E-DRUG: Barcelona AIDS conference ends with call for ARV access
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[There has been no discussion on E-drug about the AIDS conference that just
ended in Barcelona. As there was huge coverage on other sites (see
www.aids2002.com or www.hdnet.org), there was probably no need to repeat
them on E-drug. Below some interesting summaries: thanks to Andy at
DRUGINFO for scoping them.
Pilot programmes to find out how we can best make antiretrovirals and other
HIV-related drugs available to AIDS patients in developing countries seems
to be the way forward. I would invite e-druggers to comment on
how/where/when these could best be started. Messages below copied as fair
use. WB]
http://www.washingtonpost.com/wp-dyn/articles/A1397-2002Jul13.html
AIDS Meeting Ends With Hope
Formerly Inconceivable Programs to Start This Year
By David Brown
Washington Post Staff Writer
Sunday, July 14, 2002; Page A01
BARCELONA, July 13 -- Delegates to the 14th International AIDS Conference
departed for their 194 home countries this weekend with the first glimmers
of belief that the world may finally be ready to take on the global AIDS
pandemic, 21 years after the disease emerged seemingly out of nowhere.
Over the next few months, programs that seemed inconceivable, and even
foolhardy, a few years ago will commence. They will include efforts to
massively increase AIDS prevention; to bring AIDS drugs to hundreds of
thousands of people living in the world's poorest countries; to create a
global arbiter of AIDS spending; and to extract, year after year, billions
of dollars from the wealthy nations of the world.
How much of this will work is the big question. But whether these things
will be tried is no longer in doubt.
"This is the summer when everything will change," Paul Farmer, an American
physician treating AIDS patients in Haiti, told the delegates on Thursday.
"A lot is going to happen this year."
International AIDS conferences are unwieldy combinations of scientific
conversation, transnational networking, political theater, commercial
promotion and, often, manufactured conflict and consensus. This one was the
largest -- about 15,000 people attended -- and probably the most unwieldy
ever. Nevertheless, these conferences sometimes become historic moments
themselves in the unfolding narrative on AIDS, the worst epidemic in modern
times.
If that proves to be the case with the Barcelona conference, it will be
because, in some fundamental if unprovable sense, globalization came to
AIDS
this week.
No longer are the shocking tallies of infection and death, spelled out and
released each year by World Health Organization epidemiologists, the only
thing about AIDS that unites nations. Now, there's a dawning realization
that what has been done to fight the epidemic in the world's wealthier
nations can probably be done anyplace.
"If we can get Coca-Cola and cold beer to every remote corner of Africa, it
should not be impossible to do the same with drugs," said Joep Lange,
president of the International AIDS Society, in a speech at the close of
the
conference on Friday.
The seed of that realization was planted two years ago when the
International AIDS Conference was held for the first time in a place being
decimated by the epidemic -- South Africa. There, the huge inequity in
response to AIDS between rich countries and poor ones became intolerable in
a way it hadn't been previously. Since then, events have transpired and
mechanisms have been put in place that -- theoretically, at least -- can
start bridging that gap.
The list of those things is long. It includes a 90 percent decline in the
prices of antiretroviral drugs destined for use in the developing world. It
includes greatly improved epidemiological information about the disease's
toll, and the toll of its toll, such as the number of children now
orphaned,
or expected to be over the next 20 years, by AIDS. It includes the United
Nations General Assembly Special Session on AIDS, held in June 2001, that
set targets for increases in prevention services and decreases in disease
transmission through 2015.
In the past two years, there has also been a huge addition to the body of
knowledge about which AIDS prevention strategies work (and a much smaller
one for treatment strategies) in high-prevalence areas. Guidelines for
using
three-drug combinations of antiretroviral medicines -- the standard of care
for the infection -- have been simplified to a point where there is
essentially no setting too deficient in resources to use them if they're
available.
Perhaps most important is the creation of the Global Fund to Fight AIDS,
Tuberculosis and Malaria.
"As somebody who works in Washington, I think the progress that has
occurred
in the last two years has been pretty astounding," said Nils Daulaire,
president of the Global Health Council, a consortium of international
health
organizations.
Nevertheless, he added quickly, "200 AIDS patients under treatment is not
the same as 3 million," citing the size of the pilot projects done in
Africa
two years ago and WHO's target for the number of people in the poorest
countries who should be getting antiretroviral therapy by the end of 2005.
"In two years, we should have our first concrete markers of the ability of
large programs to deliver," Daulaire said. "If they don't, then we're at
risk of serious retrenchment. But it's now past ideology. There really has
to be product."
While many people privately share this feeling that much has been
accomplished recently, few will say so openly. To do so risks sounding
complacent, or even self-congratulatory, in the face of an epidemic that is
proceeding essentially unimpeded by human intervention, with 40 million
people now infected and 45 million new infections expected by the end of
2010.
