Kaiser Daily HIV/AIDS Report - Thursday 14 2001
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*Senator Frist Introduces Bipartisan Bill Allocating $700 Million to
Global AIDS Fund
*UNAIDS has Boosted Global Coordination on Disease, But Less Success-
ful on Country Level, GAO Finds
* South African President Thabo Mbeki 'Heckled' by Scottish AIDS Ac-
tivists
*South African Judge Speaks on Disparities in Treatment Access Be-
tween Africa, Developed World
*Yale Economist Introduces Proposal to Settle Debate Between Pharma-
ceutical Companies and Developing Nations
*Kenyan Lawmakers Approve Bill to 'Suspend' Drug Patent Rights and
Improve Cheaper Drug Access
*International AIDS Efforts in Africa 'Admirable' But Not Worthwhile,
Op-Ed Says
*Senator Frist Introduces Bipartisan Bill Allocating $700 Million to
Global AIDS Fund
Senator. Bill Frist (R-Tenn.) this week introduced legislation that
would appropriate $700 million over two years to the Global AIDS and
Health Fund proposed by U.N. Secretary-General Kofi Annan in April,
the New York Times reports. Last month, President Bush made an ini-
tial pledge of $200 million toward the fund, which the bill would in-
clude (Crossette, New York Times, 6/14). The International Infectious
Diseases Control Act, supported by Senators. John Kerry (D-Mass.),
Jesse Helms (R-N.C.) and Patrick Leahy (D-Vt.), would authorize $200
million in 2002 and $500 million in 2003 to be placed in a global
trust fund at the World Bank. The bill states, "Prevention of new in-
fections is the key, although treatment and care for those infected
by HIV/AIDS is an increasingly critical component of the global re-
sponse" (Garrett, Newsday, 6/14). Britain and France have also
pledged to contribute to the fund, and Swiss insurance company Win-
terthur Insurance has agreed to donate $1 million. In creating the
global fund, Annan called for $7 billion to $10 billion in contribu-
tions (USA Today, 6/14). Last week, Rep. Henry Hyde (R-Ill.) intro-
duced a House bill supporting the global fund and raising the HIV
budget of USAID. According to Newsday, instead of specifying a dollar
amount for the global fund, the House bill "leav[es] authorization
open to the White House" (Newsday, 6/14).
*UNAIDS has Boosted Global Coordination on Disease, But Less Success-
ful on Country Level, GAO Finds
In response to a request by Sen. Frist to examine UNAIDS' progress in
addressing global AIDS issues, the General Accounting Office on Mon-
day issued a 68-page report (GAO-01-625) that found that the agency
has "helped shift the global community's response to HIV/AIDS from an
exclusively health-oriented perspective to a multisectoral approach
that addresses the various ramifications of high rates of HIV/AIDS on
a country's development." However, the agency's successes have been
"partly offset by the inability of UNAIDS' cosponsors to fully inte-
grate HIV/AIDS into their programs and activities and by UNAIDS' weak
efforts at the country level," the report states. Since 1998, UNAIDS
has given "financial and technical support" to about 50 HIV/AIDS
"technical networks," which "link local communities and regions to
HIV/AIDS-related resources from universities, health organizations
and private consultants." The study's authors interviewed "key" mem-
bers of the UNAIDS Secretariat, as well as officials from cosponsor
nations and the United States. They also conducted an "extensive" re-
view of agency documents and surveyed USAID missions to "obtain per-
spectives on UNAIDS' HIV/AIDS efforts at the country level."
