E-drug: Antiretroviral Drug Availability, UNAIDS
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(discussion copied from the PROCAARE discussion)
GENEVA, Nov 5 (AFP) - The United Nations' AIDS programme
announced Wednesday a novel initiative geared to providing the
world's poorest countries with expensive cutting-edge drugs used to
save lives in the rich world.
Major pharmaceutical groups, including Glaxo Wellcome Plc and
Hoffmann-La Roche, have pledged to make available some of the world's
most sophisticated HIV/AIDS medicine to developing countries at half
price, UNAIDS said. The HIV infection causes AIDS.
Other types of help, including the supply of antibiotics to
treat sexually transmitted diseases which increase the risk of HIV
transmission and tests for patient monitoring, are also part of the
package.
Chile, Ivory Coast, Uganda and Vietnam have been chosen as pilot
countries for the project which is due to start at the end of 1997 or
the beginning of 1998 and last around two years.
Between 2,000 and 3,000 people in each country will be
beneficiaries.
"Around 20 million out of 23 million HIV-positive people live in
Third World countries where access to treatment and drugs is a daily
challenge for those infected," said Awa Marie Coll-Seck, director of
policy strategy and research at UNAIDS, a joint programme of six UN
agencies, including the World Health Organization.
Pilot countries, for their part, have agreed to make efforts to
beef up their health care infrastructure to ensure that the subsidized
medicines are not wasted, Joseph Saba, UNAIDS clinical research
specialist and coordinator of the initiative, said.
Firms including Belgium's Janssen Pharmaceutica and Organon
Teknika have expressed their interest in participating and talks are
in progress with other companies.
Targeted for distribution are three costly antiretroviral drugs
which have been proven to prolong lives by up to four years and reduce
the discomfort of patients who are in the final stages of the disease,
Saba said.
This cocktail costs around 16,000 dollars per person per year. The
medicines will be distributed according to each pilot
country's degree of development and gravity of their AIDS
epidemics.
In Chile, for example, medicines that treat diseases caused by a
weakening of the immune system are already available, so the focus
will be on providing the tri-therapy drugs.
In Uganda, where the number of HIV infected people is estimated at
1.6 million and medical treatment for the group at 150 million dollars
a year, provision of more traditional medicines will take precedence,
although antiretrovirals are not excluded Saba said.
Pharmaceutical firms will help finance the project, offering to
subsidize their products by more than 50 percent.
"The levels of subsidies will be defined separately and
independently by each company, taking into account the nature of the
drugs to be purchased as well as the economic and epidemiological
situation of the county," UNAIDS said.
The treatments transmitted to developing countries will be those
in stock in the West and the Third World sick will not be used as
guinea pigs for new drugs, UN AIDS said.
Governments are also being asked to come up with new sources of
financing in cooperation with the private sector.
UNAIDS justifies the limited number of people involved in the
pilot project by arguing that only small-scale programmes are
feasible, particularly in evaluating results. "The alternative is to
do nothing, UNAIDS executive director Peter Piot said.
"This programme will provide the information we need to
determine whether HIV/AIDS-related drugs can be obtained and
distributed effectively in developing countries," Saba said.
"Armed with this information, countries will then be able to
mobilize the necessary resources to treat infected individuals, and to
help control the global epidemic."
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KEYWORDS: Therapy, Policy, Drug Availability, Pharmaceutical Company,
UNAIDS
While I applaud the efforts of Peter Piot and UNAIDS to come up with
creative solutions to the challenge of access to healthcare for PLWHAs
in developing countries, I find this approach mind-boggling!
As I noted in an earlier posting, triple combination therapies are far
from being the most pressing problem for most PLWHAs and those caring
for them. The needs are much more basic, if much less exciting too.
Be that as it may, let's examine some of the challenges of turning
this into a reality which could help the remaining 20+ million people
in the developing world who are infected with HIV:
1. Doctors must be provided with clear information in their own
language regarding use (and abuse) of these therapies. This will be
essential to avoid poor compliance and development of strains of the
virus which are resistant to all of the drugs, thus exacerbating the
epidemic.
2. Viral load testing facilities must be made available to allow
treatment decisions to be made in a timely manner. This testing will
add significantly to the cost of the treatment.
3. We saw the time it took for Merck to build capacity to make
Crixivan in sufficient quantities to satisfy 10% of the potential
market. I have no figures for the investment required, but assume it
was not inconsiderable. How long and how much investment would be
needed to construct capacity to satisfy the remaining 90%? Given the
speed at which new drugs are appearing, how long would be before that
investment was obsolete?
4. In the AFP report, UNAIDS is quoted as saying:
Armed with this information, countries will then be able to
mobilize the necessary resources to treat infected individuals, and
to help control the global epidemic.
Good Lord! Where on earth will these countries find the resources?
With an annual expenditure on health of less than $10 in many of these
countries, please someone explain what that means!
The alternative is to do nothing," UNAIDS executive director Peter
Piot said.
UNAIDS is reported as planning to invest $1 million in this project.
With that investment, the alternative is *far* from 'nothing'. A
similar investment in informal trials on traditional medicines could
achieve major results which could quickly benefit a much larger
proportion of the infected population. Drug company money spent on
providing (relatively cheap) treatments for opportunist infections
would do wonders. Encouraging countries to find ways to improve
distribution of drugs resulting in lower costs to the consumer would
help everyone. Providing training and guidance to doctors and
specialists, together with information in their own language, would
save lives quickly. The opportunities to make a *real* difference for
many people quite quickly are there. They're being ignored!
I've tried very hard to be balanced in my assessment of the part that
drug companies are playing to address this epidemic. I've generally
thought that they have been unfairly targetted by some activists. But
this smells! 50% subsidy probably still leaves them with a profit
after tax credits. In any case, if it can avert the threat of
investment in research into traditional remedies which might impact on
their sales of expensive drugs, they probably view it as an investment
well made. But it does sound to me like UNAIDS has sold out to these
pressures and must now be considered as having a major conflict of
interest.
Yes, I did note in the UNAIDS statement:
In Uganda, where the number of HIV infected people is estimated at
1.6 million and medical treatment for the group at 150 million
dollars a year, provision of more traditional medicines will take
precedence, although antiretrovirals are not excluded Saba said.
At first I thought they were supporting my point. But on second
reading it seems they've even hijacked the terminology, since unless
I'm mistaken, 'traditional medicines' still refers to allopathic
drugs.
As I say, the mind boggles... Someone, please tell me I'm missing
something!
Chris
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Chris W. Green (chrisg@rad.net.id)
Jakarta, Indonesia
Tel: +62-21 846-3029 Fax: +62-21 846-1247
KEYWORDS: Therapy, Policy, Drug Availability, Pharmaceutical Company,
UNAIDS
..................................................................gjn
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