UNIVERSITY OF PENNSYLVANIA - AFRICAN STUDIES CENTER
Africa: AIDS Drugs Update Date distributed (ymd): 010105 Document reposted by APIC
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, publicly welcomed by international agencies, have had little effect in making treatment accessible. The Post articles also detail much of the behind-the- scenes 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]
[Note: some web addresses cited below are too long to fit on one line in an e-mail; you may have to retype them into your browser]
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/A5 1719-2000Dec26.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/A5 6492-2000Dec27.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.ht ml
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
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.
o 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."
o 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 Wellcome1s 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.
1. Waldholdz, M. "Makers of AIDS Drugs Agree to Slash Prices in the Third World". Wall Street Journal 11 May 2000
2. cf, www.globaltreatmentaccess.org/content/press_releases/051100_AU_PR _UNAIDS_ARV_.html
3. Harrington, M. "Brazil: What Went Right?" 10th National Meeting of People Living with HIV and AIDS www.aidsinfonyc.org/tag/activism/brazil.html
4. Medecins sans Frontieres/Treatment Action Campaign Satellite Conference on Improved Access to HIV/AIDS Drugs in Developing Countries, 9 July 2000
5. Gueye, M. "Disruption of ARV stock in Cote d'Ivoire" Posting to Nigeria-AIDS list serv 18 October 2000
6. Schoofs, M. "Glaxo Attempts to Block Access to Generic AIDS Drugs in Ghana" Wall Street Journal 1 December 2000
7. 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
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
- 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
1) Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome, Merck & Co., Inc., and F. Hoffmann-La Roche.
2) HIV/AIDS medicines pricing report. Setting objectives: is there a political will? MSF, July 6th 2000.
Message-Id: <200101052000.PAA01701@server.africapolicy.org> From: "APIC" <email@example.com> Date: Fri, 5 Jan 2001 13:52:45 -0500 Subject: Africa: AIDS Drugs Update
Editor: Ali B. Ali-Dinar
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