[Ip-health] Roger Bates' WAD column

[Mike Palmedo]

http://www.techcentralstation.com/120103C.html

World AIDS Daydreams and Nightmares

Roger Bate
December 1, 2003

World AIDS Day is upon us again and much of the news is dire. Not only
are there over 42 million cases around the world, with over 28 million
deaths already, it appears that AIDS may be striking again in America.
The Centers for Disease Control says that there has been a 5% increase
in diagnoses in the past four years.



Black Americans are ten times more likely to have the disease than
whites and, according to CDC director Dr. Julie Gerberding, "the HIV
epidemic in this country is not over; more often than not the face of
HIV in this country is black or Latino. Fighting HIV in America is as
urgent as it was more than two decades ago when the epidemic began."
Fortunately only about 40,000 Americans get the disease every year, with
at most a million currently infected.



Private Sector Delivers the Goods



The drugs industry went to work very early and within 4 years of the
disease's discovery in 1983, the first drug was developed to combat the
Human Immunodeficiency Virus (HIV) that causes AIDS. Now over 16 years
later there is an amazing array of 80 drugs which have been approved for
treating AIDS and the opportunistic infections that thrive in those with
the disease.



Figures out last week from U.S. industry group PhRMA showed that there
are another 83 drugs or vaccines in development. Superficially the news
is undoubtedly good. However, dig a little deeper and disturbing trends
emerge. With the continuing attacks on drug company patents and the
pricing of their AIDS drugs, the trend in drug development is actually
downwards. More important than the number of drugs in development is the
number of companies working on AIDS drugs, which has fallen by nearly
30% in the past five years. This should be a shocking statistic, but it
seems to be ignored by most commentators. At a time when the disease is
taking hold of parts of Asia, has destroyed large swathes of Africa, and
is even creeping back in America, the environment for companies to work
on AIDS is so bad that more are leaving the research field.



The Size of the Problem



As I mentioned in a column on China
<http://www.techcentralstation.com/112603E.html> recently, according to
Nicholas Eberstadt, a Harvard University demographer and a colleague of
mine at AEI, China may have as many as two million cases already, yet
its official figures say one million. Eberstadt's research shows that
Russia and India may also be underreporting, either willfully or in
ignorance. It is quite possible that there will be 100 million cases
worldwide by the end of 2010.



All health specialists hope that an HIV vaccine can be developed soon.
Without such a vaccine it may not be possible to halt the "spread of
HIV," commented Dr Anthony Fauci, Director of the National Institute of
Allergy and Infectious Disease, and a key advisor to President Bush. It
is encouraging that there are 15 vaccines in development, and none has
so far failed its trial.



Hopeful Signs



One vaccine is designed to induce different types of immune responses,
enhancing the overall immune system. The first dose primes the body to
induce cellular immunity, while the booster dose induces neutralizing
antibodies. Another vaccine candidate combines DNA snippets from the
AIDS virus with a protein that boosts an immune response. The aim is not
to prevent infection but to limit the damage the virus causes. These and
the other candidates are exciting prospects but seasoned vaccine experts
admit that the likelihood of success is slim. HIV changes so rapidly
that even announcing partial success is premature. Furthermore,
detectable HIV resistance to one drug occurred within weeks of its
introduction in 2001. Resistance always occurs but to develop so rapidly
is extremely worrying. It's one of the reasons that HIV drugs are given
in a triple drug cocktail, so that the HIV has a far harder time
adapting to all three simultaneously. It is simply a matter of
statistics. The odds on resistance developing simultaneously to three
drugs at once is many millions of times lower than developing to one
drug alone.



Resistance obviously affects the bottom line for companies since
spending hundreds of millions of dollars developing a drug or vaccine
that is possibly going to be useless in months does not make economic
sense. Some firms are spending as much as $300 million a year just on
HIV vaccine research, and many hundreds of millions more on drug
development. It has to be asked is that a good investment in the current
climate?



Groups like Doctors Without Borders, Oxfam and Act Up have largely
changed lately tactics and are attacking the lack of governmental and
aid agency financial support for AIDS drug delivery. But they still
attack corporate "greed" whenever the mood takes them. The result is
that every year companies (especially small biotech ones) escape the
no-profit zone that AIDS research has become. Over 80 companies were
working on AIDS research five years ago, today the number is 60.



AIDS claims more victims every year. Sooner or later, says Professor
Eberstadt, it will take hold of China and India. Perhaps only then will
corporations be able to make enough money from the disease by having
enough moderately wealthy customers. Or perhaps if more insured
Americans get the disease then companies can justify spending more on
AIDS research. Both scenarios are depressing, but that is unfortunately
the reality of working in an area where the righteous media pundits and
political commentators believe that profit is a dirty word.



/Roger Bate is a visiting fellow at the American Enterprise Institute in
//Washington// //DC// and a Director of health advocacy group //Africa//
Fighting Malaria./