Furthermore, the particularities of human immunodeficiency virus (HIV)
infection -- fairly easy sexual transmission, a lag of years between
infection and first symptoms, and the ability of the virus to pass from
mother to child during delivery or breast-feeding -- makes it unlikely any
interventions will have much effect in the near future.
"It is like a parachute," said Stefano Vella, an Italian physician and
former president of the International AIDS Society, describing the emerging
resolve to intervene where the epidemic is at its worst, notably in
sub-Saharan Africa. "There is a moment when you are past a point -- you can
open it, but it is over. It will not slow the impact with the ground." He
paused and added: "Let's assume that it's not too late."
The slashing of drug prices two years ago, agreed to by five huge
pharmaceutical companies (later joined by a sixth), is generally considered
the event that began to move the rhetoric of Durban, South Africa, toward
action.
"Until that happened, people thought about drug prices like gravity -- they
were a law of nature you couldn't do anything about," said Stephen Arpadi,
a
pediatrician at St. Luke's-Roosevelt Hospital Center in New York. "So
something has shifted. People seem to appreciate that a lot of problems are
socially defined."
Drugs for a year's worth of triple therapy for one patient can now be
bought
from U.S. and European pharmaceutical houses by the poorest countries for
as
little as $1,200 -- a tenth of the price charged in industrialized nations.
Generic manufacturers in India, however, can substantially undercut that,
with the current cheapest combination from one company offered at $209 for
a
year of pills.
Health economists believe the price must fall to about $30 to $40 a year
before the cost of drugs ceases to be an impediment to treatment in the
poorest settings. Prices that low are not expected in the foreseeable
future, if they're even theoretically possible.
The other event that has brought something like global resolve to the
starting gate is the Global Fund, created last year at the suggestion of
U.N. Secretary General Kofi Annan (although the idea originated with
policymakers at WHO). A free-standing entity headquartered in Geneva, it is
the intersection point where all parties -- and their doubts about one
another -- meet.
The fund collects money from governments, foundations and individuals, and
currently has $2.1 billion in pledges. Countries and organizations apply
for
grants, which are reviewed by an independent board. Initial awards are
partly based on feasibility, and the projects must be able to quantify and
demonstrate results to continue getting money.
In its first round of awards in May, the fund granted $616 million, to be
spent over two years, to 58 proposals submitted from 30 countries. It will
collect money continuously and dispense it twice a year, limited only by
its
holdings and the quality of the applications.
The Global Fund will be forced to arbitrate on many levels. Much of the
success or failure of AIDS prevention and treatment efforts will rest with
it.
It will try to avert a struggle among the advocates for the treatment of
AIDS, tuberculosis and malaria -- the three infections most important to
the
developing world and ones that, on a biological level, have synergistic
effects on one another. In the projects it chooses to fund, it will have to
find a balance between prevention and treatment -- two strategies that,
while mutually reinforcing, frequently compete. It will have to be
transparent in its deliberations, exacting in its judgments and fair in its
disbursements if it hopes to retain its credibility with the populations it
serves and the rich countries, companies and organizations it depends on
for
money.
The challenges facing it will be immediate. For example, some key players
such as Medecins Sans Frontieres (Doctors Without Borders) are likely to
urge the fund to give strict preference to projects that will use only
generic drugs, arguing that to do otherwise will waste money. Such a
position would probably be opposed by countries, such as the United States,
with important and powerful pharmaceutical industries.
The fund may also be called on to be a financial ringmaster, although its
power to tame economic lions is untested. In October, it will publish an
estimate of the amount of money that could productively be used worldwide
in
the battle against AIDS. Asked if he will then name the amounts that
specific countries should donate, the fund's newly chosen director, Richard
G.A. Feachem, said: "We may be making suggestions."
The fund's power to unify, however, is potentially immense. In one plenary
lecture, Julio Frenk, Mexico's health minister -- one of 41 national health
ministers who attended the conference -- called on middle-income countries
to contribute.
"Mexico will make such a contribution, even if it's a symbolic one," he
said. "It has to become truly a global effort where everyone participates."
Nevertheless, while programs in dozens of countries are poised to expand or
open up in the next few months, underwritten by money from many sources,
little is different on the ground today from what existed two years ago. Or
two years before that. And some people aren't optimistic that the situation
will change much.
"In places like Latin America and Africa, the pandemic is the same. All the
governments, they don't keep the promises," said Eugenio Pazarin, a
28-year-old man who works with a nongovernmental organization in Mexico
City, as he dismantled his group's booth at the end of the conference. "My
government does not have a commitment to people with HIV. We are advocating
for universal treatment, but it doesn't happen yet."
� 2002 The Washington Post Company