AFRO-NETS> New York Times: How to distribute AIDS drugs

[Claudio Schuftan <aviva@netnam.vn>]

New York Times: How to distribute AIDS drugs
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By Carol Bellamy
March 26, 2001

In the last few weeks, a ray of hope has appeared in the global fight 
against AIDS. Pharmaceutical manufacturers have finally begun slash-
ing prices for anti-retroviral drugs for sub-Saharan Africa and other 
AIDS-ravaged regions where a bottle of aspirin is beyond the means of 
most victims. 

As making vital drugs available begins to look possible, attention is 
turning to the question of how to deliver them to the infected people 
who need them. This is no simple proposition, but it is feasible. 

Twenty-five years ago, the United Nations Children's Fund and its 
partners created a model that could be used in the AIDS fight when we 
found a way to immunize millions of desperately vulnerable children 
against preventable diseases in the developing world. Now Unicef is 
prepared to step forward as the lead United Nations agency in the 
procurement of anti-retroviral drugs on behalf of individual coun-
tries. 

Unicef's global supply center in Copenhagen already works with many 
pharmaceutical companies in the purchase of vaccines and essential 
drugs. And together with Unaids, which coordinates United Nations 
work on AIDS, we have started to identify and publish sources and 
prices of the drugs needed to fight H.I.V., the virus that causes 
AIDS. 

Treating H.I.V. infection is of course far more costly and complex 
than vaccinating children. But the immunization campaign that began 
in the early 1980's succeeded because we were able to develop effec-
tive strategies for funding, procurement and distribution of vaccines 
- and these same approaches can help the world fight AIDS. 

A quarter-century ago, the notion of immunizing millions of children 
was regarded as folly. Apart from the cost, the infrastructure in 
most developing countries was considered too fragile to support a 
sustained campaign. Local governments and wealthy nations were 
thought to lack commitment. And the coordination of efforts by gov-
ernments, the private sector, the United Nations and other entities 
that would be involved was seen as too complex. This perception was 
wrong. Today global immunization is arguably the most successful pub-
lic health initiative ever, saving around three million children's 
lives each year. 

Of the estimated 25 million Africans who are H.I.V.-positive, the 
World Health Organization says five million need treatment urgently. 
Moreover, the pandemic disproportionately affects the most vulnerable 
part of the population, the young. Adolescents are the group with the 
highest infection rate. Around 600,000 infants are expected to be in-
fected with H.I.V. through mother-to-child transmission this year. 
And the number of children orphaned by AIDS, currently more than 13 
million, will continue to rise. 

Even if the cost of treatment for H.I.V. can be reduced to $350 a pa-
tient annually, the lowest of the current estimates, most countries 
won't be able to afford the drugs. Donors must step in with subsi-
dies. The Global Fund for Children's Vaccines, launched in 1999 to 
purchase vaccines for low-income countries, provides an excellent ex-
ample of how this might work. 

An international fund could be established and financed by govern-
ments, private givers and the United Nations. It would then purchase 
the drugs from pharmaceutical companies on behalf of the countries 
that need them. 

The next step would be distribution. For immunization, Unicef and the 
W.H.O. helped establish a vaccine delivery system in each country in 
need of help. Through our extensive field network, we could assist 
now in the development of AIDS drug distribution strategies tailored 
to each country's strengths and weaknesses. We could also bolster 
grass- roots and community activists, especially those living with 
H.I.V., who can educate people on testing and treatment and help run 
health services. Such local activism is the hallmark of successful 
immunization programs. 

Of course, other factors must come into play to make treatment work, 
such as considerably more support for basic health services, effec-
tive monitoring and, most crucially, political commitment from the 
affected countries. But the task, while daunting, is not out of 
reach. We're crossing the first hurdle - reducing prices. Unicef's 
immunization programs offer models for funding, procurement and dis-
tribution. Now it's time for action. 

Carol Bellamy is executive director of the United Nations Children's 
Fund. 

--
Claudio Schuftan
mailto:aviva@netnam.vn

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