Report Findings
UNAIDS has "made progress in increasing U.N. coordination" and has
"successfully developed" a series of "authoritative, high quality and
comprehensive" best practices regarding blood product safety, care of
those with HIV/AIDS and tuberculosis and improved access to medi-
cines. However, the agency has not been "as successful" in monitoring
the funding and actions taken by nations to address the epidemic at
the country level and "has yet to implement a monitoring and evalua-
tion plan that would enable [it] to determine the important results
of its overall efforts and measure progress toward achieving its ob-
jectives," according to the report. The report says that the agency's
success has been hampered by a lack of funding control, as other U.N.
agencies and donors have "marshall[ed]" the funds and resources
UNAIDS was expected to control. The agency's efforts have also been
negatively affected by a "weak political mandate" from the U.N. and
the international community, leaving its influence "dependent on how
effectively it can advocate AIDS causes to others." In addition,
UNAIDS has not always been "consistent" in its response to the
HIV/AIDS epidemic, nor has it "followed through sufficiently" on some
efforts, such as regional initiatives, the report states. The report
recommends that UNAIDS implement strategies to "hold ... cosponsor
representatives more accountable at the country level" and to improve
its monitoring and evaluation practices. The report also includes a
review of UNAIDS' International Partnership Against AIDS in Africa
(GAO report, 5/25).
GLOBAL CHALLENGES
*South African President Thabo Mbeki 'Heckled' by Scottish AIDS Ac-
tivists
South African President Thabo Mbeki, who caused an "international up-
roar" more than a year ago when he publicly questioned the causal
link between HIV and AIDS, was "heckled" yesterday by Scottish pro-
testors shouting "AIDS is the new apartheid," as he attended the
opening ceremony for a Glasgow Caledonian University health building
named after his father, the Associated Press reports. Carrying signs
that read "The Right to Life: The Right to Treatment" and "Wake up --
HIV Equals AIDS," a "few" activists greeted Mbeki, who made no men-
tion of AIDS in Africa in the speech he delivered to nearly 400 stu-
dents and officials. Mbeki, who "reignited" controversy in April by
questioning the "value" of HIV tests and rejecting proposals to pro-
vide antiretroviral drugs to South Africans with HIV/AIDS, has "bred
confusion" about the disease and "how to deal" with the country's
epidemic, according to AIDS activists (Associated Press, 6/13). Mbeki
did concede that "much still needed to be done" with respect to the
disease, adding, "It clearly cannot be business as usual when commu-
nicable diseases such as TB and malaria, HIV/AIDS continue to kill
and prevent millions of Africans from functioning at their full po-
tential." Observers said AIDS is "firmly off the agenda" during
Mbeki's four-day trip to Great Britain, one of South Africa's largest
trading partners. Mbeki is scheduled to meet with Prime Minister Tony
Blair today and is using the trip to ask wealthy nations to "slash"
debt burdens in the developing world and to "urge" companies to in-
vest in South Africa (Times of India, 6/14).
*South African Judge Speaks on Disparities in Treatment Access Be-
tween Africa, Developed World
At the National Press Club yesterday, South African Supreme Court of
Appeals Justice Edwin Cameron, who is openly HIV-positive and openly
homosexual, addressed the disparities of treatment access in southern
Africa versus the developed world. "I'm here because my life exhibits
an intolerable iniquity that is presenting itself to the rest of the
world today. And that iniquity is the disparity between what is
available ... in the wealthy world, the world of North America and
Western Europe, as opposed to the developing world, primarily Af-
rica," Cameron said in his opening remarks. He went on to explain the
"threshold reasons" for that disparity, namely the pricing of anti-
AIDS medications, which have "conferred new life" on those who can
afford them. The drug companies "deserve credit" for the "dramatic"
ways in which they have addressed their pricing practices over the
last year, he said. However, the prices remain too high, he said,
adding that the cheapest combination therapies available in Africa
cost approximately $100 a month and remain too expensive for more
than 99% of Africans. Cameron's life "embodies this iniquity" because
he is one of the few Africans who can afford antiretroviral medica-
tions, he said, adding that the disparity in drug access is "intoler-
able." Cameron said the issue of drug prices has not been "suffi-
ciently" addressed; prices need to be further reduced, and generic
drugs and parallel imports "have to be permitted," he added. Once
prices are lowered, other "conceptual" issues must be dealt with, he
said.
