[Pharm-policy] NYT Editorial on funding treatment

[love@cptech.org]

http://www.nytimes.com/2001/03/12/opinion/12MON1.html
March 12, 2001 

AIDS Drugs for Poor Nations
 
IDS Drugs for Poor Nations

The past week has brought surprising progress toward making AIDS drugs
more affordable in poor nations. The most significant development was an
announcement by Merck, which makes two of the most widely used — and
costliest — antiretrovirals used in triple therapy for AIDS. The company
will lower the drugs' prices in poor countries to a tenth of their
first-world price. There were also developments on low-cost generic AIDS
drugs. Cipla, the Bombay-based generic drug manufacturer, which a few
weeks ago offered to sell triple therapy at $600 a year to poor nations,
has now said it will ask South Africa for a license to sell eight
antiretrovirals there. In addition, Hetero Drugs, another Indian generic
drug maker, has announced that it will offer triple therapy for $350 a
year.

Just nine months ago, people in the third world could expect to pay the
same $10,000 for triple therapy that Americans pay. There were, of
course, few who could afford it. Today, thanks to the competition from
generics and the pharmaceutical companies' need to repair a public image
as AIDS profiteers, every African government will soon be able to buy
brand-name triple therapy for $1,200 a year, or a generic version for
half to a third of that.

These price cuts are occurring just as a lawsuit that opened last week
in a South African court is energizing AIDS activists against the drug
industry. South Africa's pharmaceutical industry — largely made up of
subsidiaries of multinational firms — sued the government to block the
implementation of a 1997 law that would have, among other things, given
the health minister wide discretion to import cheaper drugs. The lawsuit
has been a public relations disaster for the industry, bringing charges
that it has put its own profits and patents ahead of a public health
emergency. Many experts believe that the law is consistent with
international trade agreements that South Africa has signed.

Whatever the outcome of the suit, South Africa has other laws, not under
challenge, that would seem to allow it to import generic drugs in a
manner consistent with world trade rules. So far, it has not invoked
these laws — although health officials said yesterday that the
government is considering taking the first steps toward accepting
Cipla's offer. 

Welcome as they are, lower drug prices will not solve the AIDS crisis.
That will require a concerted political commitment by the governments in
afflicted poor nations and financial support from rich countries. South
Africa cannot afford the drugs, even at $350 a year. Few nations with a
serious AIDS problem can. Now that the price of drugs is dropping, the
worldwide fight against AIDS must find ways to finance the purchase of
antiretrovirals for poor countries.

The real battle now, which has been taken up by United Nations Secretary
General Kofi Annan, is to persuade wealthy countries to buy the drugs
for poor governments and help finance the necessary clinics and medical
personnel to deliver the drugs. In the developing world, Brazil is the
only nation that provides free triple therapy to its people. The
government there, convinced that the therapy eventually saves money in
reduced hospitalizations, pays for it without outside help.

The World Bank is now considering its first request for a loan to buy
antiretrovirals — from Barbados, which has an AIDS rate comparable to
that of some African nations. A loan might work for Barbados, which is
relatively wealthy. But loans increase a nation's debt burden, which has
cut into the health budgets of many countries.

One solution is for Washington and other wealthy nations — perhaps
acting through international agencies — to create a separate fund for
AIDS treatment that does not compete with money for AIDS prevention or
other health care. The fund could buy the drugs in bulk, as Unicef does
with vaccines, to get the best price. Wealthy nations would also have to
help poor countries improve their health infrastructure, so they could
administer the complex regime of AIDS drugs correctly.

Although the Bush administration and Congress have shown interest in
increasing the budget for improving African health systems, no rich
country is yet taking seriously the need to buy antiretrovirals. If the
drug industry continues its moves toward making these drugs affordable,
the will and money must be found to make them available.