AFRO-NETS> Kaiser Daily HIV/AIDS Report - Tue, 24 Apr 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Tue, 24 Apr 2001
-----------------------------------------------

* Following Court Victory, AIDS Activists Shift Focus on South Afri-
  can Government AIDS Drug Policies

* AIDS Crisis Has Spurred Public Relations Challenges for Pharmaceu-
  tical Industry, Wall Street Journal Reports

* After South Africa Court Case, 'Unified Strategy' on HIV/AIDS May
  Be Difficult to Find

* Nigeria Hosts Infections Disease Conference This Week, Launches
  AIDS Action Plan

* Homegrown 'cures' Undermine AIDS Efforts

* Kenyan Ministry of Health Introduces Drug Importation Bill


--
Following Court Victory, AIDS Activists Shift Focus on South African 
Government AIDS Drug Policies

Following the pharmaceutical industry's decision last week to drop 
its lawsuit against the South African government, AIDS advocates con-
cluded that the "next big barrier" to expanding access to AIDS treat-
ments "might well be the government itself," the New York Times re-
ports. The Pharmaceutical Manufacturers Association of South Africa 
and 39 pharmaceutical companies last week agreed to drop their law-
suit against the South African government over a law that would allow 
the country to import and manufacture cheaper generic AIDS drugs. 
Following the victory, AIDS advocates had hoped to "hear a sense of 
urgency" from government officials about providing treatments. In-
stead, South Africa's Health Minister Manto Tshabalala-Msimang "made 
it clear that providing AIDS drugs was not a government priority." 
She said, "For the moment, the best advice is to treat opportunistic 
infections. ... We are indeed treating people who are HIV-positive. 
It is not correct to say that just because we do not provide antiret-
rovirals that we are not treating people." Following the health min-
ister's lead, the ruling African National Congress in its online 
newspaper listed "countless reasons why the country should think 
twice about providing lifesaving AIDS cocktails," the Times reports. 
Such comments have "revived concerns" about the South African govern-
ment's commitment to providing treatment for its 4.7 million HIV-
positive residents, the Times reports. In response, AIDS activists 
have decided to "turn up the heat" in their efforts to persuade offi-
cials to provide treatments that are "readily available in the West" 
(Swarns, New York Times, 4/21). Thanduxolo Doro of the National Asso-
ciation of People Living with HIV/AIDS said, "We need not only gov-
ernment, but also the private sector including pharmaceuticals, tra-
ditional healers and faith-based organizations, to combine resources 
for treatment." The Treatment Action Campaign is calling on the gov-
ernment and private companies to expand access to treatment and urg-
ing the government to provide Nevirapine to reduce vertical transmis-
sion of HIV. TAC Chair Zackie Achmat said, "In the short term, we 
want the government to have a treatment strategy and a plan. We also 
want the private sector to announce they will put their employees on 
antiretroviral treatment and assist in bringing the prices down." He 
added, "We hope to have a treatment plan in place by Dec. 1 and to 
roll out antiretrovirals in the public sector by New Year." The Con-
gress of South African Trade Unions, representing 1.7 million mem-
bers, said it plans to "appeal to major employers to supply antiret-
roviral drugs to employees and their families" (Keeton, Agence Free-
Presse/Washington Times, 4/21).

Settlement Will Not Harm Drug Makers

Although the pharmaceutical industry agreed to drop its suit against 
South Africa, some experts say the decision will not "cost the drug 
companies anything of substance." Amir Attaran, director of interna-
tional health research at Harvard University's Center for Interna-
tional Development, said, "It is largely symbolic." Still, the Times 
reports that the settlement is "expected to embolden other developing 
nations" because the industry is "not likely" to challenge another 
developing country's efforts to manufacture cheaper AIDS treatments. 
Ron Bayer, a public health expert and professor at Columbia Univer-
sity, said that drug makers "lost by pursuing this case, not ending 
it. It was a strategic blunder. Agreeing to pay South Africa's court 
costs is an amazing kind of defeat," but only on the public relations 
front (Gellene, Los Angeles Times, 4/21).


