Medicine groups cannot save world

Richard Tren | 05 Jul 2005
Business Day (South Africa)

DRUG company Bristol-Myers Squibb and its charitable foundation, the Bristol-Myers Squibb Foundation, recently announced a $40m programme to create a paediatric AIDS treatment corps for Africa. UNAIDS estimates that there are more than 2-million children with HIV/AIDS in Africa, and they require specialised treatment, so the move is a welcome one.

Yet, typically, the company has come under fire for not doing enough and for protecting its innovative drugs with patents. Although this criticism is largely incorrect and somewhat churlish, it is appropriate to question the role that drug companies play in long-term AIDS treatment in Africa.

Bristol-Myers Squibb believes its new programme will treat about 80000 children over the next five years, and will send 250 trained doctors to Africa. The company has since 1999 spent about $150m in 10 African countries to improve treatment and access to AIDS treatment. Other drug companies are also involved in treatment programmes, such as the Accelerated Access Initiative, which has secured treatment for about 333000 people, mostly in Africa.

One advocacy group, the Global AIDS Alliance, reacted to the Bristol-Myers Squibb programme by saying how limited it was in that it would treat only 3% of the children who would die during the five years. The alliance's Dr Paul Zeitz also berated Bristol-Myers Squibb for not funding medical schools in Africa and not allowing generic drug companies to produce copies of its drugs.

Concurrently, the Brazilian government has inflated the war of words over AIDS drug prices, and threatened to licence a local company to produce generic copies of Abbott's AIDS drug, Kaletra. And to give drug company executives even more sleepless nights, the New York Times ran an editorial criticising the US policy of not buying cheaper generic versions of AIDS drugs.

There are several troubling aspects to these criticisms. A fundamental aspect of the Bristol-Myers Squibb programmes is that they are set up to be sustainable for the long term and do not attempt to provide treatment unless it is accessible, with support from the community and good clinical management.

The World Health Organisation (WHO) dreamt up the target of treating 3-million people by the end of this year, and it is now increasingly clear that target will be missed. WHO tried to blame SA, India and Nigeria for this, but the real issue is that the target was completely unrealistic. Expecting Bristol-Myers Squibb to suddenly treat all the children in Africa is not only unrealistic, but it would also compromise the health of those children by not sustaining what is in reality chronic long-term care.

Funding clinics and training doctors is not Bristol-Myers Squibb's core competence. The job of it and other drug companies is to develop medicines and make sure they work. Berating them for not spending more on medical schools is a cheap shot. Also, one has to ask why so many African governments, with billions of dollars of aid over the past 40 years, have not done more to build medical schools and improve health care.

Drug resistance is emerging in Africa. As and when treatment is scaled up, resistance will spread and then, increasingly, second and third-line therapies will be needed.

Finding long-term solutions to Africa's AIDS problem needs continuing research into new therapies. Bristol-Myers Squibb understandably wants to get as much good media coverage for its treatment programmes, but children in Africa would be better off if it concentrated on developing new drugs. Those children would also be better off if WHO were more realistic about treatment targets and if African governments started taking more seriously their role in health care and development in general.

Tren is a director of SA-based health advocacy group Africa Fighting Malaria.

http://www.businessday.co.za/articles/opinion.aspx?ID=BD4A64223