E-MED:(2)Appel � signature: lettre ouverte au coordinateur am�ricain
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[Mod�rateur: vous pouvez renvoyer la lettre pr�c�dente en fran�ais sign�e �
pdavis@healthgap.org Il s'agissait en fait d'une traduction de la lettre
ci-dessous qui a �t� publi�e sur Ip-Health. Vous trouverez apr�s la lettre
de MSF. Mes excuses pour avoir confondu les deux lettres.CB]
26 March 2004
Ambassador Randall Tobias
Global AIDS Coordinator
U.S. Department of State
Washington, D.C.
Dear Ambassador Randall Tobias,
We, the undersigned organizations, are writing to express our serious
concerns about efforts by the Bush administration and by your office
to block the use of affordable generic HIV/AIDS medicines in U.S.-financed
programs in poor countries. In order to mount a rapid and successful
response to the growing AIDS pandemic, we call upon you to ensure that
programs use the most affordable medicines available, and accept the
current drug quality standards of World Health Organization's drug
prequalification program.
We are particularly concerned about the U.S.-initiated "Conference on
Fixed-Dose Combination (FDC) Drug Products: Scientific and Technical
Issues related to Safety, Quality, and Effectiveness," 29-30 March 2004
in Gaborone, Botswana. This meeting needlessly casts doubt upon the
clinically proven quality of generic AIDS medicines, and disregards the
WHO's internationally recognized Drug Prequalification Program. The
meeting is intended to create a justification to use only expensive, less
effective branded drugs in international assistance programs, and will be
used by the US to justify its efforts to use bilateral assistance
programs to lock generics out of developing countries. Of particular
concern is your attempts to discredit the use of urgently needed fixed-
dose combinations (FDCs) of antiretroviral AIDS medications.
Single-pill combinations promote adherence, decrease the risk of
resistance, and facilitate stock and procurement management, and are
widely recognized as a core element in efforts to scale up ARV treatment
in developing countries. FDCs are strongly preferred over blister packs
and other multi-pill regimens. In addition to ease of use and other
advantages, FDCs, which are taken in the form of one pill twice a day,
are also by far the least expensive option: today, triple FDCs from
generic manufacturers are available for as little as $140 per person
per year. The same combination from brand-name companies costs a minimum
of $562 per person per year and must be taken in the form of six pills
a day. Forcing people with HIV/AIDS to accept higher pill burdens,
wasting limited taxpayer resources on brand name products, and, most
importantly, using scarce resources to treat one person when the
same amount of money could treat four is unacceptable.
If the ambitious goals of the President=B4s Emergency Plan for AIDS
Relief (PEPFAR), and the WHO's "3 by 5" initiative are to be met,
triple combination FDCs pre-qualified by WHO must be made widely
available.
FDCs are recommended in WHO treatment guidelines, and several generic
FDCs have been certified by WHO as meeting stringent international
standards for drug quality, safety and efficacy through its
Prequalification Project. The WHO's standards for prequalification
are supported by UNICEF, the World Bank, the Global Fund to Fight
AIDS. TB, and Malaria, Columbia University's MTCT-Plus program, many
national governments in developing countries, international
humanitarian organizations such as M=E9decins Sans Fronti=E8res (MSF),
and other programs with experience treating people living with HIV.
Clinicians in resource poor settings are already using triple combination
generics with tens of thousands of patients, with efficacy and adherence
rates equal-to-or-better than treatment success and adherence rates in
the United States.
Rather than disregarding the drug procurement policies of developing
nations to creating expensive new barriers that benefit US drug companies,
your office should accept the WHO's internationally recognized drug
quality standards and promote access to affordable medications.
We object to any and all efforts by the Bush Administration and your
office to block the use of WHO prequalified generic medications, and
any efforts to discredit the standards of WHO's prequalification
project that would impose new barriers to generics entering the
global market.
