[Ip-health] MSF Statement on Recent Announcements Regarding Progress in Efforts to Expand Access to AIDS Treatment in Developing Countries

[Mike Palmedo]

http://www.accessmed-msf.org/prod/publications.asp?scntid=3D2712005231239&c=
ontenttype=3DPARA&

MSF: global AIDS treatment efforts not on track

27 January, 2005

The World Health Organization released its =933 by 5=94 progress report on
January 26th 2005 at the Davos World Economic Forum congratulating
itself on progress made in the drive to fight the HIV pandemic. But only
700,000 or 12% of the nearly six million people in need of
antiretroviral treatment in developing countries have access to it
today. Looking at these figures M=E9decins Sans Fronti=E8res, who provides
ARV treatment to more than 25,000 patients in 27 countries, comes to the
exact opposite conclusion.

Instead of celebrating, WHO, UNAIDS, the Global Fund, the US President=92s
Emergency Plan for AIDS Relief (PEPFAR) and other institutions should be
sounding the alarm. Every day, more than 8,000 people die from AIDS and
every year another five million become infected with HIV. Since July
2004, only 260,000 new patients have benefited from ARV therapy in
developing countries. Treatment expansion is moving at a snail=92s pace.
 From the perspective of a medical humanitarian organisation working in
resource-poor countries to treat people with AIDS, the global picture is
bleak.

Crucial issues around AIDS treatment remain untackled:

Children continue to be a neglected population. There are few adapted
and affordable paediatric formulations for the 2.2 million children
living with HIV, and few diagnostic and monitoring tools suited to their
needs. WHO and UNICEF continue to fail to address this.

Due to lack of generic competition, much-needed second-line medicines
are already two to 12 times more expensive than the most affordable
WHO-recommended first-line generics. WHO itself describes ARV prices as
an =93increasingly serious public health hazard=94. Thus far, however, WHO
and others are demanding nothing of governments or pharmaceutical
companies and offer no practical solutions.

Trade rules are interfering with generic competition, which has brought
the prices of AIDS drugs down dramatically and was a prerequisite for
getting donors and national governments to commit to treatment. January
2005 marks a new threat to access to medicines. India, where most of the
largest producers of generic ARVs are located, no longer has the right
to produce generic versions of new drugs because it is implementing the
World Trade Organization (WTO) Agreement on Trade-related Aspects of
Intellectual Property Rights (TRIPS). This will most likely lead to a
steep rise in the prices of any new drugs to treat AIDS: if the prices
of second-line medicines are any indication, we are in for steep price
increases.

WHO must do much more to strengthen its pre-qualification project and
the US government and pharmaceutical industry (and the private groups
they fund) must stop undermining confidence in generic medicines through
inaccurate and irresponsible public campaigns, but there was little
discussion of this in Davos.

The institutions gathered in Davos claimed that the many mechanisms to
fund the fight against AIDS are working =93in tandem=94 to achieve the
acclaimed success. This simply isn=92t true. PEPFAR projects are often at
odds with Global Fund projects and national policies in terms of
procurement and distribution of drugs, processes for evaluating quality,
safety, and efficacy of medicines, and coherence with national
protocols. In fact, because of these policy inconsistencies, PEPFAR has
recently been criticised for having a smaller selection of ARVs
available for its 15 =93focus countries=94 than other treatment initiatives
and for spending far more money than other initiatives on these ARVs.

On January 26th, the US Government Accountability Office released a
report which found that PEPFAR pays US$ 40-368 more than other AIDS
initiatives per patient per year for first-line regimens because it
relies only on FDA approved drugs and =93does not include some FDCs that
are preferred by some of the focus countries=94. The report explains that
=93for every 100,000 patients on this regimen [d4T+3TC+NVP] for 5 years,
the plan could pay over US$ 170 million more than the other
initiatives=94. In other words, PEPFAR could be treating thousands more
people with the funds it is spending.

Finally, the lack of investment into research and development (R&D) for
new preventive, diagnostic, monitoring, and therapeutic tools adapted
for use in resource-limited settings is completely off the international
political agenda. New tools to diagnose HIV in children under 18 months,
to diagnose TB, and detect treatment failure, for example, are urgently
needed in the field as are new and adapted drugs, vaccines and microbicides=
.

Unless these and other pressing issues are addressed urgently, many of
those living with HIV/AIDS in developing countries will never get access
to life-saving treatment or may not be able to survive once on treatment
over the long-term.