Kaiser Daily HIV/AIDS Report - Fri, 27 Apr 2001
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* Speaking at Abuja AIDS Conference, Clinton Says AIDS Can be 'Cur-
tailed'
* Cipla to Supply Nigeria with Discounted Generic AIDS Drugs
* Kaiser Daily HIV/AIDS Report Rounds Up Public Reaction to South Af-
rican Drug Lawsuit
--
Speaking at Abuja AIDS Conference, Clinton Says AIDS Can be 'Cur-
tailed'
Speaking at the opening session of the Abuja AIDS conference yester-
day, former President Bill Clinton said that the AIDS pandemic could
be "severely curtailed with proper steps," Agence France-Presse re-
ports. Clinton said that HIV/AIDS is "100% preventable" with the use
of proper prevention methods and asked African leaders to help end
the "stigma of AIDS." He pointed to Uganda, which has halved HIV in-
fection rates, and Kenya, which he said has "stopped [AIDS] right in
its tracks," as examples of "African success stories" in the fight
against the disease. A more concerted effort against the disease in
Africa is needed "not simply to save your own people," Clinton told
African leaders, "but to show the rest of the world how to save
theirs." AIDS is "not Africa's problem alone. Today, Africa is the
epicenter of the epidemic but tomorrow it could be India, China or
even Russia," he added (Agence France-Presse, 4/26). Receiving "some
of the loudest applause" of any speaker, Clinton told conferees that
the United Nations' estimates of 40 million AIDS orphans by 2010
"should stun Americans, considering that number equals '80% of chil-
dren in schools in'" the United States (Donnelly, Boston Globe,
4/27). Clinton concluded by urging African leaders to determine the
amount of antiretroviral drugs that their health programs would need
and to "estimate the amount of money they could pay up front, as well
as the sum they needed in aid" to combat the epidemic (Agence France-
Presse, 4/26).
--
Cipla to Supply Nigeria with Discounted Generic AIDS Drugs
Nigeria and Cipla, the Indian generic drug maker that "shocked"
health officials and the pharmaceutical industry earlier this year by
offering AIDS drugs at "slash[ed]" prices, announced Thursday that
they had made an agreement that will supply the three-drug AIDS
"cocktail" to 10,000 of Nigeria's 2.6 million HIV-positive residents,
the Boston Globe reports. The deal marks the first "substantial pur-
chase" of AIDS drugs by any African nation and offers a "sliver of
hope" that wider drug access is forthcoming. Cipla officials at the
Abuja AIDS conference told the Globe that they agreed to sell the
antiretroviral combination of stavudine, lamivudine and nevirapine to
Nigeria for an annual price of US$ 350 per patient, a reduction from
the original offer it made in February of US$ 600 per person per
year. Cipla's Medical Director Jaideep Gogtay said that the company
will sell the drugs at cost to "any government" that "wants to give
away the drug" to citizens free of charge. Although the US$ 3.5 mil-
lion deal is only a "small step" toward easing the nation's AIDS cri-
sis, it "sends a strong message to Western donors that African coun-
tries will foot part of the cost of trying to control the pandemic,"
the Globe reports. David Nabarro, top aide to World Health Organiza-
tion Director-General Gro Harlem Brundtland, called the deal a "sym-
bolic purchase, given the depth of the problem," and added that WHO
would "love [the deal] to become real, more widespread." AIDS experts
are now focusing on Nigeria's health system and how it will adminis-
ter the drugs. Jeffrey Sachs, director of the Harvard Center for In-
ternational Development, met with President Olusegun Obasanjo and
"immediately offered the services of Harvard specialists" to create a
distribution system for the medications. Harvard's School of Public
Health has "strong ties" with the nation's health system, and is
slated to study the health systems in three Nigerian states over the
next few years with the aid of a $25 million grant from the Bill and
Melinda Gates Foundation (Donnelly, Boston Globe, 4/26).
