[afro-nets] Kevin de Cock's remarks at the Global Health Council

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Kevin de Cock's remarks at the Global Health Council
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(Informal summary) 19 April 2006

http://www.globalhealth.org/news/article/7337

Kevin De Cock, incoming director of WHO Department of HIV/AIDS,
sponsored by the Global Health Council, 19 April, 2006

Comments on 3x5

* 1.3 million people put on therapy by the end of 2005.

Target of 3 million was not met ­ but progress made.

* Less than 20% of those in sub-Saharan Africa who need therapy
are receiving it ­ but this is 8x the number who were are on
therapy in 2003;

* In resource-poor parts of the world, the increase was 3x5.

* Equity was generally achieved in the 3x5 initiative.

* Failures include:
1) children not reached as they should be;
2) IDUs not reached as they should be ­ particularly in Asia and
E. Europe;
3) have not made progress with pricing of 2nd line regimens that
remain out of reach of most of affected populations.

* Partnerships: the success that has been achieved is the result
of partnerships ­ including liaison with PEPFAR, World Bank and
TGFATM

* Is it useful to have targets? ­ useful ­ but they can detract
from broader targets and may lead to fatigue ­ can only do it so
many times.

* The real barrier is inadequate health systems ­ not big
pharma,not the price of drugs ­ but primarily lab infrastruc-
ture, systems of procurement/distribution, human resources.

* The next BIG policy issue is health systems ­ will not getany-
where without addressing health system issues.

* What 3x5 and PEPFAR sought/is to is the easy stuff ­ how to
keep people on therapy ­ toxicity, resistance ­ addressing other
issues faced by children is the tough part.

* Need to do better with prevention ­ treatment programs are
handicapped by inadequate prevention.

* Women have higher rates of infection than men - - - this was
not reflected in initial surveillance - - also data collection
has expanded to rural areas ­ again, urban areas have higher
prevalence than rural areas.

* The data we have for HIV is better than we have for most dis-
eases ­ certainly better than malaria and in some ways, better
than tuberculosis.

Scaling up to Universal Access

* WHO is not an implementing agency ­ it does provide technical
assistance and training ­ operational research ­ coordinating
role.

* Its strengths are three-fold: personnel around the world; mul-
tilateral legitimacy required to change the global landscape
quickly.

* The organization has its limitations ­ largely underfunded and
people and its organizational structure is not always the most
agile.

* WHO's role in promoting universal access: The G8 made a com-
mitment to work towards universal access by 2010 ­ sounds vague
­ but on the other hand, it is a very solemn statement made by
the richest countries in the world. WHO thinks it needs to be
focused to a limited number of things and do them well 5 major
strategic priorities that they would like to concentrate on:
1) increasing knowledge of sero status;
2) reinvigorating prevention;
3) continued care and treatment;
4) system strengthened;
5) guided by strategic information.

* Abstinence and condoms ­ refers to Ambassador Cokear / Ambas-
sador Tobias who have said: prevention is not a multiple choice
test question - - Cokear: ABC is fine as long as the order stays
as it should be. Sees the present argument on condoms as being
very sterile.

* Regarding need for treatment targets: De Cock says he knows
the advocacy community wants targets ­ there are many partners,
in addition to advocates, including the funders ­ the view of
WHO right now is that we support the concept of country-driven
targets ­ countries come up with realistic that can be put to-
gether into some cohesive answer. Will WHO support a quantita-
tive number? This decision will be made at high levels and in-
clude consultation ­ do not think that it will be helpful to
have a target that will not be met.

* Treat, train and retain initiative ­ health workers in the
most acutely affected countries themselves should have access to
services - - need to think of incentives to enable health care
workers to stay where they are rather than to migrate.

* On price of 2nd line drugs: What is WHO doing on IPR issues
(question posed by Global AIDS Alliance) ­ response: price is an
issue ­ it is a mistake to say that only if the price of drugs
came down, things would come down - - - amazing that there are
these simplified arguments ­ i.e. `if only we had more money' -
- - but no matter how much $$$, if we do not address health sys-
tems, won't make much of a difference - - - don't really know
much about IPR issues to presently comment.