E-drug: Spotlight sharpens on HIV/AIDS-related drug access
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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 international 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 improving the supply of HIV/AIDS-related treatments
in developing countries. A spate of press releases and newspaper
editorials followed, celebrating this step forward and alluding to what
might be up to 85% price reductions 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 moment here to state categorically, and
emphatically, that our government's stated policy is to pursue both
parallel importing and compulsory 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 expressing 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
dramatically 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 interest 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
increasing access to relatively cheap drugs - not just expensive
anti-retrovirals, but those used to treat the common HIV-related
opportunistic infections.
Twenty-three AIDS organisations from seventeen countries sent an
open letter to the bosses of the World Health Organization and
UNAIDS, requesting them to emphasise the value of an effective
antibiotic - cotrimoxazole - 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
prevention of opportunistic infections by cotrimoxazole is possible,
necessary, and urgent", the letter read. "We will take stock of your
response, 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
conditions and clauses. Irate activists were back at Pfizer's doorstep
to accuse them of acting in bad faith and tricking both TAC and the
government.
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
manufacture (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 pressure, 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
expect 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, diagnose 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 systems.
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)
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Forwarded from:
B R E A K T H E S I L E N C E
XIIIth International AIDS Conference,
Durban, South Africa, 9 - 14 July 2000
http://www.aids2000.com/interactive
To join: join-breakthesilence@aids2000.com
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