Treatment Versus Prevention
Cameron called remarks made last week by a "senior U.S. official"
suggesting that international AIDS efforts should focus on prevention
over treatment a "fundamental error," saying that the two are inter-
related. Treatment practices, such as offering antiretroviral drugs
to pregnant women to stop vertical transmission, are part of preven-
tion. The medicines also give people "hope," giving them more "incen-
tive to come forward," he added. By doing so, treatment can change
the "social nature" of the disease and help to reduce the "terrible"
stigma associated with HIV in sub-Saharan Africa. Cameron said he
struggled with his decision to reveal his HIV-positive status, but
because his job is "constitutionally protected," he had less to lose
than some. "Political will," on the parts of both African leaders and
Western leaders, will be necessary for an international HIV/AIDS ini-
tiative to work, he said. He said he "hopes" the initial U.S. contri-
bution to the proposed Global AIDS and Health Fund is only a begin-
ning and will be "superseded rapidly" by more funds. The AIDS-related
deaths that have already occurred "need not be matched," he said,
adding that preventing them is a "moral issue" for the entire inter-
national community.
An 'Emergency Relief Plan' for Africa
Cameron was joined by Cornelius Baker, executive director of the
Whitman-Walker Clinic in Washington, D.C., who said that the chal-
lenge facing Africa is "no greater" than the one faced by the United
States at the beginning of the AIDS epidemic 20 years ago. Baker said
that the U.S. health care system was not equipped to address the epi-
demic at the time, and Congress passed the Ryan White CARE Act as an
"emergency relief system" to build the necessary infrastructure. Af-
rican officials are asking for a similar system to tackle HIV/AIDS.
Cameron added that South Africa's medical system is the "most ad-
vanced" and there is "nothing to stop implementation" of an HIV/AIDS
program. However, changes in the system will be needed, as the system
is "overburdened" and "under funded," he acknowledged (Heather Scho-
mann, Kaiser Daily HIV/AIDS Report, 6/13).
*DRUG ACCESS
*Yale Economist Introduces Proposal to Settle Debate Between Pharma-
ceutical Companies and Developing Nations
A proposal to "resolve the conflict between drug companies desperate
to defend their patents and poor nations desperate to buy cheap
drugs" to treat AIDS is "attracting attention" from policy makers and
pharmaceutical companies, the Wall Street Journal reports. Yale Uni-
versity economist Jenny Lanjouw crafted the proposal, under which
pharmaceutical companies "would surrender patent rights for any new
AIDS drugs in poor countries but enforce them in rich ones." The plan
is "creating a stir" at the World Bank and United Nations, and the
U.S. Treasury Department held a conference on the plan last week.
Rich or Poor?
The "key" to the proposal, which will be published by the Brookings
Institution this week, is to create two separate markets for new
drugs -- one encompassing poor countries, where "unfettered competi-
tion would keep prices low"; and one in rich countries, where drug
companies would enforce patents to "earn the profits they require to
finance new research." Drug companies would be required to choose be-
tween enforcing patent protections in rich countries or poor coun-
tries. The Journal explains that a drug company with a new malaria
drug might choose to enforce patents in poor countries, where most
malaria patients live. But a company developing a new cancer or AIDS
treatment might prefer to establish patent rights in the United
States and Europe, where the most profit could be made. The proposal
is being viewed as a "starting point for discussion" on how develop-
ing countries can obtain cheaper drugs without compromising drug re-
search, the Journal reports. But pharmaceutical companies are still
concerned that generic drugs produced in developing countries could
"leak" into U.S. and European markets. Merck, which is reviewing the
proposal, has not yet delivered a response (Phillips, Wall Street
Journal, 6/13).
