What the World, and Its UN, Can Do
By Drew Limsky
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More than 36 million people worldwide are infected with the human immunodeficiency virus (HIV), 25 million - nearly 70 per cent - of them Africans. According to The New York Times, 2.4 million Africans died last year from AIDS-related illnesses, nearly a quarter million in South Africa alone. A funeral parlor in Alexandra, South Africa, reports that 50 to 100 hundred people die of acquired immune deficiency syndrome (AIDS) each week.
In some villages, an entire generation has disappeared. Former United States President Bill Clinton has warned that without an emergency strategy in place, AIDS will claim the lives of 100 million in the coming decade. This strategy must take the form of an international relief fund and increased distribution and monitoring of generic medications.
Both the United Nations and the World Bank have maintained that the funds supporting efforts of such agencies as the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) provide only a pittance compared to what is required to counter a crisis of genocidal proportions. What we are allowing is nothing less than a passive form of ethnic cleansing, which must be met with a response of far greater urgency than has been previously shown.
United Nations Secretary-General Kofi Annan has called for a $7-billion to $10-billion annual fund for the prevention and treatment of AIDS, but it will take a massive amount of persuasion to raise this sum. Though the European Union and Japan have promised to contribute, and European finance officials are lobbying their counterparts in Washington to participate in a worldwide AIDS relief fund, the United States remains non-committal; its current budget has shown no initiative in combating the international AIDS epidemic, earmarking, according to The Washington Post, “only a small fraction” of the $1-billion two-year fund approved by the United States Senate.
Though much has been made of the discounting of the AIDS drugs by the major pharmaceutical companies, recent legal and public relations victories merely constitute an ad hoc solution. Certainly, drug manufacturers should continue to slash prices in developing countries. Bristol-Myers Squibb has cut the price of d4T (Zerit) from 10 dollars to 15 cents a day, under pressure from Yale University which invented the AIDS drug. In March, Abbott cut prices for two AIDS drugs-Ritonavir and Kaletra-and the HIV test Determine. But this belated response obscures the reality that generic drugs are the wave of the future in combating AIDS, for large drug companies cannot hope to compete with the prices of generics. For example, Bristol-Myers’ discounting of Zerit to 15 cents per 40-milligram pill is still 50 per cent more expensive than the 10 cents replicated version.
The major obstacles in the way of increased generic distribution are the intellectual property laws that favour drug companies by preventing competition from generic imports. Thankfully, the Pharmaceutical Manufacturers Association, bowing under public pressure, recently withdrew its lawsuit against the South African Government, which aims to import cheaper medications. The University of Minnesota, which developed the AIDS drug Abacavir with the help of federal government dollars, is under pressure to support generic production of the anti-retroviral in poor countries. In a replay of similar protests at Yale, students at Minnesota are protesting unfair patent laws that preclude competition from generics and keep the prices of brand-name drugs prohibitively high.
In another proactive step, Ralph Nader and others have appealed to United States Health and Human Services Secretary Tommy Thompson to allow public health organizations, such as WHO and UNICEF, access to United States patent rights for some of the most effective AIDS treatments. But will Governments choose to alienate pharmaceutical companies merely to save lives? The Nader-affiliated Consumer Project on Technology has called upon African Governments to begin distribution of generic drugs and stop waiting for international drug companies to be shamed into lowering their prices, which will never match the cost of generics anyway. Poor nations are held hostage to drug companies because of unfair patent laws that prevent for years the affordability of AIDS drugs.
One company reducing the cost of a particular drug only offers a specious solution, when what is needed is a systematic way of making drugs available to AIDS sufferers in poor countries. The need to liberalize patent laws, exempting AIDS medications from patent protection, is paramount in halting the spread of AIDS. While the major drug companies push for lucrative, exclusive distribution partnerships with African nations, the price of even the newly discounted drugs-$300 a year-is still too costly for most Africans. The Bombay-based drug company Cipla sells AIDS drugs at significantly more affordable prices than Bristol-Myers and GlaxoSmithKline.
Though critics of generics have voiced their concerns about the quality of some copycat drugs, most AIDS activists agree that the situation demands an emergency response, arguing quite sensibly that variations in quality can be addressed once the drugs become widely available. Generics have been successful in both Brazil and India; Cipla, for example, is well respected, though it does not produce the protease inhibitors that have been especially effective in combating the disease in the United States. Legitimate questions over the safety and effectiveness of copycat drugs should not result in discouraging distribution, but rather should be directed towards establishing an international Food and Drug Administration-like agency responsible for monitoring and evaluating the range of generics increasingly being made accessible in poor countries.
Worries over the big pharmaceuticals’ lost revenue to the generic manufacturers must take second place to the moral imperative involved here. The drug companies contend that their high prices offset the costs of research and development, but for every $1 used for these, some spend almost $3 on advertising, marketing and administration. Even when prices are cut to the bone in poor countries, drug manufacturers remain among the profitable industries in the world.
Finally, in our haste to make effective, inexpensive drugs available, we must not forget to follow the advice of Bill Gates, who emphasizes the role of prevention. It is incontrovertible that countries that have made a firm commitment to educate their people about condom use, the United States chief among them, have seen a slowing of the spread of AIDS. Any international relief fund must invest in safe-sex campaigns and also provide to infected pregnant women AZT (azidothymidine), a preventative measure little used in the developing world, which markedly reduces transmission of the disease from mother to child. The kind of authoritative statements issued by Secretary-General Annan will be essential if we are to make any headway in fighting this epidemic. Perhaps his laudable leadership can be emulated the world over.
Links:
Joint United Nations Programme on HIV/AIDS (UNAIDS)
World Health Organization (WHO)
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Drew Limsky is a New York-based journalist and fiction writer. His work has appeared in The Washington Post, Los Angeles Times, San Francisco Chronicle, Genre and about two dozens other publications. He is book editor and contributing writer for Metro Source and teaches writing and literature at the City University of New York, Yeshiva University and Pace University.
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