E-drug: World bank funding of HIV/AIDS Rx (cont)
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Hi all
In partial reply to Niels Rosenquist's interesting questions (from a
personal angle, viewed from a developing country):
1) Does the World Bank have the cash to fund treatment of those
afflicted with HIV in the developing world?
That the Bretton Woods institutions can command considerable
resources is not, I think, the issue. More important is the
mechanism by which that 'aid' is provided to countries in the
greatest need. If it increases the already onerous indebtedness of
developing countries, then it may do more harm than good. Many
countries now spend more on debt servicing than on social
services. The other issue to consider is what strings are attached
to the package - in the past these have included requirements that
recipient countries adopt particular economic policies, and include
collection of user fees in their health care delivery systems. While
there is some evidence that this rigid linking of aid packages to
'structural adjustment programmes" is weakening, the jury is still
out on that one.
2)If it does:
a) would that money be best spent on treatment versus the other
programs they are running?
b) would their assistance be most useful in developing
infrastructure, procuring pharma, or a combination of both?
I'll try to respond to those questions together. The essence of the
debate is that it is often couched in "either/or" terms, rather than
(as Niels does in (b)) "and" terms. Drugs without the means to
deliver them are obviously useless. Equally, an effective
infrastructure for the delivery of health care, but without drug
stocks, is an oxymoron. Improving one places demands on the
other. The challenge in Africa and elsewhere is to develop the
infrastructure BY providing the drugs - using the economic
availability of suitable drugs to provide the impetus for systems
improvement. That may sound idealistic and impractical, but the
MTCT pilot project in Khayelitsha (part of Cape Town) has shown
otherwise. If the drugs are available, then screening tests need to
be made available, at the right times, in operating antenatal care
and maternity systems. The lessons of that pilot are now being
applied in further test sites across South Africa, and will hopefully
inform a roll-out in time. However, no matter how effectively the
infrastructure is improved, the economic realities of drug pricing
and budget constraints remain. It may sound trite, but what is
needed is a "developmental approach" - no "big bang", no "magic
bullet". But slow processes in complex systems rarely fit the
artificially imposed deadlines and neat "deliverables" of aid projects.
c) are their hands tied in countries that are threatening to violate TRIPS?
That's perhaps the most 'loaded' question - a lot depends on where
you're standing. TRIPS can be interpreted (as has been shown by
the WHO publication) to allow nations to use a full range of relief
measures - parallel importation, compulsory licensing. Many least
developed countries still have time in hand before they have to
comply with TRIPS (until 2006). What is needed is properly
implemented national law, backed by international agencies and
free of coercive pressure from countries whose narrow economic
interests might be at stake. For example, South Africa is no longer
on the US "Special 301" watch list of potential IPR violators. The
US Presidential order in fact prohibits federal agencies from
interfering in African nations' legitimate efforts to limit the negative
impacts of TRIPS on drug access. Once our national law is
satisfactorily amended, we will be able to use TRIPS-compliant
measures to improve access. That of course does not mean that
TRIPS itself should not be re-examined, to perhaps make more
explicit the relief measures that is does allow, or to make them
easier to invoke.
Returning to the issue of where one is standing - viewed from 'over
here', accusations of " threatening to violate TRIPS" too often seem
to be a smokescreen for something else. That "something else"
could, in a different era, have been captured by the term "un-
American activities" - actions that might just cost an American job,
be those Bolar provisions in Canada or challenges to the
macroeconomic status quo from developing nations.
regards
Andy
Andy Gray
Division Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
PBag X54001 Durban 4000
South Africa
Tel: +27-31-2044358
Fax: +27-31-2044792
email: agray@pixie.udw.ac.za
or: andy@healthlink.org.za
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