15 April. The spring of 2018 was marked by an excess of the epidemiological threshold of the incidence of influenza in 29 regions of Russia. Thanks to this level of morbidity, pharmaceutical companies will be able to raise billions of rubles.
In early April 2018, Rospotrebnadzor reported on the annual epidemic of influenza in the country. In the news traditionally talk about the danger of the virus and advise less to leave the house and refrain from visiting public places. In 2015 - 2016, the news of the media so excited people that they rushed to the drugstores and ransomed all the masks, medications from ARVI and Tamiflu.
But is the flu really as scary as they are scared? And is it true that we are ill with the flu because it is profitable for someone?
The root cause of epidemics
The influenza virus is constantly moving around the planet, causing diseases in different countries and regions. In general, epidemics are seasonal in nature, usually in the Northern Hemisphere and in Russia, the peak incidence is from October - November to May, in the Southern Hemisphere - from March to October.
What are the consequences of influenza
Influenza is a fairly volatile virus that has three types - A, B and C and a variety of strains. It can be transmitted to people not only from other people, but also from animals. The virus constantly changes and again affects the person. For example, among strains of type A influenza virus, 198 strains are known to science. However, in reality there are only 11 of them. Such a multitude of strains is explained by the fact that the surface of the type A virus forms two proteins - neuraminidase (N) and hemagglutinin (H). The combination of different variations of these proteins form influenza strains: H5N1 ("avian influenza"), H3N2 ("Hong Kong flu"), etc.
When the flu mutates and spreads a pandemic (the spread of a new virus on a world scale - author's comment). The pandemic is dangerous because the organism of the diseased faces this virus for the first time, and it does not have the immunity to this virus. Nevertheless, most healthy people are able to cope with the pandemic, although the likelihood of complications increases. But children, elderly people and people with chronic diseases, in a pandemic are in the risk zone. The pandemic usually falls on the same period as the influenza epidemic. But there are exceptions: for example, "swine flu" 2009-2010 caused outbreaks of the epidemic in the northern hemisphere in the summer months.
Protection against influenza
The only more or less reliable protection against influenza is the annual vaccination. When preparing the right vaccine, researchers study the dynamics of the influenza virus and make a prediction of which strains will be active in the next season. Based on this forecast, pharmaceutical companies create a vaccine that protects against 2 strains of virus A and 1 strain of virus B.
This inequality is due to the fact that influenza type A has more variations, and among the type B viruses there are only two subtypes that have ever led to an epidemic.
Recently, a vaccine has emerged, protecting against both lines of influenza B and two strains of influenza A. The vaccine has already been used in the United States.
In Russia, the majority of vaccines produced domestically. According to the Chamber of Commerce and Industry of Russia, the total volume of the vaccine market is estimated at 15 billion rubles. In the vaccine market, the main market share is held by 4 companies: Petrovax Pharm (5 billion rubles), NGO Microgen (2.2 billion rubles), Fort LLC (1.8 billion rubles and SPB NIIVS FMBA Russia (1.3 billion rubles.).
NPO "Microgen" and LLC "Fort" are part of the "National Immunobiological Company" ("Natsimbio"), a subsidiary of state corporation "Rostekh". "Natsimbio" accounts for about 60% of the production of domestic vaccines. The state corporation supplies vaccines to all regions of Russia. NPO Petrovax Farm since 2014 belongs to Vladimir Potanin's investment fund Interros. СПБ НИИВС ФМБА of Russia is the state enterprise.
Vaccination against influenza is included in the calendar of preventive vaccinations, therefore vaccines are purchased from the federal budget. In 2018, it is planned to spend 4.8 billion rubles from the federal budget. for the prevention of influenza (for comparison, in 2015 - 2016 the state allocated about 1.8 billion rubles for these purposes).
The number of vaccines against influenza, financed by the state, is growing every year: in 2006, at the expense of the federal budget, vaccines were purchased for 28 million Russians, in 2015 - for 40 million people. This significantly affected the incidence rate: in 10 years it fell from 355 to 34 cases of infection per 100 thousand people. In other words, an increase in the number of vaccines by 1.5 times helped to reduce the incidence by 10 times. This happened because the number of vaccinated citizens began to approach 40% of the population.
If the Ministry of Health so successfully copes with the prevention of influenza, then where did the epidemic come from in early 2018? The culprits were experts from the World Health Organization (WHO). This year they have not guessed which strains of influenza will "walk" around the country this year. And they made a mistake not with the most common and dangerous type A flu, but with a less pandemic type B.
In the trivalent vaccine entered strain from the line In Victoria - In Brisbane / 60/2008. The tetravalent was added to Phuket / 3073/2013 from line B / Yamagat. It is this strain, which entered only in the tetravalent vaccine, was in second place in the incidence rate this season. Therefore, those people who received the trivalent vaccine, were defenseless against the virus.
The market of medicines
Most drugs designed to fight the virus do not help fight the flu. There are only two groups of drugs, which in scientific research have proven effective in fighting the flu. The first group - inhibitors of neuraminidase ("Relenza" (zanamivir) and "Temiflu" (oseltamivir)). These drugs affect the same protein neuraminidase located on the surface of the influenza virus and determines its belonging to a particular strain. But they do not work very fast: the temperature decreases after 2 days (against the usual 3) and reduces the total time of the disease to 6.5 days against 7.