--
AIDS Crisis Has Spurred Public Relations Challenges for Pharmaceuti-
cal Industry, Wall Street Journal Reports

The international pharmaceutical industry is "reeling from an un-
precedented wave of public scorn," with the recent lawsuit against 
the South African government representing "only the latest in a 
string of business and public relations setbacks," the Wall Street 
Journal reports in a front-page story. "Worst of all," the African 
AIDS epidemic has exposed how large a profit companies make on their 
drugs, "a secret the industry has steadfastly guarded for decades." 
The Journal states that by lowering the price of AIDS drugs in Afri-
can countries to a point that they say yields "no profit," the compa-
nies "have revealed that some medicines are priced -- excluding re-
search expenses -- at eight to 10 times their cost of manufacturing 
and distribution." Tim Fuller, executive director of the Gray Pan-
thers, a seniors advocacy group, said, "All you have to do is look at 
how much they're selling drugs for in other countries to see how high 
they're jacking up prices in the U.S." For example, Merck is selling 
its protease inhibitor drug Crixivan in poor nations at $600 per year 
per patient, compared to $6,016 in the United States. Similarly, 
GlaxoSmithKline is selling its AIDS drug Combivir in Africa for $730, 
compared to $6,289 in the United States. The Journal reports that 
some companies prefer to donate their drugs at no cost rather than 
lower costs and potentially expose their profit margin. For example, 
Pfizer Inc. in December offered to donate its antifungal drug Diflu-
can to AIDS patients in South Africa. Mark Heywood, head of South Af-
rica's Treatment Action Campaign, said, "If the company had lowered 
its price to what generic makers charged, it would have shown the 
world what its profits were. People elsewhere might have started won-
dering why it has to charge so much." But in their defense, drug com-
panies warn that by meeting demands for lower prices and reduced pat-
ent protection for AIDS drugs, the same demands may develop for other 
disease treatments. GSK CEO Jean-Pierre Garnier said, "Isn't it 
ironic that the companies that brought the drugs to market are the 
ones being criticized for people dying?" (Harris, Wall Street Jour-
nal, 4/23).


--
After South Africa Court Case, 'Unified Strategy' on HIV/AIDS May Be 
Difficult to Find

Now that 39 pharmaceutical companies have settled their lawsuit 
against a South African law that would permit the importation and 
production of generic AIDS medications, the focus of the interna-
tional health community is shifting to the development of a "unified 
strategy" to deliver the drugs to those in need in developing na-
tions, the Washington Post reports. But developing an international 
anti-AIDS initiative may be an "even tougher challenge" than the 
"battle" activists and health experts have fought for lower drug 
prices. Advocates and health workers cannot agree on whether to con-
centrate money and resources on "sophisticated treatment" of AIDS pa-
tients using the discounted drugs or on prevention, basic health pro-
grams and treatment of AIDS-related diseases, and funding for any 
such program is uncertain. According to an unnamed international 
health official, "it's so politically incorrect to say, but we may 
have to sit by and just see these millions of [already infected] peo-
ple die." Though this idea is "unacceptable" to many in the developed 
world, the official continued, "If all of these resources go to 
treating the terminally ill, then we can in fact see this process 
turn into one that's really negative for the development of effective 
prevention programs." Bill Gates, who has contributed more to the in-
ternational effort against AIDS than any single donor, also warned 
that the emphasis on treatment "risked undermining prevention ef-
forts." Critics of a strategy that relies on antiretroviral therapy 
point out that Africa has "neither the health infrastructure nor the 
personnel to support widespread use of the complicated [drug] re-
gime." 

Who Will Foot the Bill?

Creating a comprehensive strategy has taken on a "new urgency" as 
several major donors have recently "indicated willingness" to provide 
"substantial new funding" for a global initiative. UNAIDS has esti-
mated that an annual minimum of $3 billion is needed to "establish 
basic HIV prevention and non-antiretroviral treatment in sub-Saharan 
Africa." Adding antiretroviral therapy for those already infected 
would push the total to $10 billion a year. Currently, international 
contributions come to less than $1 billion. The United States, the 
largest national donor, currently spends $114 million on interna-
tional HIV/AIDS efforts. The Senate voted to increase that amount to 
$1 billion in the budget it recently passed, but that version has yet 
to come before President Bush, who proposed a "small fraction" of 
that total in his budget plan. Japan and the European Union have also 
recently indicated that they will provide "major new funds" to a 
global AIDS initiative. But according to the Post, "nobody believes 
that $10 billion is a realistic expectation for the near or middle 
term." 

