Harvard Plan Calls for AIDS ‘Drugstore’ for Developing Nations
A plan created last month by Harvard School of Public Health Dean Barry Bloom calls for the establishment of an AIDS "drugstore" to "buy, warehouse and distribute" medications to fight HIV/AIDS in developing nations, the Boston Globe reports. The "Global HIV/AIDS Pharmacy" would also create an Internet database of current drug prices and aid in providing "quality assurance" and customs assistance. The plan, laid out after a series of "private" meetings with French Health Minister Bernard Kouchner and Harvard doctor Jim Yong Kim, founding chair of WHO's Green Light Committee, which procures and distributes drugs to fight drug-resistant tuberculosis, also stipulates that drugs be given only to countries with a "demonstrated political commitment to comprehensive AIDS prevention, care and treatment" and a "functioning" program for fighting TB or other infectious diseases, "technical expertise" in HIV/AIDS treatment and "enough money" to see the program through without "compromising other health functions." Bloom presented his proposal last month in a letter to U.N. Secretary-General Kofi Annan, who asked WHO Director-General Gro Harlem Brundtland and UNAIDS Director Peter Piot to "explore the idea further." The proposal draws on "elements" from the Green Light Committee, which has "driven down" TB drug prices by 60% to 90%; the Mectizan program, a 20-year-old partnership between Merck, WHO and the World Bank that provides medicine to prevent river blindness; and the Global Alliance for Vaccines and Immunizations, a partnership among the Bill and Melinda Gates Foundation, WHO, UNICEF and vaccine companies that delivers vaccines to those in developing countries.
More Action, Less Talk
Those seeking to get wider treatment access for HIV/AIDS patients in developing countries have grown "increasingly frustrated" with the slow response to their calls for action, the Globe reports. Kim estimated that it will take "at least" two years before "widescale" drug distribution can occur, based on his experience with the Green Light Committee. Kim added that in the face of six million more AIDS-related deaths in that timespan, he has been "shocked by how much talk there is, how much political maneuvering there is, and how little is in place in a concrete way to get [treatment] moving." However, some global health experts say that the wait is necessary because "most of Africa is not ready" to manage HIV/AIDS treatment because of "weak" health infrastructure and a lack of "scientific protocols" for drug distribution. Some point out that those in charge of treatment and drug distribution will have to deal with the "thorny ethical issu[e]" of "who among the vast sick populations receive the drugs first."
Bloom and his supporters argue that there is "no choice but to move ahead" with treatment initiatives, despite an "imperfect" delivery system and "trial and error" methods. "This is going to be difficult. ... It may be expensive, we may not be totally satisfied with what we need to be doing, but we will learn with time," Jose Esparza, HIV vaccine initiative coordinator for WHO and UNAIDS, said. Eric Chevallier, special adviser to Kouchner, said last week that Bloom's plan was "good as long as it goes together with the strengthening of health capacities." Kouchner recently got the European Union and the governments of France, Spain, Italy, Portugal and Luxembourg to agree to the establishment of "hospital partnerships" with health centers in Africa. The partnerships, which are expected to be operational by the end of the year, can be "connect[ed]" to the drugstore proposal to increase treatment access, Chevallier said. Paul DeLay, head of the HIV/AIDS division at USAID, said that the creation of a drugstore committee raises the "large concern" that the bureaucracy could "restrict access," resulting in "fewer" people being treated. However, Kim called for the inclusion of HIV-positive people on the committee in order to assure a "sense of urgency" among its members. "The tendency of public health officials and doctors is to slow everything down. But in this case, we need to speed everything up," he added. Kim and others will testify about drug access in a congressional hearing on Friday (Donnelly, Boston Globe, 7/17).