Kaiser Daily HIV/AIDS Report - Mon, 9 Apr 2001
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* Health Officials Question Impact Cheap Anti-AIDS Drugs Will Have on
African Nations
* Philanthropists Question Harvard Report's Emphasis on AIDS Treat-
ment, Say Focus Should be on Prevention
* WHO, WTO Begin Three-Day Meeting to Discuss Differential Drug Pric-
ing for Developing Nations
* Mali Strikes Agreement with Pharmaceutical Companies for Reduced-
Cost Antiretrovirals
* Despite South African Pleas, GlaxoSmithKline Will Not Further Re-
duce AIDS Medication Price for Developing Countries
--
Health Officials Question Impact Cheap Anti-AIDS Drugs Will Have on
African Nations
Despite several major drug makers' announcements that they will cut
prices of anti-AIDS drugs for numerous countries in sub-Sarahan Af-
rica and U.N. Secretary General Kofi Annan's success in persuading
six companies to cut their prices even further, some researchers and
health officials question "how much of a difference the drugs could
make" in light of the continent's infrastructure problems, the Los
Angeles Times reports. Although some sub-Saharan African countries
have "put in place a structure to cope with the impact of the dis-
ease," several others have "dire shortages of good roads, communica-
tions, medical facilities and trained doctors" necessary to fight the
epidemic. For example, in many African nations, annual health budgets
are less than $5 per person, hospitals lack equipment and medicine
even for "basic ailments" and AIDS is "treated as a badge of shame,"
the Times reports. To improve infrastructure, nations would have to
build roads to remote villages, construct laboratories, install re-
frigerators to store and analyze blood samples and devise an "intri-
cate communications system" to ensure that stocks are kept up to
date. To make such improvements, South Africa, for instance, would
need more than $1.24 billion over the next 10 years to deal with an
"infusion of antiretroviral drugs," according to Zweli Mkhize, health
minister for the KwaZulu-Natal province. He said, "On its own, the
question of drugs will certainly go a long way. But that is not the
complete picture." Costa Gazi, director of the AIDS Babies Battling
AIDS Trust, said, "If you don't tackle the infrastructure, you cannot
tackle AIDS."
Beyond Infrastructure
While improving infrastructure should be a priority, lack of infra-
structure should not be "an excuse to delay bringing down [medica-
tion] prices," Nathan Geffen, spokesperson for the Treatment Action
Campaign, a South African lobbying group that advocates better access
to health care for the poor, said. He added, "With the cheaper drug
prices, the pressure to improve the health care system would come.
The cheaper drugs would be an incentive to get the infrastructure go-
ing." Other health officials and researchers say that beyond infra-
structure, African countries would benefit from an infusion of "basic
medicines" to treat tuberculosis, hypertension and diabetes, which
many HIV/AIDS patients die from before their HIV infection progresses
to AIDS. In addition, education campaigns are important to help end a
"culture of denial about AIDS," Mkhize said, adding that the "under-
standing of the cause of the spread of HIV/AIDS is more potent that
the availability of drugs. We should not say that the end of our
problems would come with access to drugs."
Poverty and Compliance
High poverty levels in many African nations also will play a role in
how effective the cheaper drugs will be, the Times reports, noting
that many Africans "survive on less than a dollar a day." Tony Moll,
senior doctor at the Church of Scotland Hospital in KwaZulu-Natal,
said, "A lot of our patients cannot afford to pay the six rand (less
than $1) to reach the hospital when they are desperately sick. You
can forget about paying for antiretroviral drugs." Gazi added, "The
government would have to make these cheap drugs available to the
poor, and they would have to make them available for free because the
poverty is so deep." Even if poor Africans do receive the drugs,
there is the "question of compliance," the Times reports. Many anti-
AIDS medications are supposed to be taken on a full stomach and with
clean water, both of which are "hard to come by." Furthermore, it is
difficult enough to ensure that people adhere to medication courses
for illnesses like tuberculosis, "much less getting them to stick to
a strict and often complex regimen of sophisticated antiretroviral
drugs," the Times reports. Mkhize said, "You need very good supervi-
sion and monitoring of your patients. How do you say to somebody,
'You should take this medication at a certain time,' when they don't
even have a watch?" If patients do not comply with treatment regi-
mens, researchers warn that a "more resistant strain of HIV" could
emerge (Simmons, Los Angeles Times, 4/8).
