Former President Bill Clinton is visiting several African countries in an attempt to boost AIDS treatment programs. His visit to Africa must be welcomed as HIV/AIDS is already imposing colossal human and economic costs on the continent and this is only set to worsen in the foreseeable future. Several of the former president's initiatives, however, embrace potential short-term gains at the risk of serious and high long-term costs.
The Clinton Foundation began its foray into fighting HIV/AIDS by brokering a deal with the producers of generic and knockoff medicines. The deal was an effort to procure knockoff antiretroviral drugs for just $140 per patient per year. The former president recently announced that by the end of next year, 60 countries will be buying HIV/AIDS medicines through his foundation. His foundation intends to spend $10 million treating 10,000 children this year and seeks to increase that to 50,000 next year. These are noble intentions, but one could be forgiven for being somewhat skeptical about whether or not they can be achieved. Furthermore, in his dash to dish out drugs, Clinton may be harming future generations of AIDS patients.
The World Health Organization is going to fail to meet its target to treat 3 million people by the end of this year. The WHO currently estimates that around 720,000 people are receiving treatment, although this includes some double-counting. Perhaps at best 1 million people will be on treatment by the end of the year. The WHO has blamed, among others, the governments of South Africa and Nigeria for not meeting the target. One can find many reasons to criticize the South African government's years of inaction over HIV/AIDS, but the government now has a comprehensive plan in place and good progress is being made. Blaming them for not meeting a target that they had not set is absurd.
Earlier this month, South Africa's Minister of Health, Manto Tshabalala Msimang castigated the WHO for not consulting with countries affected by HIV/AIDS. "Targets were set for countries without objectively looking at the capacity to meet them" the Minister wrote.
Aside from procuring cheap drugs, the Clinton Foundation reportedly provides technical assistance to countries trying to roll out AIDS treatment. Improving the human capacity to treat AIDS patients is essential. When I recently visited AIDS clinics in South Africa, Lesotho and Botswana the most common barrier to scaling up treatment was a lack of trained personnel. If the Clinton Foundation really want to help increase the number of children on treatment, they are going to have to do an awful lot of training.
A report by the Global Fund for AIDS, TB and Malaria (GFATM) that looked into its HIV/AIDS grant to Swaziland, notes that a major failing is a lack of personnel. The report states:
"There has been a notable weakness in the performance of antiretroviral
training indicators with only 32% of targeted health workers trained in
clinical management and 0% of targeted traditional healers trained on HIV
The program has only been able to utilize half of the approximately $30 million, two-year budget. Swaziland is not alone in struggling to spend the money made available and struggling even more to ensure that more people have access to sustainable treatment.
The cost of drugs that is such a focus of the Clinton Foundation HIV/AIDS program is, in fact, a small part of the barrier to increased treatment. Getting all the other things in place to enable treatment is far more important. Perhaps instead of making grand promises on the number of people that it will treat that make good headlines, it should be thinking about smaller scale, sustainable interventions.
A bigger question, however, is how the Clinton Foundation's efforts will affect further investment in research and development to find new and effective drug therapies. By rewarding the makers of knockoff medical technologies, the incentives to invest in new AIDS drugs dwindles. Even if the Clinton Foundation does manage to treat 60,000 children next year, one has to ask where the drugs will come from when resistance to the current stock of medicines increases. Perhaps, then, the former president will be seen as less of a friend to the poor and downtrodden and more of a friend to a few CEOs of Indian generics companies.
Tren is a director of the South Africa based health advocacy group Africa Fighting Malaria.