Paul Davis
Health GAP (Global Access Project)
e: pdavis@healthgap.org
t: +1 215.833.4102 (mobile)
f: +1 215.474.4793
w: www.healthgap.org
on d�j� sign�
Signed,
International Organizations
Act Up-Paris, France
Action for Southern Africa (ACTSA), UK
Agua Buena Human Rights Association, Costa Rica
AIDS ACCESS Foundation, Thailand
Australian People for Health, Education and Development Abroad
(international humanitarian agency of the Australian Council of Trade
AVERT - Averting HIV and AIDS Worldwide, UK
Canadian African Partnership on AIDS (CAP-AIDS), Canada
Canadian HIV/AIDS Legal Network, Canada
Canadian Union of Public Employees (CUPE), Canada
CARE Raks Thai Foundation, Thailand
Center for Information and Advisory Services in Health, Nicaragua
Centers of Excellence- Substance Abuse & HIV/AIDS, India
Centre for International Health (CIH) of the Macfarlane Burnet institute fo=
r
Medical Research and Public Health, Australia
Difaem - German Institute for Medical Mission. Germany
Discipline of Clinical Pharmacology, Faculty of Health, University of
Newcastle, Australia
Freedom Foundation-India
Health Issues Centre, Australia
Ipas Mexico A.C., Mexico
Kenya Treatment Access Movement, Kenya
McGill International Health Initiative, Canada
People Living With HIV/AIDS New South Wales, Australia
Regional Committee for the Promotion of Community Health, Nicaragua
RESULTS, Canada
Social Welfare Association for Men (SWAM), India
Spiritia Foundation (Indonesian Peer Support Network for PLHAs), Indonesia
Unions), Australia
Women's Dignity Project, Tanzania
International organizations, multi-country
International Planned Parenthood Federation, Western Hemisphere Region,
Int=B9l - USA/NY
AIDSETI - AIDS empowerment & Treatment International, Int=B9l =AD USA/DC
Sisters of Maryknoll AIDS Task Force, USA/DC
Artists for a New South Africa, Int=B9l/USA-CA
Health Alliance International, Int=B9l =AD USA/WA
Australasian Society for HIV Medicine, Int=B9l/Australia
The River Fund, Int=B9l =AD USA/FL
INTERSECT Worldwide, Int=B9l-USA
WE-ACT - Women's Equity in Access to Care & Treatment, Int=B9l =AD USA/CA
Interact Worldwide, Int=B9l =AD UK
International Peoples Health Council, Int=B9l
Nationwide US Organizations
50 Years Is Enough: U.S. Network for Global Economic Justice, USA
ActionAid International USA
Africa Action, USA
Africa Faith and Justice Network, USA
AIDS Treatment Data Network, USA
American Jewish World Service, USA
American Medical Students Association, USA
Center for Health and Gender Equity (CHANGE), USA
CHAMP, USA
Corporate Responsibility Program, Province of St. Joseph of the Capuchin
Order, WI, USA
Essential Action, USA
Global AIDS Alliance, USA
Health GAP (Global Access Project), USA
Health Professional Student AIDS Advocacy Network, USA
Maryknoll Office for Global Concerns, USA
Medical Mission Sisters' Alliance for Justice, USA
National Association for Victims of Transfusion-Acquired AIDS (NAVTA), USA
National Minority AIDS Council (NMAC), USA
Operation USA
Student Global AIDS Campagn, USA
Treatment Action Group, USA
Washington Office on Africa, USA
Women's International League for Peace and Freedom, United States Section
US Local and Regional Organizations:
ACT UP East Bay, CA
African Services Committee, NY
AIDS Action Baltimore, MD
AIDS Policy Project, PA
Gay Men's Health Crisis (GMHC), NY
HIV Law Project, Inc, NY
Migration & Refugee Services, Diocese of Trenton, NJ
NCATA (NW Coalition for AIDS Treatment in Africa), WA
Office for Religious Diocese of Scranton, PA
Pediatric HIV/AIDS program at The Children's Hospital of Philadelphia, PA
Philadelphia International Action Center, PA
Planet Poz, NM
New Mexico POZ Coalition, NM
RESULTS Seattle, WA
Sisters of St. Joseph of Carondelet, St. Louis Province, MO
Survive AIDS, CA