--
Philanthropists Question Harvard Report's Emphasis on AIDS Treatment,
Say Focus Should be on Prevention
The heads of the United Nations Foundation, the Rockefeller Founda-
tion and the Bill and Melinda Gates Foundation on Friday expressed
concern that a new Harvard report urging that billions of dollars be
spent to treat people with HIV/AIDS in Africa could undermine the
need for a greater focus on prevention efforts, the Boston Globe re-
ports. The Harvard report, released last Wednesday, calls for $1 bil-
lion in initial funding to provide HIV-positive Africans with anti-
retroviral medications (Donnelly, Boston Globe, 4/7). The report also
recommends that an additional $3 billion a year go toward prevention
and treatment programs other than antiretroviral therapy (Kaiser
Daily HIV/AIDS Report, 4/5).
Turning Heads
The Globe reports that the Harvard proposal "turned heads" among
global health advocates worried about the "logistical problems of
building sustainable health systems in sub-Saharan Africa." Bill
Foege, a senior adviser to the Gates Foundation, said that the Har-
vard report "underestimates how difficult it is to do the infrastruc-
ture. ... My concern is [that] drugs could get ahead of the infra-
structure, and then [there is] the possibility of [drug] resistances
developing. As bad as AIDS in Africa is, one thing is worse: AIDS in
Africa with antiretrovirals used incorrectly and resistances develop-
ing" (Boston Globe, 4/7). Timothy Wirth, president of the United Na-
tions Foundation, added, "In any political system, the pressures for
funding come from people who are already sick. ... I'm concerned that
all of the pressure on treatment issues will squeeze out prevention."
Bill Gates said that it was "fantastic to see the AIDS crisis getting
the increased visibility it deserves" (Garrett, Newsday/Washington
Post, 4/8). However, he warned that prevention needs to be a "prior-
ity" because if "things aren't different, an additional 75 million
people will be getting the disease in the next 20 years." Jeffrey
Sachs, the Harvard economist who wrote the proposal, responded that
he did not disagree with the opinion that "prevention needs to be in
the forefront of efforts to fight AIDS." He added, however, that the
report was not a "comprehensive plan for AIDS control. It was about
the feasibility of antiretroviral therapy in developing countries"
(Boston Globe, 4/7).
--
WHO, WTO Begin Three-Day Meeting to Discuss Differential Drug Pricing
for Developing Nations
The World Health Organization and the World Trade Organization today
begin a three-day meeting in Norway to discuss improving access to
essential drugs for developing countries, BBC News reports (Doole,
BBC News, 4/8). The meeting, closed to the media and called "Differ-
ential Pricing and Financing of Essential Drugs," is intended to be a
brainstorming session only and delegates cannot make binding deci-
sions. "The main goal is to map conditions that today prevent devel-
oping countries' access to needed medicines on reasonable terms,"
Norwegian Minister of Development Aid Anne Kristin Sydnes said (Mell-
gren, AP/Nando Times, 4/8). Health and trade officials, joined by
representatives from drug firms like GlaxoSmithKline, Merck & Co.,
Pfizer and Bristol-Myers Squibb, as well as non-governmental organi-
zations, will also discuss how to prevent discounted drugs from being
re-exported to wealthy nations (Rodgers, Dow Jones International
News, 4/9). BBC News reports that the meeting is the first between
health and trade officials on "what is fast becoming a key develop-
ment issue."
