Kaiser Daily HIV/AIDS Report- Fri, 11 May 2001
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* Bush to Announce US$ 200 Million Contribution to Global AIDS Fund,
But Money's Source Unclear
* AIDS Activists Urge Kenyan Parliament to Approve AIDS Drug Importa-
tion Bill
* Kenyan Prostitutes' Immunity to HIV Infection May be Key to Effec-
tive Africa-Specific Vaccine
* Canada's National Post Features Dualing Op-Eds Regarding Pros, Cons
of South African Drug Trial Settlement
* AIDS Compromising Africa's Social, Educational, Political Future
--
Bush to Announce US$ 200 Million Contribution to Global AIDS Fund,
But Money's Source Unclear
President Bush, appearing alongside U.N. Secretary-General Kofi Annan
and Nigerian President Olesegun Obasanjo, is expected today to an-
nounce a $200 million U.S. contribution to the global AIDS fund first
proposed last month by Annan, the Washington Post reports. At last
month's African AIDS summit in Abuja, Nigeria, Annan called for the
establishment of a $7 billion to $10 billion annual trust fund dedi-
cated to fighting HIV/AIDS in the developing world. The expected an-
nouncement today will mark the first pledge from any nation to the
fund, yet it "remained unclear" where the funds would come from, when
the money will be made available and what, if any, conditions will be
placed on its use, the Post says. U.S. officials reviewing a draft
plan for the fund, to be released at a special meeting of the U.N.
General Assembly next month, have voiced "deep disagreements" with
some of the plan's proposals. Among the issues are whether to pur-
chase AIDS medications for Africa or to put "more emphasis" on pre-
vention programs. Administration officials have requested that men-
tions of sexual abstinence as a means to prevent the disease and
clauses calling for the "protection" of drug companies' patent rights
be added. Bush is also expected today to issue a "call for an inter-
national public-private partnership," whereby governments along with
private foundations and corporations will contribute to the fund.
Funding Sources Questioned
The US$ 200 million proposed by Bush "mirrors" the amount added to
the "nonbinding" congressional budget resolution this week as part of
an amendment proposed by Sen. Bill Frist (R-Tenn.), a former surgeon
and chair of the Senate Foreign Relations subcommittee on Africa
(DeYoung, Washington Post, 5/11). However, that allotment was
"[d]ropped" from the final version of the FY 2002 budget resolution
approved by a 53-47 vote yesterday in the Senate (Reuters Health,
5/10). Secretary of State Colin Powell, speaking yesterday before a
House panel on foreign operations funding, said the government will
"use funds that we believe are available from other accounts, not
taking away from any of the HIV funding we are doing now, to make a
significant new contribution to this new proposal of a trust fund,
and do it in a way that will encourage many other nations to join us
and many other organizations and private citizens and nongovernmental
organizations and kids dropping nickels and dimes in many boxes"
(Lake, United Press International/Aegis.com, 5/10). Some worried that
the money may be "carved out" of development assistance funds, a
prospect that David Beckmann of Bread for the World called "unaccept-
able." Mark Malloch Brown, administrator of the U.N. Development Pro-
gram, added that it is "absolutely critical that this [comes from]
additional resources, not extracted from elsewhere in the U.S. devel-
opment assistance budget" (Washington Post, 5/11). Rep. Nita Lowey
(D-N.Y.), speaking at the hearing, said that although the "interna-
tional community," including the World Bank and the United Nations,
"seem ready to commit" to a global fund, she "want[ed] to stress that
[U.S.] bilateral programs run by [USAID] have been most effective in
battling" the HIV/AIDS epidemic abroad (United Press Interna-
tional/Aegis.com, 5/10).
A 'Criminally Small' Amount, Some Say
When news of the impending announcement broke, AIDS advocates and
NGOs began criticizing the amount of money earmarked for the fund.
"It's criminally small. The United States has got ample money for
this and the money has just got to be found -- something along the
lines of $2.5 billion," David Bryden of the Global AIDS Alliance said
(Jelinek, AP/Orlando Sentinel, 5/11). The GAA estimates that a U.S.
contribution "proportionate" to U.S. economic strength would be $3
billion, making Bush's proposed contribution only 6% of what the GAA
says a "fair" government donation should be (Global AIDS Alliance re-
lease, 5/10). Sen. Patrick Leahy (D-Vt.) added that the amount "falls
far short of what the wealthiest nation in the world should be con-
tributing" (Wall Street Journal, 5/11). The Health GAP Coalition
called the amount "less than a drop in the bucket," adding that it
equaled less than 1% of the administration's proposed $1.35 trillion
tax cut.
