AFRO-NETS> Kaiser Daily HIV/AIDS Report - Thu, 7 Jun 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Thu, 7 Jun 2001
----------------------------------------------


* Legislation and Policy (part of the 20th anniversary retrospective)
* Hyde Proposes $1 Billion to Fight HIV/AIDS Globally
* Pfizer to Expand Fluconazole Donation Program to More than 50 De-
  veloping Nations
* Bill Gates' $2 Billion Donation to Gates Foundation Raises Specula-
  tion of Global AIDS Fund Contribution
* 'Unravelling Decades of Gains' in Child Welfare, Annan States


--
Legislation and Policy (part of the 20th anniversary retrospective)

International AIDS focus: The Clinton administration initially 
fought efforts by South Africa and Thailand to make cheaper, generic 
versions of patented HIV/AIDS drugs (Chicago Tribune/Baltimore Sun, 
4/30/99). In April 1999, the U.S. trade office cited South Africa on 
its Watch List, saying that the nation's Medicines and Related Sub-
stances Act, which permits parallel importing and compulsory licens-
ing of generics, could potentially "abrogate patent rights." Late in 
1999, however, the White House reversed this policy, saying the trade 
office would adopt a "don't ask, don't tell stance" and "look the 
other way" when South Africa began to manufacture or import generic 
AIDS drugs (Cooper/Zimmerman/McGinley, Wall Street Journal, 3/2). In 
April 2000, the Clinton administration, "convinced that the global 
spread of AIDS [was] reaching catastrophic diminsions," formally de-
clared the disease a national security threat and ordered the Na-
tional Security Council to "reasses[s] the government's efforts" to 
combat the disease overseas (Gellman, Washington Post, 4/30/00). In 
May 2000, Clinton issued an executive order that declared the United 
States would not "seek to interfere" with African countries that "may 
violate U.S. patent law in order to provide AIDS drugs at lower 
prices" (Lewis, New York Times, 5/11/00). And in August of that year, 
a week before "his final presidential trip to Africa," Clinton signed 
a bill that established a trust fund to care for Africans with AIDS 
and authorized U.S. contributions of $300 million over two years 
(AP/San Antonio Express-News, 8/19/00). 

The George W. Bush Years

Although President Bush is only a few months into his term, he has 
already taken some action on HIV/AIDS. Less than three weeks after 
Bush's inauguration, White House Chief of Staff Andrew Card told USA 
Today that the administration intended to close the Office of Na-
tional AIDS Policy, "anger[ing]" AIDS activists. But one day later, 
Card announced he "had erred" and that the office would remain open 
(VandeHei/Phillips, Wall Street Journal, 2/8/01). In April, Bush 
named Scott Evertz as ONAP director. Evertz, known as a person with a 
"knack for producing bipartisan consensus," is the "first openly gay 
man to be appointed by a Republican president" (Heredia, San Fran-
cisco Chronicle, 4/10). AIDS, particularly how the United States han-
dles the disease in foreign nations, also represents "one of the Bush 
administration's first tests of compassionate conservatism" National 
Journal reports. In his "first major move on the international AIDS 
issue," Bush reaffirmed a 2000 Clinton executive order that requires 
the U.S. trade representative to avoid taking action when sub-Saharan 
African countries manufacture or import generic versions of U.S-
patented anti-AIDS drugs. Bush's budget proposal also includes a 10% 
increase in funding for global AIDS programs that are coordinated by 
USAID and a 14% increase in international AIDS-related funds for the 
CDC and NIH. In addition, the administration has announced a $200 
million contribution to a new international AIDS fund, though this 
amount has been criticized as too small. Congressional members and 
activists thus far "have looked to [Secretary of State Colin] Powell 
to take the lead" on international AIDS policy, the National Journal 
reports. Powell has "endorsed" the view that AIDS in Africa is "an 
issue of national security for the United States." 

Looking Ahead

In Congress, Sen. Bill Frist (R-Tenn.) has proposed a bill expressing 
Congress' support for doubling U.S. contributions to international 
AIDS programs to $1 billion over the next two years. Rep. Juanita 
Miller-McDonald (D-Calif.) has proposed legislation that would au-
thorize $15 million over the next three years to AIDS efforts in sub-
Saharan Africa and India (Warner, National Journal, 5/12/01). And 
House Minority Leader Richard Gephardt (D-Mo.) and Rep. Nancy Pelosi 
(D-Calif.) on June 5 reintroduced the Early Treatment for HIV Act (HR 
2063), which would expand Medicaid coverage to low-income people with 
HIV before a diagnosis of AIDS (Gephardt/Pelosi statement, 6/5). How-
ever, with the administration "focusing its attention on the interna-
tional epidemic, domestic funding won't change," the San Francisco 
Chronicle reports. For example, Bush's proposed FY 2002 budget gives 
no funding increase to the Ryan White CARE Act, "to the chagrin of" 
many groups (Heredia, San Francisco Chronicle, 4/10/01).                


