HEADQUARTERS PRESS BRIEFING SPONSORED BY UNAIDS POLICY CHIEF
Everyone recognized the magnitude of the HIV/AIDS problem; it was also important to recognize some of the very solid foundations that had been laid on which to build a much greater future response, the Policy Chief of the Joint United Nations Programme on HIV/AIDS (UNAIDS) told correspondents this afternoon at a Headquarters press briefing.
Julia Cleves was joined by: Badara Samb, Programme Adviser, UNAIDS; Daniel Tarantola, Senior Policy Adviser, World Health Organization (WHO); and Fatoumata Nafo Traoré, Minister of Health, Mali. They were introduced by Anne Winter, Director of Public Information, UNAIDS.
Ms. Cleves said that care and treatment had always been central to the UNAIDS agenda. In 1997, when most of the rest of the world was saying that anti-retroviral therapy was an impossible dream outside of rich countries, UNAIDS initiated the "drug access initiative" in order to test, in a limited way, whether that was really true. In Côte d'Ivoire and Uganda, and later in Viet Nam and Chile, programmes had begun to examine the real constraints to using anti-retroviral therapy in resource-poor environments. Important lessons were learned, especially that most constraints could be overcome. Another lesson was that cost made a difference and generic competition helped bring prices down.
She said that throughout 1998 and 1999, the WHO, UNAIDS, and the United Nations Secretary-General had called for extraordinary action and an extraordinary response to the AIDS epidemic. That included reducing the price of drugs, which was still at $10,000 to $15,000 per patient per year. The first major milestone occurred on 11 May 2000 when five co-sponsors of UNAIDS -– the United Nations Children's Fund (UNICEF), the World Bank, the WHO, the United Nations Population Fund (UNFPA) and the UNAIDS Secretariat –- agreed on a statement of intent with five research and development companies, namely Bristol-Meyers Squibb Company, Merck and Company, Glaxo Smith Kline, Roche, and Boehringer Ingelheim, to reduce the price of drugs and increase access.
After a relatively slow start, progress had been very rapid, she said. An additional push occurred when the Secretary-General met in May with representatives of those companies, of Abbott and of Pfizer. Indeed, prices had fallen further since then. At the same time as research and development access was being enhanced, work was continuing with generic manufacturers. In order to increase the transparency and accountability of efforts in that area, UNAIDS had established a contact group to allow Member States, civil society representatives, drug manufacturers, and United Nations organizations to discuss progress and review some of the most critical challenges at bi-annual meetings.
Mr. Tarantola of the WHO said that less than 1 per cent of the people living with HIV/AIDS in developing countries had access to appropriate treatment. The goal was to increase access to and the quality of services for more than 5 million people by 2006. That meant more than doubling each year the number of people who had access to HIV/AIDS-related treatment and care. There were four elements that underscored the magnitude of the challenge. First, a rational selection of drugs should be adapted, including anti-retroviral, anti-cancer, and anti-pain drugs. When anti-retroviral drugs were not available, much could be done in developing countries with available and cheaper drugs.
He said that WHO and UNAIDS had looked at their treatment guidelines and realized that they included 117 different medicines for the treatment of HIV/AIDS-related conditions. Such drugs had been selected on the basis of efficacy, safety, quality and cost-effectiveness. In order to improve drug selection, WHO and UNICEF created a database of information obtained from some 200 pharmaceutical companies on the drugs they were producing or marketing. The database was further improved in 2000 when Médecins Sans Frontières (Doctors Without Borders) began to contribute to the survey. The limited data was posted on a Web site that could be accessed easily and would be updated twice a year.
The second element concerned affordable pricing, he went on. In certain countries, prices had fallen considerably. Now, therapy could be accessed for between $500 and $600 per year per patient, through a combination of available patented and generic drugs. When other substances were added to the drugs, the cost could increase to $1,000 or more per year. In developing countries, that represented four or more times the per capita gross national product. The third critical element was sustainable financing, which required the elaboration of national and international schemes to sustain access to drugs. Ethically, a shared national and international responsibility should guide sustainable financing for treatment. The fourth element concerned the capacity of health and supply systems to use anti-retroviral drugs. Contrary to the prevailing view, there was no country in the world that did not use, and use properly, anti-retroviral drugs, even on a small scale or through private sector mechanisms.
