Bookmarks - AIDS News and Newsletters

Greetings, and welcome to a new issue of Child Survival Technical Support’s (CSTS+) Bookmarks! This edition of Bookmarks! features an information source for PVOs/NGOs working with HIV/AIDS, and news on low-cost AIDS drugs.

*AIDS Information Resource

HealthNet News-AIDS, a service of SatelLife, is a newsletter published twice a month featuring literature summaries of articles, abstracts, full text articles, clinical guidelines, Web sites, and other relevant information. Health professionals who live and work in the developing world may subscribe to the newsletter free of charge. SATELLIFE has been granted permission by several medical publishers to use copyrighted journal information in this newsletter for distribution in the developing world only. For more information on the newsletter, contact Roye A. Bourke <rbourke@usa.healthnet.org> <http://www.healthnet.org>.

*Low-Cost Aids Drugs Offered Poor Nations

Offer By 5 Manufacturers Still Leaves Many Problems Unaddressed In African Epidemic
-By Merrill Goozner Washington Bureau
-From The Chicago Tribune, Internet Edition, May 12, 2000

WASHINGTON -- The United Nations campaign against the worldwide AIDS epidemic unveiled a compact with five of the world's leading drug manufacturers on Thursday to help poor countries purchase lower-cost medicines for keeping the disease in check.

The limited offer will not put the complex drug therapies used to delay the onset of AIDS within reach of the vast majority of the world's estimated 43 million HIV carriers, and it will not deal with inadequate health-care systems and the cultural blindness that keeps many less-developed countries from dealing with the crisis.

But the drug industry's offer to begin selling drugs to poor countries at prices well below those in the advanced industrial world should provide near-term help for thousands of middle-class AIDS sufferers living in the developing world, the program's designers said.

Further, it could become a building block for a more far-reaching program for tackling a crisis that threatens to devastate the African continent, where the majority of HIV carriers live.

"These drugs can only be useful [if they] move forward in parallel with a range of other issues, from building local infrastructure to destigmatizing the disease," said Daniel Tarantola, senior policy adviser to the director general of the World Health Organization. The WHO's 191-member General Assembly will discuss the worldwide AIDS crisis at its annual meeting, which begins Monday in Geneva.

The companies involved in the compact manufacture the dozen or so drugs developed during the past decade that when used in combination delay the onset of full-blown AIDS. One of the earliest anti-AIDS drugs also can be used as a prophylactic to prevent HIV-positive nursing mothers from passing on the virus to their newborn children.

Getting these medicines to the world's poorer nations has become a rallying cry for AIDS activists around the world. In recent months, they have disrupted drug firms' annual meetings and pressured the Clinton White House to force the industry to offer the drugs at more affordable prices.

An effective anti-AIDS cocktail of three patented drugs can cost more than $10,000 a year in the U.S. Yet the estimated 23 million carriers of HIV who live in sub-Saharan Africa live on an annual income of less than $1,000 a year.

Earlier this week, President Clinton issued an executive order suggesting the U.S. trade representative's office no longer will threaten trade sanctions against less-developed nations that use the World Trade Organization's intellectual property rules to gain access to cheaper drugs.

The WTO allows countries to manufacture generic versions of patented drugs if they are used to combat national health emergencies, and some countries like South Africa are contemplating going down that path.

"This order is intended to help stop the spread of this devastating disease by making HIV/AIDS-related drugs and medical technologies more accessible and affordable in sub-Saharan African countries," Trade Representative Charlene Barshefsky said. Clinton made a similar offer to South Africa during last fall's WTO meeting.

The Pharmaceutical Research and Manufacturers Association, which represents the drug industry in Washington, immediately attacked the executive order as an assault on the industry's ability to fund research and development.

Protection of intellectual property was a major concern for the individual companies as they negotiated their participation in the UN program. Among the principles announced Thursday was a promise by countries that accept the low-cost drugs to honor intellectual property rights.

The companies involved in the program are Bristol-Myers Squibb and Merck & Co. of the U.S., England's Glaxo Wellcome, Germany's Boehringer Ingelheim and Switzerland's Hoffman-La Roche.

While the U.S. firms shied from specifics on their discounts, a Glaxo Wellcome spokesman reached in London said the firm would offer its combination therapy, which includes zidovudine (AZT) and lamivudine (3TC), for about $2 a day instead of its current price of about $16 a day. AZT also can be used by nursing mothers to prevent passing the virus to their infants.

"The HIV epidemic in developing countries . . . threatens to wipe out development and economic gains made in the second half of the last century," Richard Sykes, chairman of Glaxo Wellcome, said in a prepared statement. "The private sector has a role to play in contributing to a multisector response to this epidemic."

The cheaper drugs offered by the five firms were included in a more far-reaching program outlined Thursday by the UN joint program on HIV/AIDS. At the upcoming WHO conference, the group will urge the governments of poor countries to develop HIV-prevention programs; strengthen health-care delivery systems for treating AIDS patients; and involve local health centers and not-for-profit groups, which are important health-care delivery agents in less-developed countries, in the prevention and treatment of AIDS.

The UN also asked poor countries to develop better distribution and monitoring systems to make sure drugs are delivered on a timely basis and taken in an appropriate manner. One of the great fears among AIDS physicians is that impoverished people will take their anti-AIDS drugs sporadically to save money, which eventually could breed a mutant HIV strain.

"We have to make sure they not only have the drugs, but have the tools to evaluate how well patients are doing," said Jose Zuniga, executive director of the International Association of Physicians in AIDS Care.

During the delicate negotiations leading to Thursday's offer, the drug industry offered to help finance educational programs for health-care personnel in developing countries. But they shied from offering direct financial aid for health care.

Less than 5 percent of Africa's HIV-positive population is aware they carry the virus. Comprehensive programs will require extensive testing, education and psychological counseling, which can be financed only with substantial new resources.

At the recent spring meeting, World Bank President James Wolfensohn pledged unlimited resources for poor nations that seek funding to fight the AIDS epidemic. But even that offer means little if local governments continue to ignore the crisis, as many in Africa have.

The industry's offer to lower prices for developing nations did not mollify AIDS activists.

They pointed out that even at the lower prices, the most potent three-drug combination therapy for an HIV carrier still will cost almost $2,000 a year, well beyond what most in the developing world can afford.

"With bulk production of these drugs, the cost can go down to as little as $250 a year," said Asia Russell, a leader in ACT-UP, a radical AIDS activist organization. "It is outrageous that these companies are talking about price cuts on drugs they paid almost nothing to develop."

Many of the earliest anti-AIDS medications were developed with U.S. government funding from the National Institutes of Health.

For instance, Glaxo Wellcome's AZT originally was synthesized by the Michigan Cancer Foundation under a National Cancer Institute grant.

For the two anti-AIDS drugs that Bristol-Myers Squibb offered to provide at lower prices--didanosine (ddI) and stavudine (d4T)--the key patents are held by NIH, the Michigan Cancer Foundation and Yale University, according to the Consumer Project on Technology, which is backed by Ralph Nader.

CSTS+ Bookmarks! is an electronic newsletter featuring news and stories related to Child Survival. For additional information on CSTS+ or for access to more articles of interest, check our website at: http://www.childsurvival.com.

Bookmarks! is a product of the CSTS+ Project, which is funded by USAID’s Office of Private and Voluntary Cooperation, Bureau of Humanitarian Response (BHR/PVC), and is managed by Macro International. The opinions expressed in this newsletter are those of the author(s) and do not necessarily reflect the views of USAID.