E-DRUG: WHO and ARV access
--------------------------
[AFRONETS has an interesting discussion on WHO's statements on ARV access.
They published a 30 July Boston Globe article quoting Dr Lee (copied below)
and received a challenging reply from Peter Burgess (see below). What are
the chances that we can organise a world buyers' club for ARVs just like it
was done for TB drugs? Anyone from E-drug who would like to join this
debate? Crossposted with thanks from AFRO-NETS. WB]
Dear Colleagues
I have just read the posting of August 6 about ARV access, an article
from the Boston Globe........ it started:
"The World Health Organization announced yesterday that it will cre-
ate a new model to buy antiretroviral AIDS drugs in hopes of dramati-
cally speeding distribution and reducing the cost of the life-saving
medication."
and talked about
"The plan comes from a collaboration among tuberculosis experts,
foremost among them the new WHO director general, Jong-wook Lee. That
program, called the TB Drug Facility, purchases drugs in bulk on be-
half of countries and then oversees the distribution."
I am terribly sceptical. I think the "facts" are spurious and reflect
more spin than reality. My background is numbers and understanding
the impact of investment and expenditure on economic outcomes. The
article continued:
"Global health specialists have applauded the program because it cre-
ated a larger market for TB drugs and spurred competition. That in
turn drove down the cost of TB drugs, 30 percent for front-line, or
commonly used, medication and 95 percent for secondary drugs."
That is a pretty impressive statement. And totally out of line with
the scale of the WHO intervention. My view is that this statement is
complete "hogwash" and the Boston Globe should have known better than
to report it without some serious caveats. Can this statement stand
up to independent review and validation?
"The program, which has reached nearly 2 million TB patients the past
two years, also has provided an additional benefit: The WHO works
with local partners to ensure that the drugs are being distributed
properly, providing a safeguard against improper use, which can lead
to drug resistance."
How many TB patients are there in the world? Maybe there are as many
as 2 million TB patients in a country the size of Malawi alone (I
talk about Malawi because of my personal visits to Malawi in the
quite long distant past and my surprise at the number of TB patients
in the hospitals at that time).
And the issue of meaningful numbers goes on. This bit that really
bothers me.
"At a cost of less than $20 million, the program has delivered drugs
to 33 countries and decreased the price of the main TB drugs to as
low as $11 for a six-month daily regimen of medicine".
Do the arithmetic. WHO is a big agency, and a program that is averag-
ing $600,000 per country is unlikely to be getting these really amaz-
ing price drops. It is just not credible.
There is nothing wrong with having ambitious goals. But talking about
goals and delivering on them are two different things. The UN agen-
cies and all the other alphabet soup of development agencies are long
on talk and goal setting and very short on actually delivering bene-
fits to those that need resource assistance.
"The main issue is getting drugs to patients, and we've got to make
it more rapidly available," said Ian Smith, one of Lee's top advis-
ers. Lee has embraced a goal of treating 3 million people with anti-
retroviral medicines by the year 2005. Now, about 300,000 people in
the developing world receive those drugs."
So now we go back to the planning stage. More money for plans and
studies and another delay in getting down to the real work. And other
agencies are planning to use the same delay model so that the real
issue of getting down to practical help can be deferred again.
"The WHO has pledged to draw up a plan by Dec. 1 to meet its goal.
The plan, which the WHO hopes will begin in three to four months,
also will cover anti-malarial medication. Others in the health field,
including those working in family planning, are also examining the
model and may adopt it, WHO officials said. "The primary goal in this
is to dramatically increase access," Smith said. "We also want to re-
duce the price, but that is a by-product of the program and not the
primary aim."
This is some good news. "Big Pharma" from the NORTH has been shamed
into letting some modest amount of generic from the SOUTH get into
the global market place. The advocates for PLWHA, NORTH and SOUTH
combined to denounce the horror of the prevailing global intellectual
property (IP) regime that protects big pharma profit at the expense
of human life, especially the life of poor people. "The price of ge-
neric antiretroviral drugs tumbled sharply last year to roughly $1 a
day for people with AIDS in the developing world. The cost in the
United States is about $10,000 a year. AIDS activists hope the price
falls even further, and some believe the TB model holds great prom-
ise."
Paul Zeitz says the WHO program was very successful. He may be right,
but I doubt it. What the WHO is saying is very favourable, but it
does not make it right. I do not for a minute think that the WHO num-
bers would stand up to statistical and economic peer review nor com-
petent independent audit. I agree totally with Paul Zeitz that low
cost quality generic producers should be engaged in the production of
valuable drugs, and that there is a lot of work to be done to get
drugs (and the other needed health interventions) available to every-
one who could benefit from the treatments.
"The principles of the program were very successful and we think
could be applied" for AIDS drugs, said Paul S. Zeitz, executive di-
rector of the Global AIDS Alliance, an advocacy organization. "It
could be fantastic." Zeitz cautioned that developing countries still
should explore options under consideration for pooling resources re-
gionally, until a new WHO program proves successful. But he said, "If
you can bring on other producers, and create competition among gener-
ics, you'll have Thai producers, Brazilian producers, Chinese generic
producers, all competing with the Indian producers, and as you create
more and more demand for the drugs, we believe it will continue to
drive the price down."