Obasanjo and Bush to Discuss AIDS, Economics
Today's announcement was scheduled to coincide with Obasanjo's visit
to Washington, marking the first visit by an African head of state to
the Bush White House (Washington Post, 5/11). The Nigerian president
arrived in Washington yesterday and met with Pentagon officials and
lawmakers on Capitol Hill (AP/Orlando Sentinel, 5/11). Obasanjo and
Bush will meet today in the Oval Office, after the Rose Garden cere-
mony announcing the trust fund money, to discuss the HIV/AIDS epi-
demic and economic development issues. Observers say that the visit
demonstrates that the Bush administration will not "dismantle the in-
stitutional prominence" given to Africa by the Clinton administra-
tion. However, they predict that the current administration will fo-
cus on "big problems" like AIDS, debt relief and "stabilizing" Nige-
ria and South Africa, the continent's "two fledgling democracies," a
move Timothy Bork of the Carnegie Endowment for International Peace's
Africa Initiative called "wise." Experts add that the "person most
responsible" for the administration's African focus is Powell, who
met with Obasanjo yesterday, following a State Department announce-
ment that Powell will take his first official trip to Africa later
this month. He will visit Mali, South Africa, Kenya and Uganda, plac-
ing a emphasis on the "devastation from AIDS suffered throughout Af-
rica." Powell had planned to attend the Abuja summit last month but,
according to USA Today, withdrew because of "anger" from some admini-
stration officials that former President Clinton was to give the sum-
mit's keynote address (Nichols, USA Today, 5/11).
--
AIDS Activists Urge Kenyan Parliament to Approve AIDS Drug Importa-
tion Bill
An international group of AIDS activists from the medical industry
and nongovernmental organizations yesterday initiated a campaign to
"pressure" Kenyan parliament members to approve a bill that would al-
low the country to import and manufacture cheaper AIDS drugs, the
AP/Los Angeles Times reports (Simmons, AP/Los Angeles Times, 5/11).
At a press conference yesterday in Nairobi, the Kenya Coalition for
Access to Essential Medicines, a conglomerate of Kenyan and interna-
tional organizations, urged members of parliament to "ensure that
public health takes precedence over private financial interests and
that essential medicines are affordable." The group also "warned"
that unless Kenya is "allowed to make full use of" parallel importing
and compulsory licensing, millions are at risk of death from HIV/AIDS
(Doctors Without Borders release, 5/10). The bill would adhere to the
World Trade Organization's Trade-Related Intellectual Property Rights
Agreement, which allows parallel importing and compulsory licensing
if countries declare a health emergency. With an estimated 2.5 mil-
lion HIV-positive citizens and 500 AIDS-related deaths per day, Kenya
"faces an AIDS emergency," according to Samantha Bolton, a Nairobi-
based spokeswoman for Doctors Without Borders (Los Angeles Times,
5/11).
Pharmaceutical Industry Backs Off
In the wake of the abandonment of the South African lawsuit brought
by 39 pharmaceutical companies that caused a years-long delay on the
implementation of a similar South African law, AIDS advocates "ex-
pressed concern" that the pharmaceutical industry "might try to im-
properly influence lawmakers to kill or amend the bill." However,
Newton Kulundu, chair of the parliament's Health Committee, "dis-
missed claims that legislators could be manipulated." GlaxoSmith-
Kline, one of the companies involved in the South African lawsuit,
said the company accepts Kenya's proposal but is "concerned about
procedures for implementing it," GSK Commercial Director William
Kiari said (Los Angeles Times, 5/11). According to industry sources
in Kenya, representatives from GSK and Pfizer Laboratories had
planned to meet with Kenyan MPs, but cancelled the meeting "at the
last minute" following "adverse publicity" over the meeting. A Pfizer
manager said, "There were a lot of obstacles put against the meeting
because a misconception that we were lobbying for the dropping of the
new ... [b]ill [made] the rounds and the whole thing had been inap-
propriately politicized." But the source "strenuously denied" allega-
tions that the meeting was convened to pressure MPs to exclude provi-
sions that would allow for parallel importing and compulsory licens-
ing, saying that Pfizer accepts the bill (Morland, Agence France-
Presse, 5/10). The parliament plans to vote on the bill upon return
from its May recess (Los Angeles Times, 5/11).
