Clinton Foundation Announces Details of Deal To Cut Prices of Generic Antiretrovirals in Africa, Caribbean
Former President Bill Clinton on Thursday announced the details of a program to secure antiretroviral drugs from generic drug manufacturers at discounted prices and to implement nationwide treatment plans in some African and Caribbean nations, the Washington Times reports (Trotta, Washington Times, 10/24). The Clinton Foundation HIV/AIDS Initiative has secured a deal with India's Ranbaxy Laboratories, Cipla and Matrix Laboratories and South Africa's Aspen Pharmacare that will reduce the cost of commonly used three-drug regimens to 38 cents per patient per day, down from the already discounted price of 55 cents per patient per day for generic drugs; the lowest available price of the same three-drug regimen using brand-name antiretrovirals is $1.54 per patient per day. In addition to reducing the cost of three-drug antiretroviral regimens, the deal will reduce by half the cost of the antiretroviral drug nevirapine for people in developing nations (Kaiser Daily HIV/AIDS Report, 10/23). The initial pricing agreement covers drugs used in two common, three-drug regimens: stavudine, lamivudine and nevirapine; and zidovudine, lamivudine and nevirapine, the New York Times reports.
Two Million People To Receive Drugs
The plan seeks to provide antiretroviral drugs for up to two million people by 2008 in Rwanda, South Africa, Mozambique, Tanzania, the Bahamas, the Dominican Republic, Haiti and in the Organization of Eastern Caribbean States, which includes Antigua and Barbuda; Dominica, Grenada; Saint Kitts and Nevis; St. Lucia; Saint Vincent and the Grenadines; Montserrat, Anguilla and the British Virgin Islands. More than 90% of HIV-positive people in the Caribbean live in these regions, according to the Times (Altman, New York Times, 10/24). The foundation has also helped these countries to prepare detailed government-approved plans to roll out antiretroviral drug treatment programs nationwide as opposed to rolling them out gradually. The plans seek to improve the overall health infrastructure of the countries by preparing budgets for hiring and training health care staff; building and renovating laboratories and clinics; improving drug storage and delivery channels; and developing patient-information systems (Kaiser Daily HIV/AIDS Report, 10/23). Patients in the Dominican Republic and the Bahamas have started to receive drugs under the new program on a limited basis and patients in Mozambique, Rwanda, Tanzania and South Africa will start receiving the drugs soon, according to Reuters (Orr, Reuters, 10/23).
To secure the deal, the generic drug companies allowed Clinton advisers access to information about their accounting and manufacturing practices and worked with them to cut costs (Kaiser Daily HIV/AIDS Report, 10/23). The savings on production costs were passed along as lower final prices, along with a small profit margin for the companies, according to the Economist (Economist, 10/25). In addition, consultants helped the companies cut costs by reducing marketing and distribution budgets, since the treatments are already well-known, and by using profits from other drugs to offset lower antiretroviral drug pricing, according to BBC News (BBC News, 10/24). Gaining approval from the African and Caribbean governments for the nationwide treatment plans was critical in securing the pricing deals with the drug companies because the treatment plans can guarantee the drug makers a large number of patients over time (Kaiser Daily HIV/AIDS Report, 10/23). Yusuf Hamied, chair of Cipla, said that his firm was attracted to the foundation's plan because it ensured high-volume, predictable contracts in developing countries, which are otherwise non-commercial markets (Economist, 10/25).
To pay for the cost of the drugs and for the improvements to the health systems in the developing nations, Clinton personally lobbied private donors and leaders of wealthy nations to secure funding for the initiative. Ireland has committed $58.3 million over five years -- primarily for Mozambique's program. According to a senior Canadian government official, Canada has pledged several million dollars to the plan, but the details are still being finalized. In addition, Rwanda, Mozambique and Tanzania have each secured partial funding from other sources, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank. Clinton has secured more than $1 million from private sources and has kept costs down in his foundation by working with a team of medical experts, business executives and consultants, nearly all of whom have either volunteered their time or who are financially supported by their own organizations. The funding will not be funneled through the Clinton Foundation, but will go directly to the governments of the countries involved in the programs (Kaiser Daily HIV/AIDS Report, 10/23).
Clinton said, "This agreement will allow the delivery of lifesaving medicines to people who desperately need them" (AP/Washington Post, 10/24). He added, "It represents a big breakthrough in our efforts to begin treatment programs in places where, until now, there has been virtually no medicine and, therefore, no hope" (Friedman, New York Post, 10/24). The program's goals are similar to those set by President Bush's global AIDS initiative (Economist, 10/25). However, Clinton says he is not trying to upstage Bush's initiative and would "welcome" money from the global AIDS initiative, according to the Washington Times (Washington Times, 10/24). Clinton said that the foundation also is planning to work with other organizations, such as the World Health Organization and the Global Fund (New York Times, 10/24). Irish rock star Bono, founder of Debt, AIDS, Trade in Africa, said, "This marks a crucial breakthrough in the AIDS emergency, showing that we can, and must, wage a successful war against this ... treatable disease. Now what we need is money on a scale that matches the scale of the crisis. We are waiting to see what the U.S. Congress and other rich countries will do to provide the cash" (Agence France-Presse, 10/23). Michael Weinstein, president of the AIDS Healthcare Foundation, said that the program is a "watershed achievement" that "not only allows relief dollars to treat even more people, but also inspires confidence in resource-poor nations that treatment can be sustained over the long term" (AHF release, 10/23). Dr. Jong-Wook Lee, director general of WHO, which is committed to providing treatment to three million HIV-positive people by 2005, said, "WHO welcomes the Clinton Foundation initiative and all private and public sector efforts that will both reduce the price of AIDS medicines and ensure their availability to the people who most urgently need them" (Xinhua News Agency, 10/23).