U.N. Member Nations Must Step Up Fight Against HIV/AIDS To Meet Prevention, Treatment Goals, U.N. Says
U.N. member nations will fall short of meeting HIV/AIDS prevention and treatment goals unless efforts to fight the disease are stepped up, according to a progress report released on Monday by UNAIDS at a U.N. General Assembly special session on HIV/AIDS, USA Today reports (Sternberg, USA Today, 9/23). The U.N. General Assembly Special Session on HIV/AIDS in 2001 adopted a declaration of commitment to halt and reverse the AIDS epidemic by 2015 (Altman, New York Times, 9/23). The report is based on an analysis of surveys of 103 countries -- which represent more than 90% of the people living with AIDS worldwide -- that examined progress toward implementing the goals laid out in the declaration of commitment (Online Newshour, 9/22). Without an expanded response to the disease, the United Nations estimates that an additional 45 million people will be HIV-positive by 2010; currently, there are approximately 42 million HIV-positive people worldwide. Although 93% of the countries surveyed have established comprehensive national HIV/AIDS strategies and national HIV/AIDS coordinating bodies and 88% have improved public HIV/AIDS awareness, the current pace of country-level activity will not enable the countries to meet 2005 prevention and treatment goals, according to the Times (New York Times, 9/23). AIDS-related funding for developing countries is expected to reach nearly $5 billion this year, a 20% increase over last year and a 500% increase over 1996; however, current spending is less than half of the $10 billion required to meet the 2005 goals, the report said, according to the Washington Post (Kessler/Stein, Washington Post, 9/23). The report found that despite the funding increases, few countries are delivering essential prevention and treatment services. For example, only about 1% of HIV-positive pregnant women in heavily affected countries receive information and treatment to prevent mother-to-child HIV transmission (USA Today, 9/23).
'Global Health Emergency'
In an attempt to "salvage at least one" of the U.N. goals, World Health Organization Director-General Dr. Jong-Wook Lee yesterday during the meeting announced a renewed commitment on the part of WHO to treat three million HIV-positive people in developing countries with antiretroviral drugs by 2005, the Associated Press reports. "Our failure to deliver antiretrovirals is a global health emergency," Lee said, adding, "We must change the way we think and change the way we act. Business as usual means watching thousands of people die everyday, to be more exact 8,000 people a day." Of the estimated five million to six million HIV-positive people who need treatment in developing countries, only 300,000 people are receiving antiretroviral medications. In sub-Saharan Africa, only 50,000 of the 4.1 million people needing antiretroviral treatment had access to the medications at the end of 2002 (Agovino, Associated Press, 9/22). WHO will use rapid response techniques it has learned from dealing with the severe acute respiratory syndrome, or SARS, epidemic and health emergencies in Afghanistan, Iraq and Liberia to deliver the antiretroviral treatments (Agence France-Presse, 9/22). Dr. Jim Kim, who is overseeing WHO's antiretroviral program, said that WHO will work with U.N. agencies and nongovernmental organizations and plans to announce its strategy by Dec. 1, which is World AIDS Day (Garrett, Long Island Newsday, 9/23). Under the plan, WHO will provide "emergency response teams" to governments requesting assistance in expediting the delivery of drugs, according to the Post (Washington Post, 9/23). WHO will add $100 million to its current $50 million annual HIV/AIDS budget to implement the program and will seek funding from governments and other sources (Kaiser Daily HIV/AIDS Report, 9/22).
Kim said that WHO will lead the effort to provide antiretroviral drugs and technical assitance on treatment to countries, with UNAIDS providing statistical support and the Global Fund to Fight AIDS, Tuberculosis and Malaria serving as a "financial conduit" to developing countries, according to Long Island Newsday. Dr. Nils Daulaire, executive director of the Global Health Council, said that he hopes that the organizations will work with "a joint effort, joint leadership, rather than a jockeying for position and supremacy." He added, "We don't care who is number one, as long as the job gets done." Global Fund spokesperson Anil Soni said that he thinks that the three organizations can work out any differences, according to Newsday (Long Island Newsday, 9/23). Some AIDS advocates have criticized WHO for being slow to respond to the disease and have said that the organization may not have the funds it needs to implement its three by five program. Daniel Berman, coordinator of the Access to Medicines Campaign at Medecins Sans Frontieres, said, "The WHO declaring this a health emergency doesn't mean a lot. It is a big bureaucratic organization. ... The declaration is a little late" (Associated Press, 9/22). However, other advocates praised WHO for its new plan. AIDS Policy Project member Allison Dinsmore said, "As a lead organization charged with coping with the biggest health disaster the world has ever known, [WHO] has not been very successful. They were actually arguing against treating people in large numbers as late as 2000. ... We hope they will try to make up for lost time" (AIDS Policy Project release, 9/22).
Medecins Sans Frontieres, WHO Report
Medecins Sans Frontieres and WHO on Monday at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa released a report that found that competition among generic antiretroviral drug makers lowers drug prices and doctors can simplify antiretroviral drug treatment, two factors "critical" to expanding access to the drugs, the Boston Globe reports (Donnelly, Boston Globe, 9/23). The report, contracted by WHO, documents the experience of MSF in its 10 antiretroviral treatment programs in Africa, Asia, Eastern Europe and Central America. MSF found that in countries where generic drugs are on the market, competition among pharmaceutical companies drove down prices, making the drugs more widely available. The report also found that the biggest success factor in antiretroviral drug programs is a "clear commitment" from governments to formally suspend patent rights that would otherwise have made the sale of generic drugs illegal, the AP/Las Vegas Sun reports (Tomlinson, AP/Las Vegas Sun, 9/22). Berman said that countries may wish to establish national systems to purchase drugs from generic manufacturers. In Cameroon, which set up a central purchasing system in 2000, the price of antiretroviral drug treatment fell to $277 per year per patient, according to the report (Boston Globe, 9/23).
