we could talk about developing fisheries in the Southern Ocean. One of the most valuable commercial fish in the world, the Patagonian toothfish, is found in these waters. It dwells at a depth of 600 to 1,200 meters, grows to a length of two meters, and weighs up 160 kilograms. The cost of one kilogram of this fish on the wholesale markets is sixty dollars. It is selling like hot cakes in Japan, South Korea, Hong Kong, and the US. From the 1960s to the 1980s, we were the leaders in catching it. In the 1990s, we virtually abandoned this field. The challenge now is to return. Finally, estimating the mineral reserves [in Antarctica] is an important taks. Our country’s economy is resource dependent. And if we do not keep up with the prospects of mining on earth, we have a lot to lose. We have to have our finger on the pulse.

The media periodically reports incredible events that are observed on the sixth continent. Either people disappear with enviable regularity or strange magnetic phenomena occur. What can you say about this?

These UFO publications cannot be taken seriously, of course. People have definitely not disappeared. Although there are a lot of mysteries. And we are going to encounter them again and again. Subglacial lakes, for example, were discovered a mere twenty years ago, and by chance. We were able to identify Lake Vostok due to a combination of seismic research, radar observations, and satellite measurements. It turned out that in the vicinity of Vostok Station the ice sheet was fairly smooth. There were hills all around, but here there was a flat slab, 250 kilometers long, 70 kilometers wide. Where does that happen? That is right: only on the water.

Valery Vladimorovich, many scientific programs are now feeling the pinch due to the difficult economic situation in the country. How has this affected the RAE?

Budget cuts to the expedition this year will amount to 10%. However, given the need to use foreign aircraft, sail into foreign ports, and pay with foreign currency, the real reduction in the budget will be 35%. Unfortunately, certain programs will have to be wound down. For example, we are planning no research and drilling work at Vostok Station. It is just too expensive. Boring into the subglacial lake and collecting water from it, something we have been so looking forward to doing, is not going to happen next season. In most other areas, research will continue.

Translated by the Russian Reader

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Valery Lukin, as it turned out, was much too sanguine about the effect of budget cuts on the RAE.

Russian Antarctic Expedition Halts Research Due to Lack of Funds
October 14, 2015
The Moscow Times

Russia’s state-funded Antarctic expedition has had to halt its research due to a lack of funding, the TASS news agency reported Wednesday, citing one of the scientists involved in the expedition.

“It’s not yet clear how long the research will be suspended for,” Ruslan Kolunin told TASS. He said that work on drilling a borehole in the ancient Lake Vostok has also been suspended. “The borehole is frozen at the moment, no work is under way there right now,” he was cited as saying.

The only research being carried out in the Antarctic as part of the expedition this year is a meteorite project by the Ural Federal University, Kolunin said. “That is financed by sponsors and the university, though,” he added.

Earlier this year, the expedition’s head Valery Lukin said that scientists wouldn’t be able to continue researching Lake Vostok during the next season, which lasts from December 2015 to February 2016, due to decreased funding, TASS reported.

The expedition, Lukin said, is financed directly from the federal budget. In 2015 it was allocated 1.18 billion rubles ($18 million), but in 2016 that will decrease to 1.061 billion rubles ($16 million), which he said was not enough to continue work at the lake.

Lake Vostok lies buried beneath a 3,769-meter layer of ice. Locating it and accessing its relict waters is considered one of the main discoveries of the expedition so far, the report said.