*Kenyan Lawmakers Approve Bill to 'Suspend' Drug Patent Rights and
Improve Cheaper Drug Access
The Kenyan Parliament yesterday voted unanimously to pass legislation
that permits the nation to import and manufacture cheaper generic
drugs, a move that "def[ies] the global pharmaceutical industry,"
Reuters/Washington Post reports. The Industrial Properties Bill 2001
"effectively loosens the pharmaceutical giant's hold on patent rights
for a variety of medicines," including antiretroviral medicines to
fight HIV infection (Reuters/Washington Post, 6/13). The bill allows
Kenya to "suspend drug patent rights" in a national health emergency,
allowing the passage of less expensive generic medicines into the
country. Both government ministers and opposition lawmakers supported
the bill, which brings the country "in line" with World Trade Organi-
zation rules (Wall Street Journal, 6/13). Advocates say the bill will
improve access to antiretrovirals for the 2.2 million HIV-positive
Kenyans. However, Kenyans will have to wait for the importation of
the cheaper drugs, as the bill stipulates that Kenya give drug makers
six months' notice before licensing other companies to import or pro-
duce generic versions of patented drugs. Before it can become law,
the measure must proceed to a third reading in Parliament, during
which small amendments may be made, and must be approved by the
president. Kenya is the second African country to pass such legisla-
tion, following South Africa's Medicines and Related Substances Con-
trol Act of 1997 (Reuters/New York Times, 6/13). A lawsuit filed by
39 of the world's largest drug makers against the South African law
alleging patent rights violation was dropped in April (Kaiser Daily
HIV/AIDS Report, 4/19).
*OPINION 8
*International AIDS Efforts in Africa 'Admirable' But Not Worthwhile,
Op-Ed Says
As "admirable" as the passion fuelling international AIDS efforts in
Africa may be, "effective AIDS treatment confronts a host of poten-
tially insurmountable barriers" on the continent, Roger Bate, direc-
tor of the South African non-governmental organization Africa Fight-
ing Malaria, writes in a Wall Street Journal Europe op-ed. In addi-
tion, "the international community's continuing overemphasis on AIDS
masks the immediate and large threat of malaria and respiratory dis-
ease" on the continent, conditions that, unlike AIDS, are "genuinely
curable," Bate writes. While $100 million in combined AIDS funding
from the Bill and Melinda Gates Foundation and Merck incite "opti-
mism," Bate notes, "Private initiatives alone cannot alleviate the
AIDS pandemic" when many African nations' health budgets allocate
less than $10 per person annually. Furthermore, recent offers from
international drug companies to provide discounted AIDS drugs do not
present an approach that is "feasible, due to low capacity to deliver
treatment." Bate writes, "AIDS programs are expensive and will divert
funding from child immunization, oral rehydration therapy for dysen-
tery, removal of malaria mosquito breeding grounds and delivery of
clean water, all of which save many more lives at much lower cost
than AIDS prevention, let alone treatment, which only delays death
and does not cure."
The administration of AIDS drugs is an "onerous
task" that requires routine monitoring and testing, and "Africa's
widespread incapacity to test who should have what doses of what
medicines, then ... deliver medicines correctly every hour of every
day, is the real stumbling block for AIDS treatment in Africa," he
writes. Bate also states that though many companies operating in Af-
rica have "stepped in to assist proper treatment" with their own
clinics or by funding others, the "unintended consequences of such
corporate action is to polarize communities." While employed families
receive treatment, the unemployed do not. Bate concludes, "It does
seem inevitable that an AIDS fund will be established, probably run
by the World Bank, which will bring treatment to many AIDS victims in
Africa. Anyone arguing against such a fashionable, seemingly benefi-
cent program will earn himself few friends. But it does seem para-
doxical -- nay, tragic -- that the world may end up spending tens of
billions of dollars annually to provide painful, only moderately suc-
cessful treatment to prolong life, while not making millions of peo-
ple healthy from curable diseases like malaria for only a few bil-
lion. In these days of emotional politics, perhaps the rich world
will only spend money on diseases with which it has some familiarity"
(Bate, Wall Street Journal Europe, 6/13).
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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