[Pharm-policy] Boston Globe: Nigeria reaches deal with Indian firm to buy AIDS drugs

[Mike Palmedo]

http://www.boston.com/dailyglobe2/116/nation/Nigeria_reaches_deal_with_Indian_firm_to_buy_AIDS_drugs+.shtml

Nigeria reaches deal with Indian firm to buy AIDS drugs

By John Donnelly, Globe Staff, 4/26/2001

BUJA, Nigeria - In the first substantial purchase of AIDS cocktails by
an 
African nation, Nigeria will announce a deal today with the Indian
generic 
drug maker Cipla to buy enough drugs to treat 10,000 people a year.

Cipla officials, attending a summit on AIDS and other infectious
diseases, 
told the Globe that the company agreed to reduce the price of a
three-drug 
combination to $350 for Nigeria, lowering its previous $600 offer for 
low-income countries. Nigerian officials confirmed the terms of the 
agreement.

While the $3.5 million deal for Nigeria is just a small step toward 
addressing treatment for an estimated 2.6 million Nigerians infected
with 
the human immunodeficiency virus, it sends a strong message to Western 
donors that African countries will foot part of the cost of trying to 
control the pandemic.

It also gives the first sliver of hope for some Africans living with the 
disease that antiretroviral drugs readily available in the West since
1995 
will no longer be denied them for financial reasons. Cipla officials 
revealed yesterday that they are negotiating AIDS-drugs deals with
Cameroon, 
Ivory Coast, and Algeria. Senegal and Uganda offer small-scale treatment 
programs.

''If any government wants to give away the drug free to people with
AIDS, 
Cipla will basically sell it to them at the cost to us,'' said Jaideep
A. 
Gogtay, Cipla's medical director. While he said that the Bombay-based 
company will look at each deal country by country, ''we are prepared to
make 
the $350 offer to other countries.''

In February, Cipla shocked public health officials and pharmaceutical 
companies by announcing that it would slash the price of its generic
AIDS 
cocktail to $350 for Doctors Without Borders and $600 for low-income 
countries. The move caused private drug companies to slash prices as
well, 
and for the first time some of the 25 million Africans infected with the 
virus learned that they had the possibility of getting treatment.

While Doctors Without Borders just began a treatment project for 150
people 
with HIV in Cambodia and hopes to begin programs in Guatemala and
Thailand, 
no countries had appeared to be in line to make deals with Cipla. That 
raised doubts about the poor countries' commitment to fight the disease.

But for many countries, the cost still remains prohibitively high, and 
vastly out of proportion to meager national health budgets that are
often 
under $10 per capita.

Nigeria's purchase plan won immediate praise at the AIDS conference. It
will 
be buying the drugs stavudine, lamivudine, and nevirapine.

''Enabling wider access to HIV care gives a lot more meaning to
prevention 
of AIDS,'' David Nabarro, the top aide to the World Health Organization 
director general, Gro Harlem Brundtland, said in an interview. ''It also 
gives a lot more meaning to improving access to counseling and testing.
For 
years before, there has been nothing to say to HIV patients, except that
if 
we treat your pneumonia, you might have a few more weeks to live.''

Nabarro said that while the Nigerian deal could be viewed as a symbolic 
purchase, given the depth of the problem, ''We'd love it to become real, 
more widespread. The challenge now is to get the health systems to
work.''

President Olusegun Obasanjo of Nigeria told Jeffrey D. Sachs, the
director 
of the Center for International Development at Harvard University, about
the 
purchase during a meeting at the leader's office. Sachs immediately
offered 
the services of Harvard specialists to set up a delivery system.

''We could help with the training by bringing experts who have
experience in 
how to oversee the use of antiretroviral drugs,'' Sachs said.

Harvard's School of Public Health already has strong ties with Nigeria's 
health plan. Using a $25 million grant from the Bill & Melinda Gates 
Foundation, Harvard will study health systems in three states in Nigeria 
during the next several years.

The health school's dean, Barry Bloom, also is attending the AIDS
summit, 
which is expected to attract 15 to 25 African heads of state and Bill 
Clinton for the deliberations today and tomorrow.

Daniel Berman, coordinator of the Doctors Without Borders Access to 
Essential Medicines campaign, called Nigeria's agreement with Cipla
''very 
significant.'' But he said it would be vital for the country to make a 
long-term commitment to purchasing the drugs as well as ''gearing up the 
public sector so they can effectively administer the drugs.''

In another development at the conference, the World Health Organization 
released a Boston University study that found five African countries had 
reduced or abolished taxes and tariffs on insecticide-treated bed nets
in 
the past year.

The bed nets have helped reduce mortality from malaria among children by
an 
average of 25 percent, according to surveys in three countries.