[Ip-health] Globe & Mail: Drug access is critical, activists warn

[Sheila.SHETTLE@geneva.msf.org]

Drug access is critical, activists warn=0D
STEPHANIE NOLEN=0D
17    August 2006=0D
Globe and Mail=0D
=0D
TORONTO =E2=80=94 Critical issues of access to life-saving medications are =
being=0D
overlooked in the excitement about new technologies and prevention methods,=
=0D
activists warned at the international AIDS conference yesterday, with the=
=0D
risk that the hundreds of thousands of people newly started on=0D
anti-retroviral drugs in poor countries could be left without medications=
=0D
in a year or two.=0D
=0D
The price of the so-called =E2=80=9Cfirst line=E2=80=9D of drugs =E2=80=94 =
the optimal initial=0D
regimen for a person with AIDS =E2=80=94 has come down to $132 (U.S.) per p=
atient=0D
per year, thanks to competition from generic companies and activist=0D
pressure. But within three or four years, people taking those drugs become=
=0D
resistant, and need to switch to a new regimen =E2=80=94 which today costs =
at least=0D
six times more.=0D
=0D
This is costly for a country such as Canada, but unsustainable for one such=
=0D
as Malawi, which is already using the bulk of its health budget to put=0D
people on first-line drugs.=0D
=0D
The problem looms increasingly large as the world's poorest countries,=0D
which are also some of the most infected, scramble to get people on to=0D
anti-retrovirals.=0D
=0D
Mthati Manthanyane of Peka, Lesotho, 31, weighed just 23 kilograms a year=
=0D
ago. Since taking anti-retroviral drugs and working out, she is 63 kg.=0D
=0D
On Tuesday, former U.S. president Bill Clinton said one of the key lessons=
=0D
at the conference for him was the urgent need for these drugs and the fact=
=0D
that their existing prices put them out of reach for most developing=0D
countries.=0D
=0D
Today the standard second line of treatment in Africa costs $1,500.=0D
=0D
=E2=80=9CThat's 10 times the price of the first line, so if 10 per cent of =
your=0D
patients go on it, your overall costs double,=E2=80=9D said Anil Soni, dire=
ctor of=0D
pharmaceutical services for the Clinton HIV/AIDS Initiative. =E2=80=9CSo th=
e first=0D
issue is that the products are not available and patients are dying today.=
=0D
=0D
=E2=80=9CBut the macro issue is that this is driving an exponential increas=
e in=0D
cost, just as we're talking about universal access.=E2=80=9D=0D
=0D
And it isn't just =E2=80=9Csecond line.=E2=80=9D The World Health Organizat=
ion released=0D
recommendations this week on optimal AIDS treatment, but the new list of=0D
drugs includes many that are priced far out of reach for developing=0D
countries.=0D
=0D
The newly recommended first line, for example, is a combination with=0D
Tenofovir, which is not available in many developing nations. =E2=80=9CIt m=
eans=0D
countries can't implement the guidelines,=E2=80=9D said Alexandra Calmy, HI=
V-AIDS=0D
adviser for the access to essential medicines campaign.=0D
Compared with the current first line used all over Africa, the combination=
=0D
with Tenofovir causes fewer of the side-effects that plague people on ARVs,=
=0D
such as nerve damage and disfiguring fat redistribution.=0D
=0D
Much of this debate centres on the drug Kaletra, a key component of=0D
second-line treatment. Abbott Laboratories introduced a new version of the=
=0D
drug that doesn't require refrigeration =E2=80=94 essential for African cou=
ntries.=0D
But Abbott is not giving a voluntary licence to any generic company to make=
=0D
the drug (spokeswoman Jennifer Smoter said the manufacture of the drug=0D
involved proprietary technology), insisting instead that it will scale up=
=0D
production to make quantities for the developing world.=0D
=0D
And new pricing announced on Monday did little to placate organizations of=
=0D
people with AIDS desperate for the drug. In Thailand, for example, Abbott=
=0D
will sell the new Kaletra for $2,200 per patient per year =E2=80=94 down fr=
om=0D
$3,000.=0D
=0D
But in a country where the monthly wage of a university-educated office=0D
worker is $120, it is still not feasible, said Nathan Ford, who has been=0D
struggling to get the new Kaletra for Thai AIDS patients treated by=0D
M=C3=A9decins sans fronti=C3=A8res (Doctors Without Borders).=0D
=0D
Meanwhile, those working in front-line HIV health services in Canada said=
=0D
yesterday that people at the conference may be left with the =E2=80=9Cfalse=
=0D
impression=E2=80=9D that everything in this country is fine.=0D
=0D
=E2=80=9CIt's a total myth that people have access or equal access to drugs=
 in=0D
Canada,=E2=80=9D said Louise Binder, the chair of the Canadian Treatment Ac=
tion=0D
Council, which lobbies on behalf of people with HIV.=0D
=0D
Bigger, wealthier provinces such as Ontario, Quebec and Alberta tend to pay=
=0D
for and provide HIV drugs. But not the Maritimes, she said. =E2=80=9CPeople=
=0D
literally have to move to stay alive,=E2=80=9D she said.=0D
=0D
As well, Ms. Binder said there are about 19 different federal drug plans=0D
that cover HIV medications. Some drugs that aren't covered for aboriginals=
=0D
are covered for military personnel or pensioners, she said.=0D
With a report from=0D
Carolyn Abraham=0D
=0D
=0D
+++++++++++++++++++++=0D
at Toronto AIDS Conference:  +1.416.455.7916=0D
+++++++++++++++++++++=0D
Sheila Shettle=0D
Communications Officer=0D
M=C3=A9decins Sans Fronti=C3=A8res=0D
Campaign for Access to Essential Medicines=0D
Rue de Lausanne 78=0D
1211 Geneva=0D
Switzerland=0D
+ 41.22.849.8403=0D
sheila.shettle@geneva.msf.org=0D
www.accessmed-msf.org=0D
=0D