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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: AIDS Drugs Update
Africa: AIDS Drugs Update
Date distributed (ymd): 010105
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +health+
Summary Contents:
This posting contains (1) links to the most recent series in the
Washington Post (December 27, 28 and 29) on AIDS, Drugs and Africa,
and (2) December press releases from the Global Treatment Access
Campaign and Medecins sans Frontieres on the same topic. These
sources document that the publicized pharmaceutical industry
promises to reduce the cost of such drugs, welcomed by
international agencies, have had little effect in making treatment
accessible. The Post articles also detail much of the behind-thescenes
maneuvering between the drug companies and the international
agencies.
There is still an enormous gap between the current position of the
pharmaceutical companies and the emerging consensus on what steps
are necessary, as expressed not only by activists but also by
gatherings such as the African Development Forum 2000 in Addis
Ababa in December, which included the following statement in its
final declaration:
'A substantial reduction in the prices of anti-retroviral drugs and
treatments for opportunistic infections is required. African
governments, donors and international financial institutions must
work in partnership to reduce the prices of drugs to a level
commensurate with their production costs.'
For a statement on this and other AIDS-related issues, see
APIC/Africa Fund director Salih Booker's remarks to a panel on
'Combating HIV/AIDS in Africa' at the November African Studies
Association meeting:
http://www.africapolicy.org/desk/asa0011.htm]
+++++++++++++++++end profile++++++++++++++++++++++++++++++
Death Watch: AIDS, Drugs and Africa (seven-part series)
http://www.washingtonpost.com/wp-dyn/world/issues/aidsinafrica
Most recent articles in series:
An Unequal Calculus of Life and Death: As Millions Perished in
Pandemic, Firms Debated Access to Drugs - Dec. 27, 2000
http://www.washingtonpost.com/wp-dyn/world/issues/aidsinafrica/A51719-2000Dec26.html
A Turning Point that Left Millions Behind: Drug Discounts Benefit
Few While Protecting Pharmaceutical Companies' Profits - Dec. 28,
2000
http://www.washingtonpost.com/wp-dyn/world/issues/aidsinafrica/A56492-2000Dec27.html
The Death Curve: Annual AIDS Deaths since 1982 - graph comparing
deaths in USA and sub-Saharan Africa
http://www.washingtonpost.com/wp-dyn/articles/A55171-2000Dec27.html
The Limits of $100 Million: Epidemic's Complexities Curb Impact
of Bristol-Myers' Initiative - Dec. 29, 2000
http://washingtonpost.com/wp-dyn/world/issues/aidsinafrica/A60114-2000Dec28.html
http://www.globaltreatmentaccess.org/
Health GAP Coalition position paper presented at UNAIDS meeting
in Rio de Janeiro
13 December 2000
QUESTIONING THE UNAIDS/PHARMACEUTICAL INDUSTRY INITIATIVE
SEVEN MONTHS AND COUNTING. . .
[see also
http://www.globaltreatmentaccess.org/content/camp/dec1/reportcard.html
for comments on particular companies]
In May 2000 UNAIDS announced a HIV drug price reduction
initiative in partnership with major multinational drug
companies. The announcement, regarded with much fanfare by the
American media, promised "slashed drug prices" and followed
mounting international criticism of the global pricing strategies
of the pharmaceutical industry.
AIDS activist, humanitarian, and public health organizations
reacted to the announcement with deep skepticism and many
unanswered questions . Seven months after the announcement, the
initiative as executed by UNAIDS and the pharmaceutical industry
has not made substantial progress in achieving the goal of broad,
sustainable access to HIV medication in developing countries.
Instead, many of the same deadly flaws of the UNAIDS pilot
project on antiretroviral drug access will be repeated.
Only Senegal has concluded negotiations with participating drug
companies; Senegal's deal, seven months in coming, will only
provide anti-HIV medication to an estimated one per cent of its
infected population once implemented .
In contrast, since the UNAIDS announcement in May, Brazil has
confirmed the success of its national provision of combination
antiretroviral therapy: broad access to affordable generic
antiretroviral medication has resulted in a drop in AIDS related
mortality by at least 50 per cent, a $442 million savings in
hospitalization fees.
Health GAP Coalition is opposed to the following aspects of the
UNAIDS/pharmaceutical industry initiative:
1. The UNAIDS/Industry initiative is designed to meet the needs
of the pharmaceutical industry, not people with AIDS.
The pharmaceutical industry is explicitly driven to protect its
intellectual property, and to protect and increase its profits.
In the midst of a devastating global health crisis, these
interests must not be allowed to power efforts by UNAIDS to
increase affordable drug access.