--
Kenyan Prostitutes' Immunity to HIV Infection May be Key to Effective
Africa-Specific Vaccine
Researchers who have documented and studied HIV immunity in more than
100 Nairobi prostitutes have "concocted the first experimental vac-
cine expressly intended for Africa," and the initial phases of clini-
cal trials in Kenya show promise, the Washington Post reports. The
vaccine prompts the same immunologic response observed "so strik-
ingly" in the immune sex workers: elevated levels of cytotoxic T-
lymphocyte cells, or the "killer T-cells" that most effectively fight
HIV. The "operating theory" of the prostitutes' immunity is that it
is "built up like a callus" over time. T-cell production in the blood
increased with their first exposure to HIV, and the next encounter
provoked even more T-cells, boosting immunity until the women proved
essentially "uninfectable." Researchers noted that when several women
left prostitution and then returned to it later, they ended up con-
tracting the virus, an observation that reinforced the theory that
continuous exposure kept their T-cell levels high. Frank Plummer,
scientific director of Canada's National Microbiology Laboratory and
the first recorder of the immunity among Nairobi sex workers,
stressed the need for a vaccine to come out of this observed immu-
nity, saying, "I'm all for [AIDS] treatment, but focusing on treat-
ment as the solution is not going to solve this" disease. Oxford Uni-
versity researcher Andrew McMichael and his team began developing a
vaccine that appears to boost the production of T-cells in the same
way that HIV would boost cell production in the prostitutes, and
studies of blood taken from the 18 Kenyans who received the vaccine
show "an 80 to 90% indication that it actually presents an immune re-
sponse." But McMichael pointed out that while the vaccine will make
it more difficult to become infected, it will not provide "absolute
insurance against the virus" (Vick, Washington Post, 5/11).
--
Canada's National Post Features Dualing Op-Eds Regarding Pros, Cons
of South African Drug Trial Settlement
Robert Goldberg's Wall Street Journal editorial "Fight AIDS in Africa
With Reason, Not Rhetoric," is an "ill-informed opinion piece" that
misses several important pieces of information, Dr. Anne-Valerie Kan-
inda, a medical adviser with Doctors Without Borders' Access to Es-
sential Medicines Campaign, writes in an op-ed in Canada's National
Post. While Goldberg, a senior fellow at the National Center for Pol-
icy Analysis, called the recent abandonment of the lawsuit filed by
39 drug giants against South Africa a "tragedy" because it will in-
hibit further research and development of AIDS drugs. However, Kan-
inda asks, "But for whom exactly is it a tragedy? Certainly not the
4.7 million HIV-positive South Africans currently facing almost cer-
tain death because they cannot afford the antiretroviral medicines
that have turned HIV/AIDS into a manageable illness in the United
States and Europe." She calls the case a "victory for the nearly 30
million other people in the developing world living with HIV. Armed
with a newfound understanding of international trade law and boosted
by the groundswell of international public support that the South Af-
rican case has generated, AIDS activists can now demand that their
own governments do everything possible to make treatment available."
Kaninda says that Goldberg "overlooks the fact that research and de-
velopment for many antiretrovirals was largely financed by the public
sector. This, together with the reality that Africa represents little
more than 1% of the worldwide drug market, ensures that companies can
prosper and continue research and development into new AIDS drugs and
vaccines even if drug prices are lower in poor countries." Kaninda
concludes, "It is time to stop using lack of infrastructure, threats
to drug company profits, and the cost-effectiveness of prevention
alone as excuses for allowing thousands of people to die each day of
a treatable disease. The message from South Africa is loud and clear:
People with AIDS will no longer wait in silence to die" (Kaninda, Na-
tional Post, 5/10).
Goldberg Responds
In an accompanying op-ed, Goldberg writes that Kaninda "unfortunately
[provides] more evidence in support of my original point: For many
AIDS activists ... the real virus isn't HIV, it's capitalism and the
profits which support research and development of the next generation
of AIDS drugs and -- one hopes -- a vaccine against the disease."
