Kaiser Daily HIV/AIDS Report Tue, 20 Jun 2000
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AFRICA: DEVELOPING COUNTRIES HIT HARDEST BY AIDS OFTEN FACE HIGHEST
DRUG COSTS
In many African countries, the high cost of lifesaving AIDS drugs of-
ten puts them out of reach for those who need them most, while in
Europe and North America, many of the same drugs sell for less, ac-
cording to two studies released last week at a recent Kenyan confer-
ence on African drug prices. For example, 100 units of Nevirapine, a
drug that helps prevent mother-to-child HIV transmission, costs US$
430 in Norway, where "there is hardly any market for it," but it
costs US$ 874 in Kenya, where more people are in need of the drug.
Considering that most Africans pay 80% of prescription drug costs
out-of-pocket and that African countries have little purchasing
power, the prohibitive prices mean that many Africans must "simply do
without and go home to die," World Health Organization Regional Offi-
cer Dr. Sam Muziki told attendees at the conference, which was spon-
sored by Doctors Without Borders and other organizations that have
pressed pharmaceutical companies to lower drug costs.
According to Kirsten Myhr, the pharmacist who oversaw one study,
"[p]harmaceutical pricing is about the law of the jungle where might
is right. Profit maximization seems to be the only objective of the
industry." In another study presented at the conference, UNAIDS offi-
cials analyzed anti-AIDS drugs in Brazil, where the government disre-
gards foreign patents and permits its companies to make cheaper ge-
neric versions of the latest American and European drugs. AIDS drugs
produced in Brazil carry a low price tag: the antiretroviral cocktail
ZDV/3TC costs US$ 1.44 a dose in Brazil, compared with US$ 18.78 in
the United States and US$ 7.34 in Uganda. Dr. Amukowa Anangwe,
Kenya's minister of health, opened the conference with a speech that
defended the rights of developing countries to cancel the patents of
manufacturers whose products are too expensive for average citizens.
He added that he expects Kenya's Parliament to pass a new patent law
with clauses on importing practices and patent seizures (McNeil, New
York Times, 6/17).
SOUTH AFRICA: ANNOUNCES PLAN TO FIGHT AIDS
Warning that six million South Africans will have HIV within five
years, health officials yesterday launched a national plan to help
curb the epidemic through education, prevention and care. The five-
year strategy appeals to the nation to change sexual behavior and re-
duce the number of new infections among youth. As it stands, 4.3 mil-
lion South Africans have HIV. Researchers at the British Columbia
Center for Excellence in HIV/AIDS predict that without antiretroviral
treatment, another 276,000 infants will be born with HIV by 2005. The
proposal, which has not yet received government funding, commits the
government and research groups to continue their evaluation of anti-
retroviral drugs for use among rape victims and to block mother-to-
infant transmission, but it does not address providing HIV medica-
tions because of their prohibitive cost. "This epidemic is a crisis
that demands urgent attention," Health Minister Manto Tshabalala-
Msimang said, reiterating that AIDS drugs remain beyond the health
ministry's budget, despite an offer by five pharmaceutical giants to
give deep discounts to countries hit hardest by HIV/AIDS (Reuters,
6/19).
AIDS VACCINE: PROMISING CLINICAL TRIAL GEARING UP IN SOUTH AFRICA
As South Africans prepare to host the international AIDS conference
next month in Durban, 190 miles away in the rural area of Hlabisa,
where one in three pregnant women has HIV, scientists from the United
States and South Africa are preparing to test an AIDS vaccine for
strains of the disease prevalent in Africa, the Philadelphia Inquirer
reports. In South Africa, one year of combination therapy for the
four million people infected with HIV would cost the government US$
400 million. Last year, the government's entire budget for HIV was
US$ 22.5 million. Instead, the government has invested roughly US$ 5
million a year into developing a vaccine that might save lives for as
little as US$ 10 per dose. "Traditionally, Africa has looked to the
West for solutions. This is an African solution," Quarraisha Abdool
Karim, a South African scientist working on the vaccine project,
said. Despite the fact that many AIDS vaccines have failed in humans
after showing promising signs in tests on animals, the research team
is moving forward with the Hlabisa clinical trial, scheduled to begin
in 2002.
Researchers are attempting to educate villagers about the trial to
ensure that participants give informed consent, but in a culture
where the language lacks words for concepts such as "placebo" or
"control group," some have raised concerns about the ethics of con-
ducting such clinical trials. Operating under a community advisory
board, the researchers have hired outreach workers to go door-to-door
to explain the trial and round up volunteers. "There must be people
to volunteer," a member of the community advisory board, said, add-
ing, "I am busy now telling them to come out and volunteer. But it is
difficult because people are ashamed" (Collins, Philadelphia In-
quirer, 6/19).
VACCINE SHOWS PROMISE
The vaccine that will undergo testing in Hlabisa, developed by a Dur-
ham, North Carolina-based biotech company called AlphaVax, Inc., has
shown promise in protecting macaque monkeys from the primate version
of HIV, the Philadelphia Inquirer reports. In early 2001, the vaccine
will be tested on a handful of uninfected people in the United States
and South Africa, and if proven safe, it will be tested for effec-
tiveness in Hlabisa. Based on a disarmed version of the virus known
as Venezuelan equine encephalitis (VEE), the AlphaVax vaccine carries
three HIV genes that are expected to trigger a response from den-
dritic cells, which lie in mucosal surfaces, such as the vagina. When
infected, dendritic cells travel to the lymph nodes, where they acti-
vate antibodies and T-cells needed to fight HIV. "Among things we've
seen, it looks good," Anthony Fauci, director of the National Insti-
tutes of Allergy and Infectious Diseases, said (Collins, Philadelphia
Inquirer, 6/19).
MAKING IT AVAILABLE
If the vaccine proves successful, AlphaVax has agreed to sell it to
countries in sub-Saharan Africa for no more than 10% above production
costs, the Philadelphia Inquirer reports. If the company is unable to
provide the vaccine at that price, the International AIDS Vaccine
Initiative, which gave AlphaVax US$ 4.5 million in seed money for the
VEE project, has the right to find another company that can. While it
is "too soon to know" the vaccine's cost, it will be offered at a
much greater discount in developing countries than in the U.S., Al-
phaVax President and CEO Peter Young said. For example, if the vac-
cine sold for US$ 100-US$ 300 per dose in the West, it might cost US$
5 in developing countries, Young said, adding, "The company believes
that it should be possible to offer a technology relevant to the de-
veloping world and still make a handsome profit overall." IAVI, heav-
ily financed by Microsoft Chair Bill Gates, has developed four vac-
cines, including the VEE approach, with plans to announce two other
experimental vaccines shortly (Collins, Philadelphia Inquirer, 6/19).
--
Cecilia Snyder
mailto:csnyder@pcdc.org
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