--
Hyde Proposes $1 Billion to Fight HIV/AIDS Globally

House International Relations Committee Chair Henry Hyde (R-Ill.) 
yesterday introduced a bill to authorize more than $1 billion to 
fight HIV/AIDS internationally and initiate a $50 million pilot pro-
gram for AIDS treatment, part of "a comprehensive strategy to combat 
the global pandemic," the Washington Times reports (Washington Times, 
6/7). Hyde proposed spending $519 million for prevention, education 
and treatment programs in sub-Saharan Africa and other developing 
countries. Although he said he faces "an uphill battle" to convince 
legislators to fund the program, Hyde stated that the world is on the 
verge of "a modern-day plague." The committee has a hearing today 
(USA Today, 6/7).


--
Pfizer to Expand Fluconazole Donation Program to More than 50 Devel-
oping Nations

Pfizer Inc. announced yesterday that it will expand the donation pro-
gram for the antifungal medication fluconazole, brokered earlier this 
year with South Africa, to include five other countries in the region 
-- Botswana, Lesotho, Malawi, Namibia and Swaziland -- and "in-
vit[ed]" the governments of the 50 countries considered by the United 
Nations to be "the world's poorest and most affected by AIDS" to also 
partake in the offer, the New York Times reports. Pfizer began pro-
viding the drug, marketed under the brand name Diflucan, free of 
charge to South Africa earlier this year to treat cryptococcal menin-
gitis, an inflammation of the membranes around the brain and spinal 
cord seen in about 10% of AIDS patients in that country, and esophag-
eal candidiasis, a fungal infection of the throat that affects be-
tween 20% to 40% of AIDS patients in South Africa. The initiative 
will also include "medical training and patient education," Pfizer 
CEO Dr. Henry McKinnell announced (Crossette, New York Times, 6/7). 
This "commitment to infrastructural support" was a "key element" to 
the deal, South African ambassador Sheila Sisulu told Newsday. 
"[U]nless there's a real partnership that recognizes that infrastruc-
ture is critical ... unless you actually have people who are able to 
administer and monitor the use of these medications and their effects 
on people, eventually you end up creating new, worse problems," she 
added. The expansion of the program to other parts of the region also 
is intended to prevent "mass immigrations of AIDS-sufferers" to South 
Africa for treatment with the drug, she said (Garrett, Newsday, 6/7). 
The donation program will be operated in conjunction with the United 
Nations and the World Health Organization, which will "identify" eli-
gible countries and "help negotiate distribution and monitoring 
agreements" for the drug. The organizations estimate that the latest 
offer will reach about 12 million AIDS patients (Warner, Philadelphia 
Inquirer, 6/7). The exact cost of the program is not known, but the 
South African program alone is estimated to cost $50 million over the 
next two years. "There is no time or dollar limit set on this pro-
gram. We are ready to begin providing Diflucan immediately," McKin-
nell said. 

Reaction

UNAIDS Director Peter Piot "welcomed" the announcement, saying it 
would have a "significant impact" in the fight against AIDS-related 
diseases. Joel Pressley, executive director of the New York AIDS Coa-
lition, said at a press conference, "Pfizer has made a step in the 
right direction, a major step. However, it and other pharmaceuticals 
along with policymakers near and far must make giant strides to find 
proactive and comprehensive solutions to stem and stop the tide of 
despair and misery" (New York Times, 6/7). Other activists were more 
"skeptical" of the deal. "It's a light you can switch on, and it's a 
light you can switch off when the spotlight is off you," Kate Krauss, 
a spokesperson for the Health GAP Coalition, said. Kris Torgeson of 
Doctors Without Borders said her organization is regarding the an-
nouncement with "careful happiness because we think it's good that 
people will have access. But we know that, in the past, these dona-
tion schemes have not worked out for providing drugs to people in 
need" (Philadelphia Inquirer, 6/7).