Goldberg writes that Kaninda's statement that "the end of the court
case removes the barriers preventing the South African government
from securing cheaper AIDS drugs" is "untrue." Bristol-Myers Squibb
"never had a patent" on AIDS drugs in South Africa, he says, nor has
Merck had a patent on the antiretroviral drug Crixivan there. Gold-
berg also disputes Kaninda's statement that the public sector fi-
nanced most of the research and development for many anti-AIDS drugs,
pointing out that a private firm did the clinical trial work to de-
termine the efficacy and safety of AZT in humans, and private compa-
nies like Merck and Abbott discovered and developed "the current gen-
eration of nucleoside drugs." He continues, "None of these break-
throughs would be possible under the shaky sort of patent protection
Dr. Kaninda envisions," adding, "even if all the HIV drugs needed to
treat every person with AIDS in Africa were available for free, it
would be difficult and even dangerous to administer them." Goldberg
concludes, "If people in Africa continue to die in silence, it will
not be due to the price of HIV drugs. It will be due, in part, to
policies such as those Dr. Kaninda pushes that make it unprofitable
and harder to develop and distribute a vaccine that can control or
prevent the eruption of AIDS once and for all" (Goldberg, National
Post, 5/10).
--
AIDS Compromising Africa's Social, Educational, Political Future
HIV/AIDS will continue to affect the economic, social and political
structure of Africa unless the developed nations of the world, along
with African governments, allocate more funding toward fighting the
epidemic, Chinua Akukwe and Melvin Foote of the Constituency for Af-
rica write in a Foreign Policy in Focus brief. Foote, who serves as
president and CEO of CFA, and Akukwe, a CFA board member, write that
at least 10% of the population in 16 African countries have HIV, and
in these countries almost 80% of all deaths among individuals ages 25
to 45 will be "directly linked to AIDS." The virus is also taking its
toll on the continent's health care system -- by 2005, it is esti-
mated that between 8% and 25% of doctors on the continent will die
from AIDS-related infections. Thus, the construction and sale of cof-
fins is one of the fastest growing industries in southern Africa.
One-fourth of women in southern Africa have HIV, and in some coun-
tries, between 10% and 20% of teen girls have the virus. The spread
of the virus among young women may "revers[e] decades of slow but
steady progress in female education," since HIV-positive girls are
"more likely than boys to drop out of school." African military
troops are also affected by the disease -- in some countries, 15% to
20% of those in the military are infected with the virus. Travel by
military troops, along with other mobility through migrant labor and
shifts from rural to urban centers, "exacerbates" the spread of HIV.
The article notes that although African social services and economies
are "imploding from the deadly consequences" of HIV/AIDS, "political
instability and violent conflicts keep many African governments from
focusing on the AIDS crisis." However, this instability "will likely
intensify as AIDS gobbles up scarce human and economic resources,"
the article states.
Stepping Up AIDS Funding
Akukwe and Foote write that the United States must step up its fund-
ing directed at fighting the epidemic and must also urge debt relief
initiatives for developing nations affected by HIV/AIDS. They write,
"The immediate goal of a reinvigorated U.S. policy should be the dis-
mantling of all legal and logistic obstacles to the provision of af-
fordable drugs to all Africans living with AIDS," adding that the
U.S. government should "work closely" with drug firms to "ensure that
all obstacles to speedy and effective delivery of AIDS medicines to
poor nations are eliminated." They urge the United States to adopt
the pledge: "No African Man, Woman, Child or Infant Should Be Denied
Access to Lifesaving AIDS Drugs by December 2002." However, African
nations must do their part, they write, adding that "even today, very
few African nations match their AIDS rhetoric with commensurate
budget allocations," although Uganda and Senegal are "prominent ex-
ceptions." Akukwe and Foote criticize the "corruption and the squan-
dering of scarce national resources" currently occurring in some Af-
rican countries, stating, "Government spending on wars, white ele-
phant projects and persecution of political and economic opponents is
still rife across the continent." The United States and African gov-
ernments need to work together, they write, to ensure that the lead-
ers of developing nations allocate more funding toward anti-AIDS ef-
forts and engage in "pluralistic political and multisector campaigns
against AIDS." In addition, efforts must be made to "end corrupt
practices that siphon foreign aid and investments," and promotion of
community-based health programs is also needed. Akukwe and Foote con-
clude, "A strong case can be made that the AIDS pandemic in Africa
represents a direct threat to U.S. national interests and national
security because of associated political instability, economic down-
turn and the intercontinental spread of infectious diseases. In the
end, however, U.S. citizens and U.S. policymakers face a moral im-
perative and should ask: Have we done all we can to save 25 million
fellow human beings from an avoidable death?" (Akukwe/Foote, Foreign
Policy in Focus, May 2001).
--
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