Bulk Purchase of Drugs
WHO has said that it will set up a procurement agency to make it easier for countries to purchase generic drugs. The program will be based on an existing WHO program for tuberculosis drugs and will attempt to get the lowest prices on antiretrovirals by buying drugs in bulk on behalf of developing countries. The facility will also ensure that good quality drugs are purchased. Berman said that purchasing drugs through such procurement agencies could allow the price of antiretrovirals to drop from about $300 per patient per year to $100 per patient per year (Dyer, Financial Times, 9/23). The MSF report also found that simplifying antiretroviral treatment by checking patients' CD4+ T cell counts less frequently has produced positive results. When asked if such a strategy was risky in larger drug programs, Berman said, "We think it's dangerous not to simplify care if we are serious about reaching three million people by 2005. ... It doesn't mean we are just throwing drugs out there. We are looking to simplify in a smart way" (Boston Globe, 9/23).
Powell, Thompson Speak
Secretary of State Colin Powell speaking at the special session on Monday called AIDS "more devastating than any terrorist attack" and defended the Bush administration's efforts to combat the disease, the Washington Post reports. Powell said that the Bush administration was at the "forefront" of the fight against AIDS, being the largest single donor to the Global Fund and the largest donor of bilateral assistance, according to the Post. Powell also highlighted Bush's five-year, $15 billion global AIDS initiative (Washington Post, 9/23). Although the measure (HR 1298) supporting the initiative authorizes $3 billion for the first year of the program, the Bush administration has requested $2 billion for fiscal year 2004 (Kaiser Daily HIV/AIDS Report, 9/17). HHS Secretary Tommy Thompson at the special session said that the 14 countries set to receive the money could not absorb $3 billion in the first year. "This takes some time. ... It doesn't make sense to put $3 billion in the first year when the infrastructure is still in the embryonic stages," he said (Giacomo, Reuters, 9/22). The Senate on Sept. 9 rejected an amendment to the FY 2004 labor, health and education services appropriations bill (HR 2660) that would have added $1 billion to the roughly $2 billion already appropriated by the Senate for the initiative. The House has approved approximately $2 billion for the AIDS initiative in FY 2004 (Kaiser Daily HIV/AIDS Report, 9/17).
Thompson, who is board chair of the Global Fund, said that Bush "would like to see the European Union step forward and also contribute [to the Global Fund] to the extent that the president and the United States is agreeing to" (Reuters, 9/22). The global AIDS initiative authorizes up to $1 billion in FY 2004 for the Global Fund. However, the amount of funding actually appropriated may be less than $1 billion and is contingent upon the contributions of other countries. Under the measure, the United States can contribute up to $1 billion to the fund only if that amount totals no more than one-third of the fund's total contributions. Therefore, in order for the total $1 billion to be appropriated, other nations must contribute more money (Kaiser Daily HIV/AIDS Report, 7/16). Thompson said that because of the congressional restriction, "we cannot put more money in at the present time until more money comes into the fund. For those individuals who criticize (the United States), they should be looking at other avenues in which more money can come in from other sources." French President Jacques Chirac is urging the European Union to donate $1 billion annually to the fund, provided that the United States does the same (Reuters, 9/22). "My country continues to be the largest donor to UNAIDS," Powell said, adding, "And we will be issuing another grant for $100 million" to the Global Fund (Long Island Newsday, 9/23). According to Thompson, the United States so far has given $130 million to the fund (Reuters, 9/22).
Representatives of more than 130 countries and organizations addressed the General Assembly on Monday, with representatives of Chile, Benin and other countries speaking well after midnight (Leopold, Reuters, 9/23). U.N. General Assembly President Julian Hunte said that there are "signs we are making progress" but that "[r]egrettably, it must be juxtaposed against a shortfall in the resources of the Global Fund" (Xinhua News Agency, 9/23). Hunte added, "[I]t falls to governments to provide the leadership and vision to confront the crisis in their own countries and to cooperate in the global fight against HIV/AIDS" (U.N. release, 9/22). U.N. Secretary-General Kofi Annan said that AIDS "must always [be kept] at the top of our political and practical agenda" and "[w]e cannot claim that competing challenges are more important, or more urgent" (U.N. release, 9/22). Joaquim Chissano, president of Mozambique and chair of the African Union, said that while looking to capitalize on regional and subregional approaches to effective treatment and prevention, "Africa maintained the need for a strong international partnership, particularly between the public and private sectors." Marc Ravalomanana, president of Madagascar, said that he hoped delegates would leave the meeting with a sense of accomplishment to guarantee action. "We must not wait, for AIDS is not waiting," he said (Xinhua News Agency, 9/23).
A kaisernetwork.org HealthCast of select portions of the General Assembly meeting will be available online after 5 p.m. ET on Sept. 24.
NPR's "Day to Day" on Monday discussed drug companies' discounted prices for developing countries with PRI's "Marketplace" correspondent Tess Viegland (Shuster, "Day to Day," NPR, 9/22). The full segment is available online in RealPlayer.
A WHO fact sheet describing the organization's three by five HIV/AIDS treatment plan is available online.