However the initiative as currently structured is based in
cumbersome, non-transparent and unbalanced negotiations between
developing countries and extraordinarily wealthy pharmaceutical
companies on a country-by-county basis. Drug companies cannot be
expected to negotiate in good faith with poor countries. UNAIDS
refuses to provide poor countries with the leverage they need in
order to obtain the deepest possible price reductions, in the
most expedited fashion. UNAIDS must insist that participating
drug companies comply with uniform price reductions from the
outset, for all drugs and for all poor countries that wish to
participate in the initiative.
2. Generic HIV drug manufacturers must not be shut out of the
initiative.
UNAIDS must publicly endorse the importance of partnerships with
generic manufacturers, as it has readily endorsed the involvement
of the multinational drug companies. Big Pharma is not pleased by
the price reductions created by competition from generic
producers around the world. UNAIDS drug access policies are
currently being structured, by and large, in response to Big
Pharma's displeasure. Health GAP is outraged by reports that
generic manufacturers are being kept from negotiating drug price
reductions as part of the UNAIDS initiative.
3. Without reform from UNAIDS, the gravest defects of the UNAIDS
pilot project on antiretroviral drug access will be repeated.
- In Uganda, antiretroviral drugs obtained from the UNAIDS pilot
project at "discount" were actually more expensive in some cases
than drugs obtained from local pharmacies - because UNAIDS did
not do its job and require drug companies to adhere to their
"promised" price reductions. People with AIDS could not afford
their treatment, and drug company lies resulted in interrupted
care, bankrupt households, the development of drug-resistant
virus, and untimely death. Dr. Peter Muygenyi of the Joint
Clinical Research Center in Kamapla, Uganda pronounced the pilot
project "a miserable failure" and called the new initiative "more
political than practical; it was done for the media."
- In Cote d'Ivoire, the director of AfriCASO, Moustapha Gueye,
reports that "a breakdown in the supply of antiretrovirals for
HIV infected people who took part in the drug access initiative
supported by UNAIDS" has resulted in a four month drug shortage
and the recent deaths of about ninety people with HIV.
HIV-positive Ivoirians are participating in a hunger strike in
protest. Gueye places blame for the interruption on both the
Ivoirian government and poor planning of the initiative . Drug
companies have already proven they do not respond when
life-extending medication access is interrupted. If UNAIDS cannot
correct this debacle in Cote d'Ivoire, how can they assure
sustained access to affordable therapy for all countries
participating in the initiative?
4. The same drug companies promising increased access through the
UNAIDS initiative are preventing life-extending medications from
reaching people with AIDS in the developing world.
In Ghana, importation of generic, low cost AZT/3TC from India's
Cipla, Inc. has been squelched by Glaxo Wellcome�s bogus claim of
"patent infringement." Recent reports indicate Glaxo Wellcome's
patent claims to AZT/3TC in Ghana are nonexistent; but their
actions against Cipla and the Ghanaian drug distributor have
halted drug distribution and are resulting in needless death.
Meanwhile, Glaxo Wellcome continues hypocritical negotiations to
provide brand-name Combivir at reduced cost to countries
participating in the UNAIDS initiative. UNAIDS must insist that
Glaxo Wellcome, as a partner in the access initiative,
immediately abandon its lawsuit against Cipla, Inc. and assure
the Healthcare, Inc, the Ghanaian distributor, that it can
distribute generic AZT/3TC without retaliation.
5. UNAIDS is not advising countries entering industry
negotiations against adopting overly restrictive domestic patent
laws.
UNAIDS must state that the public health interests of developing
countries are not served by adopting laws above and beyond that
which is dictated by relevant international agreements. UNAIDS
must proactively support countries in efforts to obtain model,
"best practice" domestic intellectual property legislation, and
must proactively advise and support countries in enacting access
strategies such as manufacture and importation of generics, and
compulsory licensing.
6. UNAIDS must act on the criticisms of people with AIDS in the
Third World who have spoken out in disappointment against the
UNAIDS initiative and who are being shut out of negotiations.
Inexcusably, the current non-transparent structure of the UNAIDS
initiative excludes people with AIDS while favoring the
pharmaceutical industry.
- Waldholdz, M. "Makers of AIDS Drugs Agree to Slash Prices in
the Third World". Wall Street Journal 11 May 2000
- cf,
http://www.globaltreatmentaccess.org/content/press_releases/051100_AU_PR_UNAIDS_ARV_.html
- Harrington, M. "Brazil: What Went Right?" 10th National
Meeting of People Living with HIV and AIDS
http://www.aidsinfonyc.org/tag/activism/brazil.html
- Medecins sans Frontieres/Treatment Action Campaign Satellite
Conference on Improved Access to HIV/AIDS Drugs in Developing
Countries, 9 July 2000
- Gueye, M. "Disruption of ARV stock in Cote d'Ivoire" Posting
to Nigeria-AIDS list serv 18 October 2000
- Schoofs, M. "Glaxo Attempts to Block Access to Generic AIDS
Drugs in Ghana" Wall Street Journal 1 December 2000
- Kenya Coalition on Access to Essential Medicines "Kenya
Coalition Urges Government not to Trade Long-term Rights in Deal
with Drug Companies" 7 November 2000
http://www.accessmed-msf.org/msf/accessmed/accessmed.nsf/html/4DTSR2?OpenDocument
Medecins Sans Frontieres
December 1, 2000-Geneva-Press Release
Six-month report card: have AIDS drugs prices for the poor been
slashed?