The cost to manufacture incremental quantities of these drugs is
tiny. The big expense is the development and the testing. But once
they are just being manufactured the costs are modest. Pricing is not
about cost. It is about profit and funding the next round of develop-
ment. That is OK, as long as ALL the people needed the drugs have ac-
cess.......... but it is not OK when almost 100% of the people need-
ing the drugs cannot get access.
"The price of generic antiretroviral drugs tumbled sharply last year
to roughly $1 a day for people with AIDS in the developing world. The
cost in the United States is about $10,000 a year. AIDS activists
hope the price falls even further, and some believe the TB model
holds great promise."
The big danger in articles like this is that the general reader comes
away with the idea that the WHO program is going to solve the prob-
lem, when in fact the WHO program will at best address maybe 1% of
the problem. The WHO looks good. The problem goes on the back burner
for the reader once again.
The WHO is not the only development agency that does this. All the
official development assistance community (The World Bank, the IMF,
the various bilateral donor agencies, all the UN agencies, even the
NGOs) talk about how their programs are doing good work. To some ex-
tent they are. But in aggregate their programs are totally insuffi-
cient to make a big difference, and there is nothing happening to
change the fund allocations so that the problems can get to be ad-
dressed in a time frame that is meaningful for the present generation
of PLWHA.
There are some amazing things that are done by the development agen-
cies, and especially by individuals in the system who are willing to
put themselves in harm's way. But there is a serious systemic problem
that is causing major damage to development performance. Development
agencies do NOT have the resources to do the work that needs to be
done, and they will not say this out loud and clearly. They hardly
have enough money for their own staff (and the related pensions) and
they are seeking desperately to stay funded. They need more re-
sources. And development problems need more resources. In my view,
the continuing cycle of study and "spin" is getting in the way of
solving the underlying big problem of development "process" and de-
velopment "resources".
A lot of people reading this list know the problems. The challenge is
to find a solution, and I will argue that a solution is going to
found when we think much more about "people" instead of organization
or program or procedure and we have a lot better "information" in-
cluding the accounting and accountability dimension of information.
Sincerely
Peter Burgess
ATCnet in New York
Tel: +1-212-772-6918
Fax: +1-707-371-7805
mailto:peterb@iitc.safe-mail.net
--
WHO and ARV access
------------------
WHO looks to ease access to AIDS drugs
30 July 2003 - The Boston Globe
By John Donnelly
The World Health Organization announced yesterday that it will create
a new model to buy antiretroviral AIDS drugs in hopes of dramatically
speeding distribution and reducing the cost of the life-saving medi-
cation.
The plan comes from a collaboration among tuberculosis experts, fore-
most among them the new WHO director general, Jong-wook Lee. That
program, called the TB Drug Facility, purchases drugs in bulk on be-
half of countries and then oversees the distribution.
Global health specialists have applauded the program because it cre-
ated a larger market for TB drugs and spurred competition. That in
turn drove down the cost of TB drugs, 30 percent for front-line, or
commonly used, medication and 95 percent for secondary drugs.
The program, which has reached nearly 2 million TB patients the past
two years, also has provided an additional benefit: The WHO works
with local partners to ensure that the drugs are being distributed
properly, providing a safeguard against improper use, which can lead
to drug resistance.
At a cost of less than $20 million, the program has delivered drugs
to 33 countries and decreased the price of the main TB drugs to as
low as $11 for a six-month daily regimen of medicine.
"The main issue is getting drugs to patients, and we've got to make
it more rapidly available," said Ian Smith, one of Lee's top advis-
ers.
Lee has embraced a goal of treating 3 million people with antiretro-
viral medicines by the year 2005. Now, about 300,000 people in the
developing world receive those drugs.
The WHO has pledged to draw up a plan by Dec. 1 to meet its goal. The
plan, which the WHO hopes will begin in three to four months, also
will cover anti-malarial medication. Others in the health field, in-
cluding those working in family planning, are also examining the
model and may adopt it, WHO officials said. "The primary goal in this
is to dramatically increase access," Smith said. "We also want to re-
duce the price, but that is a byproduct of the program and not the
primary aim."
The price of generic antiretroviral drugs tumbled sharply last year
to roughly $1 a day for people with AIDS in the developing world. The
cost in the United States is about $10,000 a year. AIDS activists
hope the price falls even further, and some believe the TB model
holds great promise.
"The principles of the program were very successful and we think
could be applied" for AIDS drugs, said Paul S. Zeitz, executive di-
rector of the Global AIDS Alliance, an advocacy organization. "It
could be fantastic." Zeitz cautioned that developing countries still
should explore options under consideration for pooling resources re-
gionally, until a new WHO program proves successful. But he said, "If
you can bring on other producers, and create competition among gener-
ics, you'll have Thai producers, Brazilian producers, Chinese generic
producers, all competing with the Indian producers, and as you create
more and more demand for the drugs, we believe it will continue to
drive the price down."
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