--
Kaiser Daily HIV/AIDS Report Rounds Up Public Reaction to South Afri-
can Drug Lawsuit
The public continues to weigh in on AIDS drug access in developing
countries and last week's settlement of the lawsuit against South Af-
rica's government brought by 39 pharmaceutical companies. Excerpts
from some pieces appear below:
* New York Times:
The statistics about the prevalence of AIDS in Africa are "so stag-
gering as to seem unbelievable," columnist Thomas Friedman writes in
the Times. With 25 million Africans infected with HIV, attention has
recently been focused on securing cheaper antiretroviral drugs,
"which would allow Africans afflicted with HIV to live meaningful
lives," he says. Although "anything that will alleviate the suffering
of Africa's destitute HIV/AIDS victims should be supported," experts
are "worried that all this focus on drug companies ... is diverting
attention from the real issue -- stemming the spread of the disease,"
Friedman writes. Drugs are not "going to enable us to overcome this
major, major social problem," Dr. Fred Sai, Ghana's top AIDS expert,
said. "It can only be done by education, preventive health measures
and creating better living standards," he said, adding that he is
"afraid" that the U.N. General Assembly's special session on AIDS in
June will "get hijacked by this clamor for drugs." Even at the lower
prices, the cost of drug treatment is still out of reach for many Af-
ricans and distribution plans are lacking, Friedman writes. Adding
the antiretroviral drugs will most likely "cause distortions to the
already struggling African health systems, by forcing in a new tech-
nology when they can't even distribute treatments for tuberculosis,"
he continues. What is needed is more education and prevention ef-
forts, because despite the prevalence of HIV/AIDS, "many Africans re-
main either uneducated about how HIV is spread or simply do not be-
lieve they'll be infected," he writes. Senegal and Ghana are two ex-
amples of how the epidemic can be successfully stemmed with "home-
grown self-help responses" and "widespread education" (Friedman, New
York Times, 4/27).
* South Florida Sun-Sentinel:
The lawsuit brought by 39 pharmaceutical companies against South Af-
rica's Medicines and Related Substances Control Act was "one battle
not worth winning," a Sun-Sentinel editorial states. "Technically,
the companies are correct. Patents enjoy legal protections and it
should be this way," in order to ensure that research and development
continue, the editorial continues. "But knowledge that relieves human
suffering should also be considered the patrimony of mankind," the
editorial states. Even discounted drugs "will not stem the AIDS cri-
sis" in developing nations. "Education, prevention and health systems
are needed to combat the disease," the editorial continues, adding
that "[w]ealthy nations also have a role to play" in subsidizing AIDS
medications for the developing world. The affected countries them-
selves "clearly need to do more" or else "cheap anti-AIDS medications
won't do much good." The attempt to block the legislation that would
have allowed importation and manufacture of cheaper AIDS medications
was "one battle the drug companies were wise to let go," the edito-
rial concludes (South Florida Sun-Sentinel, 4/27).
* Wall Street Journal:
"The settlement is a tragedy," Robert Goldberg, senior fellow at the
National Center for Policy Analysis, writes in an op-ed to the Jour-
nal. "[B]ecause it is part of a strategy to impose price controls and
limit patent protection on new biopharmaceuticals developed in the
U.S., the settlement will help ensure that this current generation of
AIDS drugs is the only one we have for a long time to come," he
states. Goldberg continues, "It's a delusion to think that making
antiretroviral drugs cheap, or free, will make millions healthier.
... Free and highly effective tuberculosis and malaria drugs in Rus-
sia and Africa have done little to stop the spread of a disease that
claims two million lives a year." Goldberg concludes, "The truth is
that the ultimate solution to AIDS is prevention. ... Price controls
and the wanton destruction of intellectual property will do little to
improve public health. But they will reduce innovation. The lag in
HIV research and treatment will condemn the African continent to
deeper darkness and death. And for that, the AIDS activists, their
uncritical followers in the media, and their monstrous certainty
about the evil of the drug companies will largely be to blame" (Gold-
berg, Wall Street Journal, 4/23).
* Philadelphia Inquirer:
"Even the newest and best drugs alone aren't enough for a crisis as
serious and widespread as the tragedy of AIDS in Africa," Grade-Marie
Arnett, president of the Galen Institute, a health policy research
organization, writes in an Inquirer op-ed. "The problem is much
deeper," she writes, "rooted in poverty and culture. Arnett contin-
ues, "Even when the drugs are donated, African countries and interna-
tional relief agencies lack the resources and infrastructure to dis-
tribute, much less to monitor, drug treatment for even a fraction of
the tens of millions of people infected with the AIDS virus." Arnett
describes the dangers of loosening patent restrictions, stating,
"When the U.S. government doesn't help U.S. companies to protect
their intellectual property, fewer of the new miracle drugs that the
world both wants and needs will be created. And if our government ca-
pitulates on drug patents, can other technologies be far behind?" Ar-
nett concludes, "Instead of spending so much time pointing the finger
of blame, companies and countries should work together to get a more
precise diagnosis of the problem and then bring their best resources
together toward solutions" (Arnett, Philadelphia Inquirer, 4/25).