Mr. Samb of UNAIDS said that a total of 58 countries had expressed interest in gaining access to lower priced drugs by being part of a programme of accelerating access. Twenty-three countries had finalized, or were in the process of finalizing, care plans of action. Of the 58 countries now part of the accelerating access scheme, 11 had already reached agreement with manufacturers on significantly reduced prices. Most of those had canceled import taxes and duties on HIV/AIDS drugs. Today, the cost of therapy ranged from $500 per year to $1,400, depending on the combination of drugs. Consequently, Gabon had announced universal access to drugs for those in the country who were living with HIV/AIDS. Last week, Chile announced increased coverage from 40 per cent to 80 per cent.
In Kampala, Uganda, the number of patients with access to anti-retrovirals had increased from 1,000 to 3,000 since implementation of the scheme, he said. Still, the price of drugs was beyond the reach of many living with HIV/AIDS in the developing world. The process was gaining new momentum as regional groups of countries recognized the potential of reducing prices through regional procurement. That approach also potentially offered people moving between countries in the same region a relatively standard level of care. Some Governments were now devoting more public funds towards care. Others, including Côte d'Ivoire, Cameroon, Gabon, Mali, Morocco, and Senegal, were allocating special funds to subsidize access to anti-retrovirals for individuals unable to afford them.
Burundi and Rwanda contributed to a special fund for buying drugs at a subsidized price, he continued. Countries were also directing debt relief towards HIV/AIDS prevention and care. Cameroon and Mali had converted part of their debts into funds for care and subsidized access to drugs. Some governments had invited private companies to subsidize access for their employees and families. In Brazil
and South Africa, regulation of existing insurance schemes had provided access to HIV/AIDS care to thousands who would have otherwise been unable to afford it. Still other countries were exploring the possibility of increasing drug supplies through loans and grants from financial institutions.
[No official interpretation was available for the remarks delivered in French by the Health Minister of Mali, Ms. Traoré. Mr. Samb of UNAIDS provided unofficial interpretation.]
Ms. Traoré said that Mali was a country in Western Africa of 10 million people that shared its borders with seven other countries. That should give an idea of the risk of HIV/AIDS in the country. Among the adult population, some three per cent were infected. That meant that 130,000 people were living with HIV/AIDS and 33,000 had been orphaned. From the beginning of the epidemic, her Government had concentrated on prevention. Now the country was more and more interested in integrating efforts of prevention and care in order to cope with the epidemic. Since May 2000, the focus had been on expanding access countrywide to care and support. Today, the technical environment was in place to allow the country to support its thousands of AIDS sufferers.
She said that it had taken several months to prepare a comprehensive plan of action with a care component, and to mobilize the funds needed for wider access to care and support and biological follow-up. In April 2000, her Government had initiated negotiations with four pharmaceutical companies, namely Merck, Bristol-Meyers Squibb, Glaxo Smith Kline, and Boehringer Ingelheim. Those companies provided the Government with an 80 per cent reduction in their usual prices. The Government had directed $1,250,000 towards HIV/AIDS care, making it possible for AIDS victims in Mali to have access to anti-retrovirals at a price that was 10 per cent lower than in the Western world. A subsidy system tailored to the specific economic profile of AIDS sufferers had meant that 500 people living with HIV/AIDS in Mali could be treated. But of 130,000 victims, that was a "drop in the ocean", she added.
Asked about plans to distribute drugs among illiterate AIDS victims,
Mr. Tarantola said that some new approaches were being tested and hard work was under way. In the case of tuberculosis, one successful strategy had been for patients to take their drugs in the presence of a third person to ensure compliance. Such supporting activity could be generated at the community level and within health care systems.
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