Colliding Strategies

Today in London, members of UNAIDS are expected to present a "broad" 
plan for the establishment of an international trust fund to be ad-
ministered by a "joint governing committee" of donors and aid recipi-
ents. Representatives from each of the Group of 8 nations, the Neth-
erlands and Scandinavian countries, and private donors such as the 
Gates Foundation are participating in the meeting. U.N. efforts, how-
ever, were recently "thrown into an uproar" when UNICEF Executive Di-
rector Carol Bellamy wrote in a New York Times op-ed that her agency 
was "prepared to step forward as the lead United Nations agency in 
the procurement" of anti-AIDS drugs. That op-ed, which was not ap-
proved by U.N. Secretary General Kofi Annan, "upset" other agencies 
within the U.N., as well as World Health Organization Director Gen-
eral Gro Harlem Brundtland, who saw the op-ed as a "premature policy 
proposal" and a "public challenge to WHO's primacy on AIDS," the Post 
reports. A group of Harvard scholars, led by economist Jeffrey Sachs 
has also drawn up a proposal for a global AIDS trust fund. That pro-
posal was criticized by activists for including the major drug compa-
nies at the exclusion of generic drugmakers, who many see as respon-
sible for helping to drive drug prices down. 

An African Solution

The "big decisions" in AIDS policy may no longer lie with interna-
tional health organizations or the drug companies, said James Love of 
the Consumer Project on Technology. Instead, Love said African na-
tions must "have the guts" to take the next step in battling HIV/AIDS 
by drafting legislation to produce and import generic drugs. African 
governments "seem caught between their desire" to procure part of the 
proposed new funding and "early resentment of the expected onslaught 
of advice and dictates" from western officials. "We'll do what we 
can, not because of pressure, but because we think it's right," South 
Africa's Foreign Minister Nkosazana Dlamini-Zuma said last week at 
the settlement of the drug lawsuit (DeYoung, Washington Post, 4/23).


--
Nigeria Hosts Infections Disease Conference This Week, Launches AIDS 
Action Plan

Nigeria is hosting a "major" conference this week, targeting Africa's 
three "biggest killers" -- HIV/AIDS, malaria and tuberculosis, the 
Agence France-Presse reports. The four-day conference, scheduled to 
begin Tuesday, is sponsored by the World Health Organization and the 
Organization of African Unity, and attendees will include former 
President Bill Clinton and U.N. Secretary-General Kofi Annan 
(Cunliffe-Jones, Agence France-Presse, 4/22). At the close of the 
conference, the government plans to launch an "emergency action plan" 
against AIDS. Nigerian Health Minister Alphonsus Nwosu said, "Since 
AIDS has constituted itself to an extraordinary emergency problem, 
Nigeria has decided to launch an extraordinary emergency response to 
combat it" (Agence France-Presse, 4/22). But some health workers and 
administration officials are skeptical of whether the conference will 
yield action, based on the current state of the country's public 
health infrastructure. One Nigerian health worker said, "To put it 
plainly, we have had a lot of conferences and what they produce most 
is hot air and not much else. Where's the impact?" The country cur-
rently spends less than $3 per person per year on public health, and 
70% of the health care budget goes towards Nigeria's "giant" teaching 
hospitals, "leaving little for basics such as primary health care for 
the population, mostly living in places remote from the main cen-
ters," according to health workers. Another health official noted, 
"There are a number of big public hospitals but the staff there are 
generally badly trained and often go on strike. Primary care barely 
exists. Many people cannot afford to go to doctors, and drug sellers 
do not know the right prescriptions or dosages to hand out. Public 
health education is a joke" (Agence France-Presse, 4/22).


--
Homegrown 'cures' Undermine AIDS Efforts

Nigeria's efforts to stem the AIDS epidemic are "being undermined by 
the growing number of homegrown 'cures,'" Reuters reports. The north-
ern Kano state assembly recently passed an bill endorsing a group 
"claiming a spiritual cure" for AIDS, which involves "smearing honey 
and petroleum jelly on sufferers and reading versus of the Koran." 
Reuters reports that more than 60 groups in Nigeria have announced 
"purported cures" for AIDS, and the government has allocated about 
$1.7 million to test these claims. WHO's African Regional Director 
Dr. Ebrahim Samba said at a news conference yesterday, "This is very 
dangerous. There are no cures. But this isn't only a problem in Nige-
ria, there are claims all over Africa" (Doran, Agence France-Presse, 
4/22).


--
Kenyan Ministry of Health Introduces Drug Importation Bill

Kenya's Ministry of Health has introduced a bill that would legalize 
the importation of cheaper generic AIDS drugs, BBC News reports. Ken-
yan Public Health Minister Sam Ongeri said the government "would not 
helplessly watch as Kenyans continue to die from the disease while 
drugs protected by unrealistic patent laws remain unaffordable." Like 
South Africa's 1997 Medicines and Related Substances Control Act, the 
Kenyan law would adhere to the patent protection provisions of the 
World Trade Organization (BBC News, 4/22).

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