The second group is adamants or blockers of M2 channels. Examples of such drugs are rimantadine and amantadine. These drugs block the action of the protein M2, which prevents the development of the virus in the body. However, many strains of influenza have developed resistance to adamantanes. Therefore, at present, doctors do not recommend the use of these drugs.
Therefore, the flu should only be treated with neuraminidase inhibitors and used only in special cases: the elderly, children under the age of 2, pregnant women, people with chronic diseases.
And what about the most popular drugs on the Russian market for influenza? Among the best-selling drugs are Kagocel (5 billion rubles.), Ingaverin (5.2 billion rubles.) And Arbidol (2.5 billion rubles.).
The issue of "Kagocel" is dealt with by "Niarmedik Plus" LLC. Among the beneficiaries of the company are more than 50 people, the top managers of the company and their relatives own the largest blocks of shares (company's CEO Vladimir Nesterenko, his son Sergei Nesterenko and others). "Ingaverin" produces the company "Valenta Farm". Most of the company's shares belong to PJSC "Domestic drugs". Through an offshore company in Cyprus (Lekarstva Holdings), the company is controlled by Anton Strekalov, Dmitry Shulzhenko, Zinaida Reyhart, Alexey Romanov, Svyatoslav Petrushko, Oleg Kedrovsky, Vladimir Nesteruk and Kirill Syrov - Vedomosti found out. "Arbidol" is produced by Otisipharm, owned by billionaire Viktor Kharitonin.
Most of the research on the effectiveness of Arbidol was conducted by Russian scientists, so WHO does not particularly trust the results of such studies. The composition of "Ingaverin" includes the complex substance "imidazolyl-ethanamide of pentanedioic acid", which is not known to anyone with its antiviral properties. This drug is not on the WHO list, it is not registered in Western Europe and the United States. The effectiveness of Kagocel in the fight against influenza has also not been proven by any clinical research.
And some "medicine", used in the treatment of influenza by a majority of Russians, such as "Anaferon" and "Oscillococcinum" are by homeopathy, which does not work at all. These drugs are just a gold mine for businesses wishing to make money on the flu.
Let's analyze one of the popular means for the flu and cold - Anaferon. In 2013, the drug entered the TOP-20 drugs with sales of 2.2 billion rubles. How much did the manufacturer earn from this?
In 2013, Anaferon cost about 150 rubles. for a package of 20 tablets. Usually, drug manufacturers explain their high cost by costly clinical trials and the cost of the original components. Homeopathic preparations do not need research, so the manufacturer's costs are reduced to zero. Perhaps the high cost is due to the costly manufacturing of the drug?
The tablet "Anaferona" is based on lactose, which in 2013 was sold for about 100 rubles. for 25 kg. The preparation also includes "antibodies to human gamma interferon affinity purified - 0.003 g active form containing not more than 10-15ng / g of active ingredient '- is specified on the packaging of the preparation. Now the Russian language: one molecule of active substance is about 100 million tablets. Those "antibodies to gamma interferon, human affinity-purified" are extracted from the blood serum of rabbits. From one rabbit, you can type antibodies for the next 100 years of production.
As a result, the manufacturer sells Anaferon at a price of 25 thousand rubles. for 1 kg at a cost of raw materials 4 rubles. The extra charge is over 600 thousand percent.
And how is the sale of a useless drug justified? The website of the manufacturer indicates the results of research, for example, "Anaferon child". The results stated that investigations were carried out at the Research Institute of Influenza in St. Petersburg, at the same time to study co-author worth Scientific and Production Company "Materia Medica Holding", whose name coincides with the name of the manufacturer of the drug.
Why do doctors prescribe useless drugs for treatment?
Quite often Russian doctors prescribe non-working drugs to patients. The reasons for this may be several:
- activity of representatives of pharmaceutical companies - people who come to doctors and talk about the beneficial properties of the drug. This leads to the fact that doctors start recommending patients such drugs. An important role in this moment is played by the outdated knowledge of physicians and the unwillingness or inability to read modern articles. Most modern medical articles are published in English, which causes difficulty for those who do not know this language.
- very often people who do not want to get sick with the flu, ask doctors to write to them some medicine for the virus, so doctors prescribe harmless medications for them - dummies. The maximum effect that can be obtained from such drugs is the placebo effect.
Investing in the development of a truly effective medicine against influenza is not profitable - this virus mutates very quickly. But what you really need to invest in is mass vaccination, which seriously affects the incidence of influenza and mortality from the epidemic.
Russian manufacturers are engaged in this issue. So, NPO Petrovax Pharm in 2017 presented clinical studies of the first Russian tetravalent vaccine. This vaccine will better protect the Russians from the flu. Such a vaccine could save Russians from the epidemic in 2018, but, unfortunately, for now the company is just preparing a new vaccine for entering the market. According to forecasts, this vaccine will appear in Russian polyclinics in 2018.