NEW FOCUS ON TREATMENT

[Guest guest]

Dear eFORUM Members:

You may be interested in the following article of mine published

on 4 June in the editorial page of The Telegraph (Calcutta). It can

also be seen in www.telegraphindia.com.

Your Comments are welcome.

Moni Nag, Adjunct Professor of Anthropology

Columbia University, New York

moni nag <mn1925@...>

NEW FOCUS ON TREATMENT

Moni Nag

AIDS is a fatal disease that threatens human population all over the world.

It represents the late clinical stage of infection with a virus called HIV

which caused 30 lakhs of deaths globally only in 2000. According to UNAIDS’

estimate, number of people living with HIV/AIDS in India at the end of 1999

was 37 lakhs, second only to South Africa’s 41 lakhs.

Despite billions of dollars spent on bio-medical research, so far there is

no curative drug or preventive vaccine for AIDS. But during the last 3-4

years a few drugs, which can prolong the productive life of people living

with HIV/AIDS, have been discovered and patented by some multi-national

corporations (MNCs) in Western countries. But these drugs, which have

to be taken in various combinations a few times every day, are

so expensive (about $7,000 to $15,000 per patient a year in USA)

that countries like India have not so far even considered using

them at all in their AIDS control programmes. Most developing countries

have, however, by now initiated AIDS prevention programmes with varied

degrees of success.

Three recent events have changed the perspective regarding HIV/AIDS in

developing countries:

(i) a few Indian drug manufacturers’ offer to sell

anti-AIDS drugs at significantly lower prices than those of Western MNCs; \

(ii) withdrawal of a long-standing lawsuit by some powerful MNCs---

possessing patents of anti-AIDS drug cocktails--- against South African

Government’s legislation allowing import of generic substitutes at much

lower costs; and

(iii) announcement of United Nations General Assembly Special Session

(UNGASS) on AIDS to be held in New York during 25-27 June. These three

events have been widely publicised and have raised realistic hopes that

developing countries can also start limited programmes for the care and

treatment of people living with HIV/AIDS along with their expanded

prevention programmes.

Indian Pharmaceuticals’ Achievements

In early February this year Cipla, a major player in the Indian

pharmaceutical industry, offered to sell a cocktail of three generic

anti-AIDS drugs---stavudine, lamivudine and nevirapine--- for $350

per patient a year to the Nobel prize-winning NGO called Medecins

Sans Frontieres (MSF) and for $600 to interested countries. Mumbai-based

Cipla was established in 1935 and has by now factories in four locations

approved by World Health Organisation, United States Federal Drug Agency

and a few other foreign agencies. MNCs manufacturing ant-AIDS drugs

justify their extraordinary high profit margin in the name of huge

expenditure incurred by them in inventing new drugs. But immediately

after Cipla made its offer, the prices started coming down drastically.

Three big drug-makers---Merck, Abbott and Bristol-Meyers Sqibb--- came

up with one international price ($750) for the developing countries.

Cipla’s offer has not yet been matched by any MNC. However, two other

Indian firms have done so. Hetero has offered the package for $347 and

Aurobindo Pharma for $297. Dr. Y.K.Hamied, Founder-Chairman of Cipla

is confident that by 2003 the drug cocktail could cost little less

than $200. The MSF has already started using the drug obtained from

Cipla in its AIDS treatment project in Cambodia and proposes to do

so in about 10 other countries. These developments have changed the

concept of HIV/AIDS care in the Third World. Until recently,

international agencies, governments, donors, NGOs, academics,

physicians and AIDS-activists were talking only of how to prevent

HIV/AIDS in developing countries. Now they have started to also

discuss care of those who are already infected in terms of treatment

---a privilege limited so far mostly to those infected in the

industrialized countries.

MNCs’ Lawsuit in South Africa

The second important event was the decision made on 20 March

by some powerful MNCs possessing patents for anti-AIDS drugs

to drop their protracted lawsuit against the legislative efforts

of the South African Government to import generic versions of anti-AIDS

drugs available at considerably lower prices. The MNCs argued that some

companies in developing countries are unfairly copying drugs that cost

them millions of dollars for several years of research conducted by very

high-level scientists and for marketing the products. But worldwide

pressure of numerous NGOs, governments and international agencies

on MNCs to withdraw their lawsuit compelled them to do so. It has

paved the way for other developing countries handicapped by MNCs’

patent rights on branded anti-AIDS drugs to follow South Africa’s example.

UN General Assembly Special Session on AIDS (UNGASS)

The third event raising some hope for people living with HIV/AIDS

and also for its prevention programmes is the announcement that a

UNGASS on AIDS will be held in New York during 25-27 June. This is

the first time that the UN has called for a special G.A. session

on a specific disease. In a speech delivered at the African Summit

on HIV/AIDS held in Nigeria during the last week of April, UN

Secretary General, Mr. Kofi n, laid out a solid basis for

a global attack on AIDS, tuberculosis and malaria. He called

for a global fund to fight these diseases and added that " we

need to be able to spend seven to ten billion dollars a year

on the struggle against HIV/AIDS in the world as a whole,

over an extended period of time " . The total amount of money

spent on AIDS in developing countries last year was $1 billion

---a sum not even sufficient for adequate prevention programmes.

The World Bank, the International Monetary Fund and the group

of world’s seven largest industrialized countries have already

endorsed the idea of a global fund. Former U.S. President Bill

Clinton has suggested that the U.S. Government should contribute

a quarter of the global fund proposed by Mr. n. It is hoped

that the fund will be formally established in the on-coming UNGASS

on AIDS.

A critical issue likely to be debated in the UNGASS is how much of

the total fund available for HIV/AIDS is to be spent on its prevention

and how much on the care including treatment of those already living

with HIV/AIDS. Some AIDS experts in developing countries have

expressed their concern that the recent publicity about price

reduction of anti-AIDS drug cocktails may divert attention from

the urgent need of expanding and strengthening prevention

programmes. For example, Dr. Fred As, the top AIDS expert in

Ghana, commented a few weeks ago that the devastation caused

by AIDS cannot be overcome by drug cocktails and that it can

only be done by " education, preventive health measures and

creating better health standards " . According to Mr. J.V.R.

Prasada Rao, Director of Government of India’s National AIDS

Control Organisation (NACO), the estimated cost of treating

only 5 percent of people living with HIV/AIDS in India even

at the reduced rate would be around Rs. 1,300 crores annually

which is more than the Central Government’s total annual budget

for public health. He hopes, however, that a limited treatment

programme for a few specific categories of HIV-infected people,

who need immediate treatment but cannot afford its expense,

would be possible with assistance from the proposed global fund.

In a meeting of 30 World Class AIDS experts held in Mont Perelin

(Switzerland) in the second week of May, Dr. Piot, Executive

Director of UNAIDS, said: " The world does not need to make a

choice as to whether to care for AIDS patients or prevent the

spread of AIDS " because " the two are complementary and work

in tandem –this is not an either /or situation " . This statement

will hopefully set the tone of discussion in the UNGASS on AIDS.

Presuming that a global fund would be established in the UNGASS,

the needed contributions from expected donor agencies would be

readily available and funds would be allocated fairly to

countries according to their needs, each of these countries has

to set its own priorities regarding AIDS prevention and care.

The ultimate eradication of HIV/AIDS is only possible through

long-term, comprehensive and effective prevention programmes,

but those already infected with HIV should not be left totally

uncared-for and abandoned to a wasting death when anti-AIDS

drugs are not so unaffordable as in the recent past and drugs

for treating the opportunistic diseases related to HIV/AIDS

are not very expensive.