Will WHO and UNAIDS please promote the use of Cotrimoxazole
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Spotlight sharpens on HIV/AIDS-related drug access
As the start of the International AIDS Conference moves closer, the
temperature is rising rapidly around the issue of access to HIV/AIDS-
related drug treatments. Unless last-minute negotiations can generate
explicit agreements and commitments, a head-on confrontation between
African governments, community advocates and the major pharmaceutical
giants looks inevitable.
With the prospect of the intense spotlight on AIDS that the forthcoming
conference will generate, governments, treatment activists and interna-
tional organisations are stating their positions more explicitly. And
they may be more similar than you would at first think. Last month five
of the largest pharmaceutical companies and the UN announced that a
'new dialogue' had started to explore ways of accelerating and improv-
ing the supply of HIV/AIDS-related treatments in developing countries.
A spate of press releases and newspaper editorials followed, celebrat-
ing this step forward and alluding to what might be up to 85% price re-
ductions for some drugs. But no details of concrete price reductions
have since appeared.
Last weekend a special meeting of Southern African Health Ministers,
convened in response to the industry/UN statements, noted with strong
concern that the manner in which the proposed offer was announced could
lead to alienation of governments from their people, as the public was
given the impression that the prices of anti-retroviral drugs have been
drastically reduced and immediately available. The meeting also
stressed that as of now, no concrete offer or mechanism to affect such
an offer is in place. They also emphasised the need for developing
countries to take charge of the negotiation process themselves.
During the meeting, Health Minister Dr. Manto Tshabalala Msimang, made
South Africa's position clear on the legal mechanisms it has at its
disposal to improve drug access unilaterally: "May I take a brief mo-
ment here to state categorically, and emphatically, that our govern-
ment's stated policy is to pursue both parallel importing and compul-
sory licensing... We will pursue ... [them] with vigour, determination,
and everything else that we have at our disposal."
Compulsory licensing and parallel importing would allow the government
to either manufacture or import drugs that are currently covered by
pharmaceutical company patents in South Africa.
Also during the past week, Joseph Perriens of the United Nations Joint
Programme on HIV/AIDS (UNAIDS) added to the emerging consensus by ex-
pressing their concern that "if price quotes are not made available by
the time of the Durban World AIDS Conference, there will be trouble".
Treatment activists appear to have a similar standpoint too: "The fact
that a serious discussion has begun among drug companies on dramati-
cally reducing the price of AIDS drugs is a victory, but a small one -
much like an elephant giving birth to a mouse", said Dr. Bernard Pecoul
of Medecins sans Frontieres (MSF - Doctors without Borders) at the time
of the announcement. An MSF spokesman responded this week to the SADC
Ministers statement by saying: "They demonstrate the high level of in-
terest in the region in using mechanisms such as compulsory licensing
and parallel importing to facilitate access to drugs to treat
HIV/AIDS".
The South Africa-based Treatment Action Campaign (TAC) said that they
too welcomed the SADC statement on access to essential HIV/AIDS drugs.
But two other events this week also underscored the importance of in-
creasing access to relatively cheap drugs - not just expensive anti-
retrovirals, but those used to treat the common HIV-related opportunis-
tic infections.
Twenty-three AIDS organisations from seventeen countries sent an open
letter to the bosses of the World Health Organization and UNAIDS, re-
questing them to emphasise the value of an effective antibiotic - co-
trimoxazole - in the treatment of AIDS-related conditions.
"We need you, WHO and UNAIDS, starting today, to carry this simple and
essential message to international fora and media : effective preven-
tion of opportunistic infections by cotrimoxazole is possible, neces-
sary, and urgent", the letter read. "We will take stock of your re-
sponse, Mrs Bruntland, Mr Piot, in Durban, as Directors respectively of
WHO and UNAIDS, and before the thousands of actors of the fight against
AIDS who are due to attend. "
In the past few days there was also a protest outside pharmaceutical
giant Pfizer's South African plant in Pietermaritzburg near Durban.
Pfizer recently announced they would provide the anti-meningitis drug
fluconazole free of charge to people living with HIV in South Africa.
They have since back-peddled on the pledge by introducing detailed con-
ditions and clauses. Irate activists were back at Pfizer's doorstep to
accuse them of acting in bad faith and tricking both TAC and the gov-
ernment.
This week's events also served as a reminder that there are several
converging, but separate, areas in this whole drug & treatment access
debate. 1. Patent-related issues - whether governments should manufac-
ture (under compulsory licences) their own versions of drugs despite
current patent protection, or import cheaper versions from elsewhere.
2. The possibility that in the face of increasing international pres-
sure, drug companies will voluntarily reduce their prices in countries
most affected by the HIV/AIDS pandemic - the so-called two- tiered
pricing approach. 3. The need to improve the use of already available
treatments for HIV-related conditions, including by raising awareness
among governments and medical workers.
Clearly the spotlight is turning towards the drug industry to say and
do something concrete in the next week or two. As usual, we should ex-
pect them to finesse the questions by turning attention on governments
and international agencies - by accusing them of allowing the health
systems in developing countries to deteriorate to such an extent that
drug availability is a minor consideration. Arguing that hospitals and
health centres do not have the infrastructure to do relevant tests, di-
agnose or monitor people's conditions, or even let doctors know what
drugs should be used to treat specific conditions.
But strengthening already fragile health systems is made more difficult
by the increasing strain of a widespread HIV epidemic. As more people
fall sick, the health systems become even less able to cope. Improved
access to drugs can only help to reduce that burden of care - a respite
that may be the last window of opportunity to strengthen health sys-
tems.
In some respects the pharmaceutical industry have been an easy target
for criticism, and ailing health infrastructures need a similar scale
of attention - but that is by no means an excuse to do nothing about
improving drug access where and however they can.
Key Correspondent Team
Email: kcteam@aids2000.com
(Sources: UNAIDS, San Francisco Chronicle, e-drug@usa.healthnet.org,
Wall Street Journal, treatment-access@hivnet.ch, intaids@hivnet.ch,
Medecins Sans Frontieres)
Courtesy of Jamie Uhrig
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Claudio Schuftan
mailto:aviva@netnam.vn
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