E-DRUG: Brundtland on cheaper drugs
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[Letter of Dr Gro Brundtland, DG of WHO, in Int Herald Tribune; copied as
fair use. NN]
Editorials and Opinion
Cheaper Drugs Offer Hope in the War Against AIDS
Gro Harlem Brundtland IHT Wednesday, February 14, 2001
GENEVA Outrage about the plight of people with HIV in developing countries
has recently reached the pages of Western newspapers. This is good. The
fact that fewer than a tenth of the 36 million people infected by HIV can
afford the drugs used to treat the disease is outrageous. .
But it is not a lost battle. In fact, we have begun dismantling the
obstacles that are preventing essential drugs from reaching the millions
who need them. .
We are seeing an unprecedented effort, driven by committed people from
governments, non government organizations, UN agencies and the private
sector. Popular outrage, political will, market forces and the best science
are enabling the pursuit of a fundamental principle of public health: the
supply of essential medicines on the basis of need rather than on the
ability to pay. In this case, the forces of globalization are being used to
narrow the gap between rich and poor.
A year ago, the medicines needed to slow the progression of AIDS were far
beyond what most Africans, Latin Americans and Asians, or their
governments, could afford. At a cost of $10,000 to $15,000 per person per
year the drugs were out of reach. Today, antiretroviral combination drug
therapies have become available to some African countries for around $1,000
dollars per patient per year. Offers last week by a pharmaceutical company
producing generic drugs mean that these combination therapies could be made
available in Africa for a price of $600 or less per person per year. .
True, such prices are still beyond what almost any African health system
and most patients are able to spend. But it must not stop here. We must
ensure that not only HIV/AIDS drugs but all essential medicines and
vaccines are accessible to all. It will take time, but we must make sure
that no moment is wasted. .Yes, it is a difficult process. Along the road,
there will be disputes about how trade agreements are to be interpreted.
There will be challenges to national drug policies which threaten to change
the established order of things. There will be arguments about patent
rights. The stakes are indeed high.
We want differential pricing to work in practice. This means appreciating
companies' concerns that lower prices in the poorest countries should not
be used as a lever to influence negotiations in those which can easily
afford to pay more. We need mechanisms to prevent illicit re-export of
lower priced drugs into richer economies. We need an environment where the
right regulations are fairly enforced so that competition can work
effectively. This is starting to happen. .It would be naive, however, to
think that cutting the prices of medicines is enough. The prospect of
cheaper medicines stimulates demand for care, and this will actually
increase the need for resources.
No matter how low prices go, it is inevitable that additional funding will
be needed to meet the costs of care for the poorest. Developing country
governments can commit their own resources, as Brazil and other countries
have already shown. But most of this money must come through increased
development assistance as well as debt relief. .This has to be new money.
We cannot take from the little that is already being spent on other common
deadly diseases such as those which kill 4 million children each year.
Experience has shown that combination therapy can be effectively
administered in Africa without the elaborate laboratory monitoring which is
routine in industrialized countries. But there is concern that lack of
monitoring will cause resistance of the HIV viruses to AIDS medication that
quickly will render the available medicines useless. We can deal with this.
We can find a safe minimum standard that ensures safe use of quality drugs
while being affordable in poor countries. .
Through all this we must ensure that the new hope of wider access to care
complements and strengthens efforts to prevent HIV from spreading. Keeping
people free from HIV must always remain our main goal.
The writer, a former prime minister of Norway, is director-general of the
World Health Organization. She contributed this comment to the
International Herald Tribune.
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