* Washington Post:
"The feisty advocates who lead nongovernmental groups like to paint
themselves as little guys, and in some ways this is reasonable," a
Post editorial states, adding, "Yet the South African AIDS-medicine
case that closed [last week] demonstrates the power of campaigning
groups like Doctors Without Borders and Oxfam. These supposed Davids
loaded their slings against the pharmaceutical-industry Goliath and
felled him." The editorial continues, "[B]ecause the firm's arguments
were self-serving and thin, nongovernmental groups were able to shame
them into capitulation." The editorial criticizes the Bush admini-
stration for showing "little interest in leading an international ef-
fort to fight the scourge." The editorial concludes, "It is this in-
difference, echoed to varying degrees in capitals throughout the
world, that is the real scandal of the international system" (Wash-
ington Post, 4/22).
* Lancet:
"The outcome in South Africa has taught the world several important
lessons," a Lancet editorial states. It continues, "Drug companies
cannot put shareholder interests before their moral responsibility to
take part in improving the world's public health. ... If the princi-
ple of access to affordable drugs applies to HIV treatment, it should
equally apply to other infectious diseases, such as malaria and tu-
berculosis." The editorial concludes, "[I]t is time now for western
governments to use the prevailing momentum worldwide to create an ef-
fective strategy to provide affordable drugs for all less-developed
countries (Lancet, 4/28). In a separate letter to the editor, V. Man-
frin of the Infectious Diseases Department of Vincenza, Italy-based S
Bortolo Hospital, writes, "Although widespread availability of anti-
retroviral drugs can positively affect the HIV epidemic by diminish-
ing transmission, some difficulties can be expected in less-developed
countries." For AIDS drugs to be effective, patients must take them
"regularly with no interruption." Therefore, "[a]dherance and drug
availability is ... crucial." However, cohort studies have shown that
"treatment failure is common" even in more-developed countries, and
thus, in Africa, "we expect major difficulties, especially in remote
rural areas." Further, he notes, much of the region currently does
not maintain the health care infrastructure to monitor patients and
determine appropriate timing of treatment. Manfrin states, "Deploy-
ment of resources to antiretroviral drugs without consideration of
existing health structures, staff, equipment and their distribution
will be wasteful. ... The goal must be the empowerment of the exist-
ing health systems, with a range of activities to fight AIDS" (Man-
frin, Lancet, 4/28).
* Hartford Courant:
"The companies' arguments about their rights are legitimate. An in-
dustry that spends billions of dollars on research and development of
new drugs should not be expected to shrug off patent infringements,"
a Courant editorial states, adding, "[B]laming the companies for
South Africa's AIDS woes would be unfair. For its part, the govern-
ment in Pretoria has done little to control the spread of the dis-
ease." The editorial states, "Even with the court victory, the gov-
ernment's health minister said it might not move quickly, if at all,
to get drugs to AIDS patients. Such a lackadaisical attitude is mad-
dening" (Hartford Courant, 4/23).
*Chattanooga Times & Free Press:
"A Wall Street Journal report ... note[s] that drug-company share
prices rose more than twice as fast [as] the rest of the S&P 500 in
the late 1990s, primarily for two reasons," a Times & Free Press edi-
torial states. "One is that a growing, aging population has been us-
ing increasingly large amounts of medicine, as drug therapies have
become the front line of medical defense against an increasingly
broader range of disease. The other is that the Hatch-Waxman Act,
passed by Congress in 1984, eased entry of generic drugs onto the
market. That spurred drug companies to protect prices and patents,
and to speed up innovations," the editorial continues. However, the
editorial notes that the Hatch-Waxman Act "also greased the way for
unconscionable profiteering." The editorial continues, "[T]he differ-
entials between U.S. and 'at cost' prices under the African agreement
suggest that the companies were charging far too much to begin with.
Indeed, drug makers merit little praise for what at first glance ap-
pears a humane act. They stalled several years after the African na-
tions' pleaded poverty and requested discounts because, industry
sources say, they did not want to reveal the size of their profit
margin" (Chattanooga Times & Free Press, 4/24).
* Dallas Morning News:
Commenting on the South African government's "inaction" on distribut-
ing AIDS drugs to HIV-positive citizens, a Morning News editorial
states, "Inexplicably, South Africa is proceeding like a country that
has time on its side when it certainly does not." The editorial con-
tinues, "The government's refusal to validate scientifically proven
treatment options is crippling the nation with doubt, confusion and
inactivity. Wors[e] yet, when given an opportunity to build on the
drug industry's concessions, South Africa again hedges" (Dallas Morn-
ing News, 4/26).
--
Cecilia Snyder
mailto:csnyder@ccmc.org
--
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