[Pharm-policy] formatting fixed: Brundtland on CIPLA to staff

[James Love]

-------- Original Message --------
Subject: Brundtland on CIPLA to staff
Date: Tue, 13 Feb 2001 15:52:46 +0100
From: EHOEN@paris.msf.org (Ellen T HOEN)
To: love@cptech.org

DG statement to WHO staff, issued 12 February 2001

Affordable AIDS drugs are within reach

Most of the 36 million people throughout the world who are infected with
HIV cannot access effective treatment. In Africa less than 1 out of every
one thousand people with HIV/AIDS are today benefiting from combination
therapy.  At a cost of $10.000 to $15.000 per person year, the medicines
needed to slow the progression of AIDS and to control opportunistic
infections are far beyond what most Africans, Latin Americans, and Asians,
or their governments, can afford. With the drugs out of reach, there is
little stimulus for developing country governments to organise their health
care systems to treat those living with HIV. In short, once infected, a
person can only wait for a slow, painful death. 

Today, antiretroviral combination drug therapies have become available to
some African countries for around $1000 dollars per patient per year - a
tenth of what they used to be. Offers this week mean that these combination
therapies could be made available in Africa for a price of $600 or less per
person per year.  

True, such prices are still beyond what almost any African health system
and most patients are able to spend. But it will not stop here. Affordable
drugs for HIV/AIDS care are within reach. It will take time, but we are
moving much faster than ever before. 

We are seeing an unprecedented effort, driven by committed people from
governments, non-government organizations, UNAIDS, WHO, other UN
organizations, and the private sector.  They share the same goal and pursue
it relentlessly despite the numerous obstacles that stand in their way. The
feasibility of combination therapy for people with HIV infection in
developing countries has now been demonstrated in a growing number of
successful programmes. The momentum to scale up access and close this gap
is unstoppable.

Political will, popular outrage, market forces and the best science are
enabling the pursuit of a fundamental principle of public health.  That is
the supply of essential medicines on the basis of the need rather than on a
person's ability to pay. The forces of globalisation are being used to
narrow the gap between the wealthy and the poor. 

The work ahead will focus on four areas.  First, people with HIV need to be
offered the treatment best suited to health systems in low-budget settings.
Clinicians experienced with AIDS care in Africa believe that combination
therapy can be effectively administered without the elaborate laboratory
monitoring which is routine in industrialized countries.  Yet many medical
researchers are concerned that - without adequate monitoring - resistance
to AIDS medication will develop and the available medicines will quickly
become useless. Clinicians and researchers will now analyse current
experience and to define essential components for diagnosis, laboratory
support, and effective care.

Second, we will seek the best possible prices for essential medicines for
poorer countries. A process initiated ten months ago by five research-based
pharmaceutical companies, working with national governments and UN system
agencies, has led to some substantial price reductions for several African
countries.  A major generic pharmaceutical manufacturer has announced
further reductions.  But for poorer countries to benefit from the lowest
possible drug prices, mechanisms are needed to prevent re-export of lower
priced drugs into richer economies. And lower prices in the developing
world should not be used as a lever in countries that can pay the full
price. 

Third, we will work to protect intellectual property rights, but in a
manner that supports efforts to achieve the best prices for AIDS drugs and
other essential medicines in poorer countries. An effective regime for
international trade is one which allows countries to implement mechanisms
that secure people's health, while respecting intellectual property.

Fourth, we recognise that a medicine cost of $600 per person per year is
still beyond what almost any African health system and most patients can
afford.  Governments with per capita annual health budgets in the region of
$20 who struggle to provide access to life-saving treatment for malaria at
$0.50 per case are understandably  overwhelmed by the cost of caring for
people with HIV. They need additional resources if they are to respond. .
They are now better placed to make the case for increased international
funding for HIV care.   They will want this to be additional to the
existing assistance for  health action which is needed for HIV prevention
and for reducing the impact other common deadly diseases such as malaria
and childhood pneumonia.

And as we move ahead, we must ensure that the new hope of wider access to
care complements and strengthens efforts to prevent HIV from spreading.
Keeping people free from HIV must always remain our main goal. 

Expanding care to millions of people in developing countries will be
immensely difficult.  It is a process that will take years.  It will
require more practical treatment and monitoring regimens, still lower
prices for AIDS drugs, and greater financial resources.  But the
alternative to success is an AIDS epidemic that far exceeds our worst fears
and further devastates development in many of the world's poorest
countries.

Gro Harlem Brundtland
Director General
World Health Organisation

February 12th 2001