December 1st 2000, World AIDS Day, Geneva
http://www.accessmed-msf.org/
The international medical aid agency Medecins Sans Frontieres
(MSF) calls on multinational drug companies to deliver on their
promise to drastically reduce AIDS drug prices. On May 11th 2000,
The Wall Street Journal reported that UNAIDS and five drug
companies (1) were offering "to slash the prices of HIV drugs for
people living in poor countries". According to the article, exact
prices were supposed to be settled upon in the weeks to come. More
than six months later, there is still little progress on the
promised discount (see Report Card below).
As a first step, MSF calls on the five multinational drug companies
to immediately reduce the price of their AIDS drugs in poor
countries by 95 per cent. In practice, this means that Glaxo
Wellcome should make its drug AZT/3TC available for US$1.00 a day
against its current $19.60, Bristol-Myers Squibb should charge
$0.49 a day for d4T against the present $9.80, and Merck $0.65 for
efavirenz, which now costs $13.20. Major discounts for poor
countries should be similar to those already in place for vaccines
and contraceptives. The polio vaccine, for example, is sold to UN
agencies for $0.09 while it costs $10.93 in the US (2).
"95 per cent of people living with HIV/AIDS dwell in poor countries
and cannot afford medicines that could prolong and improve the
quality of their lives. We challenge the drug companies to deliver
on their promises and publicly respond to this demand by the first
week of 2001", says Dr. Bernard Pecoul, director of MSF's Access to
Essential Medicines Campaign.
Countries that have not waited for large multinationals to lower
prices have already brought down the cost of antiretroviral drugs
dramatically, as MSF research (2) shows. Brazil is the most
striking example of how local generic drug production can reduce
prices. Due to the introduction of less expensive generics, as many
as 1000 HIV/AIDS patients are being treated in Brazil for the price
of treating only 228 in Uganda.
The Brazilian approach has been to import the best quality generic
raw materials and locally manufacture finished products. Countries
such as Burkina Faso, Cambodia, Guatemala, South Africa and Uganda
have been speaking both to Brazilian and Indian generic
manufacturers that can sell the products at true discounted prices.
Brazil has also been discussing technology transfer with other
developing countries, so that they can begin producing their own
quality medicines.
The UNAIDS company initiative requires countries to negotiate with
each of the multinational companies for each of the drugs they
produce. This system diverts precious human resources from national
AIDS programmes, whereas real across-the-board price reductions
would benefit people immediately.
Medecins Sans Frontieres has HIV/AIDS programmes in more than 20
countries. Traditionally, MSF has focused on reducing the stigma of
people with HIV/AIDS, as well as on prevention and pain
alleviation. More recently, the organisation has expanded its
approach to encompass preventing transmission from mother to child,
and preventing and treating opportunistic infections in
HIV-infected people. Small-scale antiretroviral programs are being
or will be launched in Thailand, Guatemala, El Salvador, Cameroon,
South Africa, and Cambodia.
Six-month Report Card - UNAIDS five company Accelerated Access
Programme
Number of countries that have negotiated price reductions to date
: One (Senegal)
Number of people with HIV in sub-Saharan Africa: 26 million
Number of patients that will benefit once this programme in Senegal
is implemented (according to UNAIDS):Approximately 900
Number of patients that Brazil has put on antiretroviral therapy by
using affordable generic medicines:More than 90,000
Amount that prices of generic antiretrovirals have fallen because
of introduction of generics in Brazil (1996-2000):79%
Amount of money Brazil has saved on hospitalisations and treatments
for opportunistic infections avoided by successful use of
antiretroviral therapy (1997 - 1999):$472 million
Annual cost of triple combination in the US:$10 000 -15 000
Annual cost of triple combination offered by a generic Indian
manufacturer (quality meeting international standards):$800-1000
Footnotes:
- Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome,
Merck & Co., Inc., and F. Hoffmann-La Roche.
- HIV/AIDS medicines pricing report. Setting objectives: is there
a political will? MSF, July 6th 2000.
This material is being reposted for wider distribution by the
Africa Policy Information Center (APIC). APIC provides
accessible information and analysis in order to promote U.S.
and international policies toward Africa that advance economic,
political and social justice and the full spectrum of human rights.
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