[Ip-health] Hudson Institute's Carol Adelman in the IHT on the WHO

[Jordan]

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Let's learn from global health failures

  Carol C. Adelman International Herald Tribune
  TUESDAY, MAY 23, 2006

  WASHINGTON The World Health Organization and its member countries are hol=
ding their annual meeting, known as the World Health Assembly, in Geneva th=
is week. With hopes dashed for meeting its ambitious AIDS prevention and tr=
eatment goals, criticisms of its failed Roll Back Malaria Program, and chro=
nic illnesses such as heart disease, cancer and diabetes threatening even t=
he poorest of countries, the organization's limits are being tested.

The greatest tribute to Lee Jong-wook, the WHO director general who died Mo=
nday, would be a new commitment to implementing policies that work.

Even before WHO and the United Nations AIDS agency announced their "3 by 5"=
 initiative to treat three million HIV-infected people with life-saving dru=
gs by the end of 2005, the effort was destined to fail. The centrally plann=
ed program was not even approved by member states until six months after th=
e announcement.

Instead of learning from existing AIDS programs in the private sector, enga=
ging with other countries' ongoing treatment programs in India, South Afric=
a, Botswana and Brazil, and setting realistic treatment goals, WHO played t=
o the crowds. It proclaimed that unrealistically large numbers of people wo=
uld be treated quickly.

Sadly, WHO promised much and delivered little. Of the 1.3 million who have =
been treated for AIDS since Jan. 1, 2004, more than half were funded direct=
ly by the pharmaceutical industry's Accelerated Access Initiative and much =
of the rest came from European governments and U.S. donations to the Global=
 Fund and through President George W. Bush's initiative. Once these numbers=
 revealed the WHO shortfall, the agency downplayed its previously trumpeted=
 goal. WHO must reach out beyond its normal circles of consultants and gove=
rnment health ministries in order to work with local doctors, clinics, hosp=
itals and businesses in fighting AIDS and other diseases.

WHO allowed advocacy to trump science. Routine HIV tests should be a corner=
stone of science-based medicine and a global AIDS program, yet WHO decided =
they were too expensive.

WHO has focused on patents and alleged high prices of AIDS drugs as primary=
 barriers to treatment in poor countries. It recommended using copies of AI=
DS drugs produced in the developing world - with unknown safety and efficac=
y - as the key therapies for its "3 by 5" program. In 2004, the global heal=
th agency then had to disqualify 18 of these antiretroviral formulations du=
e to lack of proven bioequivalence.

In reality, drug prices have not been a major barrier to treatment. The maj=
ority of patented AIDS drugs are either less expensive or the same price as=
 copied drugs, because drug companies either donate them or provide them at=
 highly subsidized prices to developing countries.

The real barriers to AIDS treatment receive little attention from WHO. Subs=
tandard and counterfeit medicines may be contributing to dangerous drug- re=
sistant strains of HIV, yet registration of proven drugs continues to be co=
mplicated and lengthy.

Developing countries also place exorbitant taxes and tariffs on many essent=
ial medicines. The U.S. Mission to the United Nations in Geneva, citing UN =
statistics, points out that "almost $33 billion in pharmaceuticals and $23 =
billion in medical equipment are still traded subject to duty, predominantl=
y by developing countries." Accordingly, the United States, Switzerland and=
 Singapore introduced a proposal to eliminate these tariffs and substantial=
ly lower the price of medicines for poor people.

To its credit, WHO did admit publicly that its "3 by 5" strategy had failed=
. But the failed campaign did not prevent WHO from quickly announcing a new=
 "10 by 10" AIDS treatment program - with the goal of treating 10 million p=
eople by 2010. The effort calls for $28 billion a year for treatment starti=
ng in 2008, even though there are no modifications to WHO's strategy. Shoul=
d the G-8 countries really be expected to continue footing the bill for pro=
ven failure?

Sound medical and public health policies, not publicity and exaggerated num=
bers, should be WHO's priority. Governments, nongovernmental organizations,=
 industry leaders and global bodies should check their ideological guns at =
the door and work in good faith to break down the real obstacles to AIDS tr=
eatment. Developing countries need to provide the leadership for improved h=
ealth care infrastructure as well.

It is time for WHO to rethink its strategies and modus operandi. It must re=
ach out to new health care players in developing countries, reorient itself=
 to science- based medicine, and reclaim a leadership role to meet the loom=
ing public health challenges. The world's global health authority must stop=
 chasing numbers in order to achieve the desired bureaucratic outcome and i=
nstead focus on testing and evaluation, responsible treatment, and monitori=
ng of AIDS patients.

Health professionals and policy makers around the world will be watching th=
e World Health Assembly for lessons learned from failed campaigns, and hopi=
ng that member states demand accountability. WHO should be judged by its pe=
rformance, not by its rhetoric. Good intentions are not good enough.

Dr. Carol C. Adelman is the director of the Center for Science in Public Po=
licy at the Hudson Institute in Washington.


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