Johannesburg, South Africa -- AIDS has been in the news a great deal lately, more than usual. The South African generic drugs company, Aspen Pharmacare has just announced that its generic versions of its AIDS drugs have been accepted by the US drug regulator, the Food and Drug Administration (FDA). At the same time, the WHO has announced that -- depressingly, and some might say predictably -- it has fallen far short of its target of treating 3 million people by 2005. Yet concurrently the Accelerating Access Initiative (AAI), a treatment access partnership between the research based drugs industry and various UN bodies has announced a sharp increase in people receiving medicines via its programs. These stories highlight some of the ongoing problems in delivering treatment and show a way forward.
The FDA approval of Aspen's drugs has not only boosted Aspen's share price, but also, potentially, boosts efforts to deliver safe and effective medicines to those in need. The FDA is a notoriously tough regulator, but with that approval, Aspen's drugs can now be bought with President Bush's emergency AIDS treatment funds, PEPFAR. The decision to require FDA approval was controversial, but it seems to have paid off. The unseemly episode where several Indian generics companies were forced to withdraw their drugs from the WHO list of pre-approved medicines jeopardised treatment for thousands in Africa that were using those drugs and reflected very badly on the WHO system that had approved them in the first place.
Aspen's drugs only have the potential to boost access to treatment because cheap medicines are only one element in ensuring better access to healthcare. There are numerous reasons for the fact that many Africans do not have access to Asprin, let alone antiretroviral therapy. Chief among these is sheer poverty and a complete lack of healthcare infrastructure.
Some governments, such as Botswana's, have for many years taken healthcare seriously and tried to improve this infrastructure, but many others have not. While Zimbabwe's health personnel are fleeing the country and its health infrastructure crumbles, the government has chosen to increase funding to Robert Mugabe's hated secret police six fold. Unfortunately Zimbabwe is among many other countries where the political will to fight disease of any sort is sorely lacking.
Some countries are actively building barriers to drug access. Kenya and Uganda have just announced that patients in those countries will now be forced to pay 10% more for medicines. Those countries have joined the East African Community's Customs Union which demands a 10%tariff on any imported medicine. Other countries, such as the ironically named Democratic Republic of Congo, have even higher tariffs at 30%. These outrageous taxes on the sick and dying show that much of Africa's leadership on AIDS is empty rhetoric.
Bizarrely at the World Economic Forum meeting in Davos, France's President Jacques Chirac has called for some sort of international tax on air travel or financial transactions to fund 'the war on AIDS'. This classic Gallic solution will only create some monstrous and corrupt international bureaucracy and is hardly likely to help any unfortunate AIDS patients.
Despite the many difficulties associated with improving treatment, AAI is attempting to find solutions. Among the principles of the AAI is that it will work with countries where there is political commitment, work with all sectors of society, acquire additional funding and continue investment in research and development.
The AAI has just announced that its partnership now secures treatment, around the world, for 333,000 people. Most of those are in Africa, where the number on treatment via AAI increased by more than 50% between September 2003 and September 2004 to 157,000. An example of an AAI initiative is Merck's collaboration with the Gates Foundation and the Botswana Government. This partnership has succeeded in building clinics, training medical staff and treating patients, while other initiatives, notably in South Africa have failed.
The spirit of cooperation in Botswana contrasts sharply with the acrimonious battles between the drugs industry, government and NGOs in South Africa. The unfortunate reality is that while the politics continues, thousands go without treatment and into an early grave.
Apart from the incalculable benefit of ensuring that patients have access to medicines right now, we have to ensure that those in the future also receive effective drugs. That is why the focus on continued research and development is so important. The worrying reality is that the number of firms conducting research into AIDS drugs is down by just under a third from 1997. Part of this drop is because AIDS has increasingly become a poor country problem, but the vilification of the research based industry by activists around the world has certainly also played a large part. Few CEOs are happy to have their photos daubed with blood at demonstrations.
AIDS medicine has come a long way since the early 1980s, but unfortunately the politics and grimy reality of medicine in Africa has not changed much. AIDS patients don't need more taxes nor do they need more demonstrations; they need their own governments to take their disease seriously and implement the solutions that are already working.
Tren is a director of the health advocacy group Africa Fighting Malaria and is based in Johannesburg, South Africa