Seeking a 'Win-Win' Situation
Although some pharmaceutical companies have recently lowered prices
on AIDS drugs in Africa, the Norway conference will examine "whether
all essential drugs should be offered at lower prices in poorer coun-
tries" (BBC News, 4/8). The WTO and WHO seek a "win-win situation
that would benefit everyone involved," although "few believe" drug
giants will "yield much ground in what promises to be a vastly com-
plex argument over drug pricing and patents." WHO Director-General
Gro Harlem Brundtland said she wants companies and governments to
"drastically reduce the burden on developing countries" and recom-
mends partnerships similar to the Global Alliance for Vaccines and
Immunization, which has successfully "harness[ed] substantial private
funds" (Dow Jones International News, 4/9). But the drug industry has
said that "differential pricing" of drugs "can only work if companies
are permitted to remain competitive and are not subject to rigid and
systematic rules," and it places greater emphasis on drug financing.
International Federation of Pharmaceutical Manufacturers Associations
chief Harvey Bale said governments must improve health service fund-
ing to ensure drugs get to those in need (BBC News, 4/8). Bill Fulla-
gar, president of the Association of the British Pharmaceutical In-
dustry, added, "The pharmaceutical industry can't be a health service
of the world," noting that increasing drug access is dependent upon
governments improving the infrastructure and staffing of national
health services (Dow Jones International News, 4/9).
--
Mali Strikes Agreement with Pharmaceutical Companies for Reduced-Cost
Antiretrovirals
Mali's government on Saturday announced an agreement with four West-
ern pharmaceutical companies to obtain antiretroviral drugs at
"sharply reduced rates," AP/CNN.com reports. The companies partici-
pating in the deal -- Bristol Myers-Squibb, GlaxoSmithKline, Boering-
her-Ingelheim and Merck Sharp and Dohme -- agreed to give Mali, one
of the world's poorest countries, an 89% price cut on HIV drugs,
bringing the cost per person down from $485 per month to $85. How-
ever, Mali's Health Ministry has acknowledged that the reduced price
still remain out of reach for most Mali citizens and plans to subsi-
dize drug costs up to 100% for the "poorest" patients. The government
hopes to provide treatment for up to 600 HIV-positive individuals per
year through a program funded partly by an international initiative
forgiving some of its old foreign debts. About 130,000 of Mali's 11
million people have AIDS (AP/CNN.com, 4/8).
--
Despite South African Pleas, GlaxoSmithKline Will Not Further Reduce
AIDS Medication Price for Developing Countries
Despite "pleas" from South African health officials that Western
anti-AIDS drugs are "still too costly," GlaxoSmithKline said last
week that it would not cut the price of AIDS medications for develop-
ing countries any more than the 90% it already has offered, Reuters
Health reports. South African Health Minister Manto Tshabalala-
Msimang said, "We have no objection in principle to the use of an-
tiretrovirals. But cost remains an enormous barrier that cannot be
wished away." GSK has offered Combivir to the South African state of
Pretoria for $56 per patient for one month's treatment, "a major dis-
count on the average world price," Reuters Health reports. A GSK
spokesperson said, "A 90% reduction is a significant offer ... a huge
reduction. We are not going to go further because we would get into a
ridiculous situation." But Pretoria officials say that the drug firm
has "failed to offer concrete price discounts on sustainable supplies
of medicines," adding that the company is only offering the reduced-
price drugs for up to five years. Pretoria officials add that the
price mentioned in meetings with the drug maker "would still break
its health budget." GSK's announcement that it would offer no further
price reduction comes only a few weeks before an international court
case addressing South Africa's 1997 Medicines Control Act is set to
resume on April 18. In that case, 39 drug firms say that the
"planned" legislation will infringe on their patent rights by allow-
ing the Health Ministry to import or manufacture cheaper generic
medicines. AIDS activists and organizations say that the drug firms
"are putting profits ahead of lives and abusing their patents," not-
ing that 25 million Africans have HIV/AIDS (Woodman, Reuters Health,
4/6).
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