Donations Versus Price Cuts

Pfizer chose the donation program for the drug, which costs about $10 
a dose in the United States, instead of offering the price cuts many 
other pharmaceutical companies have recently announced for other 
medications. Diflucan was patented in 1982 and will remain patented 
in the United States and many other nations through 2004, but Pfizer 
recently has been "under pressure" from generic drug makers in Thai-
land, Bangladash and India, where manufacturers produce and sell ge-
neric versions of fluconazole. McKinnell "acknowledged" yesterday 
that Pfizer was "intent on keeping its market share" for the drug 
even after its patent expires. The donations are one way of 
"boost[ing]" the image of the company, critics say. Paul Zeitz, foun-
der of the Global AIDS Alliance, called the donation program "a 
strategy to block access to generically manufactured drugs" and 
called for the agreements to be "carefully ... scrutinized." He said, 
"We don't know the details of the written deal. What kind of influ-
ence are they buying with this? Are there unwritten ways that the 
pharmaceutical companies are influencing the governments? ... A free 
donor program effectively blocks the demand for generically manufac-
tured drugs" (New York Times, 6/7). "This is one approach we think is 
right for us. We don't claim this is a be-all and an end-all," Pfizer 
spokesperson Andrew McCormick said (Philadelphia Inquirer, 6/7). 
Pfizer also announced yesterday that it is "partially underwriting" 
the Academic Alliance for AIDS Care and Prevention in Africa and will 
finance the building of its headquarters in Kampala, Uganda (Newsday, 
6/7).


--
Bill Gates' $2 Billion Donation to Gates Foundation Raises Specula-
tion of Global AIDS Fund Contribution

Bill Gates has contributed an additional $2 billion to his charity, 
the Bill and Melinda Gates Foundation, to fund research and other 
initiatives aimed at halting the spread of HIV/AIDS and other dis-
eases in the developing world. The Wall Street Journal reports that 
the donation has "increased speculation about the role the foundation 
may play at the United Nations' General Assembly special session on 
HIV/AIDS, since both Gates and his wife support U.N. Secretary-
General Kofi Annan's proposal of a global fund to fight HIV/AIDS, TB 
and malaria. A Gates Foundation spokesperson, however, said that the 
contribution is "unrelated to the activity at the United Nations" and 
added that "no decisions had been made about how to best support Mr. 
Annan's efforts." Gordon Perkin, director of the foundation's global 
health program, said the foundation is "unlikely to make a direct do-
nation to the fund, but is discussing several new initiatives that 
might complement the U.N. effort." Such efforts include providing 
funding for increased microbicide research and a plan to offer debt 
relief to developing nations to "enable them to increase their anti-
AIDS funding." Gates met with Annan in March to "urge" him to "create 
a central framework through which governments could increase their 
funding for AIDS prevention and treatment." The Gates Foundation, 
which has an endowment of $23 billion, has already committed about 
$300 million toward AIDS prevention efforts, including more than $125 
million for the International AIDS Vaccine Initiative (Bank, Wall 
Street Journal, 6/7).


--
'Unravelling Decades of Gains' in Child Welfare, Annan States

In a new UNICEF report released in advance of a special U.N. General 
Assembly on children scheduled for September, U.N. Secretary-General 
Kofi Annan states that HIV/AIDS has proven "catastrophic" for the 
world's children and is "unravelling decades of gains" in child wel-
fare, the Guardian reports. At the 1990 World Summit for Children, 71 
heads of state pledged a "firm commitment" to put the interests of 
children first, but that goal has been "elusive," according to the 
report. The AIDS epidemic has "gradually shift[ed]" to affect the 
"young, poor and illiterate," especially young girls, the report 
warns. Ninety-five percent of AIDS orphans, a a group specifically 
addressed in the report, live in Africa, where incomes have continued 
to drop, the level of immunizations has decreased, the number of mal-
nourished children has increased and "major child-killers" such as 
malaria and cholera have reemerged. "Faced with social stigma, isola-
tion and discrimination, and deprived of basic care and financial re-
sources, AIDS orphans are less likely to be immunized, more likely to 
be malnourished, less likely to go to school and more vulnerable to 
abuse and exploitation," the report states. A "first call" for the 
children of Africa will be at the "[t]op of the agenda" at the Sep-
tember meeting, which will include heads of state from France, Can-
ada, Mexico, Algeria and Mozambique (Britain, Guardian, 6/6).

--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.

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