WHO Announces Details of ‘Three by Five’ Plan To Combat HIV/AIDS
The World Health Organization on Monday as part of its World AIDS Day activities announced details of its "three by five" HIV/AIDS plan, which aims to treat three million HIV-positive people with antiretroviral drugs by 2005, the Washington Post reports (Brown, Washington Post, 12/1). WHO Director-General Jong-Wook Lee on Sept. 22 during a U.N. General Assembly special session on HIV/AIDS in New York City announced WHO's commitment to the "three by five" plan and declared the lack of access to antiretroviral drugs a global health emergency (Kaiser Daily HIV/AIDS Report, 11/26). WHO's plan, which "lays out a timetable and roadmap" for treating three million people with antiretroviral drugs in the next two years but does not provide or subsidize the drugs, calls for training 100,000 health care workers, "redirecting the focus" of 10,000 clinics in poor countries to treat HIV/AIDS, and using some "one size fits most" antiretroviral drug combinations, the Post reports. Thus far, 20 countries have sought WHO assistance in establishing HIV/AIDS treatment programs and WHO estimates that 20 more will ask for help by June 2004, the Post reports. WHO has already sent consultation teams to Kenya, Burkina Faso, Malawi and Zambia (Washington Post, 12/1).
The $5.5 billion plan recommends four "simplified" combination antiretroviral treatments, including stavudine, lamivudine and nevirapine; zidovudine, lamivudine and nevirapine; stavudine, lamivudine and efavirenz; and zidovudine, lamivudine and efavirenz; the combinations do not include protease inhibitors. Each country participating in the plan will be able to choose the treatment based on the patient's needs and the availability of certain regimens, the New York Times reports. The plan also recommends using "quality-assured 'fixed-dose combinations'" or "blister packs" if available, according to the Times (Altman, New York Times, 12/1). In addition, poor patients will not be required to make a copayment in order to receive antiretrovirals. Under the new plan, WHO expects the cost of antiretroviral therapy per person per year to fall from $450 to $250, the Wall Street Journal reports (Naik, Wall Street Journal, 12/1). The plan calls for "rapidly expanding programs to train workers and improve services," but does not call for the creation of new programs, the Times reports. Dr. Charles Gilks, head of the "three by five" plan, said, "We cannot in a two-year period build new health systems," adding, "Clear decisions will have to be made where programs will be started, and that will involve winners and losers" (New York Times, 12/1).
The plan will face some "significant ... hurdles," including funding and securing antiretrovirals for distribution, the Wall Street Journal reports. WHO officials say that "a good chunk" of the needed funding has been pledged "in one form or another," but WHO needs to raise another $350 million from member states to fund its own "three by five" activities and to "make the plan work," according to the Journal. In addition, it remains unclear how the agency's plan will "mesh" with other efforts to fight the pandemic, including President Bush's global AIDS initiative. Also, drug manufacturers will have to increase production of antiretrovirals' active ingredients before the drug treatments could be distributed, the Journal reports. Also, deciding which patients should receive treatment likely will prove to be a "politically and socially tricky decision that health agencies of individual countries will have to make," according to the Journal. Gilks said, "It's sometimes been an obstacle. It's a divisive issue," adding, "The question of who shall receive [antiretroviral treatment] is a question of who will live" (Wall Street Journal, 12/1).
WHO experts wrote in a 55-page document detailing the plan, "This may be the toughest health assignment the world has ever faced, but it is also the most urgent. The lives of millions of people are at stake. Everyone involved must find new ways of working together and new ways of learning from what they do" (Washington Post, 12/1). UNAIDS Executive Director Peter Piot said, "The lack of HIV treatment is without a doubt a global emergency," adding, "We firmly believe that we stand no chance of halting this epidemic unless we dramatically scale up access to HIV care. Treatment and prevention are the two pillars of a truly effective, comprehensive AIDS strategy" (New York Times, 12/1). Gilks said, "It is unacceptable to let 8,000 people die every day from a treatable and preventable disease. We hope this will be a universal framework" for treating HIV patients in poorer countries with antiretrovirals (Wall Street Journal, 12/1). Lee said, "The lives of millions of people are at stake. This strategy demands massive and unconventional efforts to make sure they stay alive," adding, "This is a global health crisis." Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said, "HIV/AIDS is the greatest disease recorded in human history. We have made a good start in prevention, particularly in some countries. But in treatment we have hardly started and we must rapidly accelerate effective treatment of HIV and people all over the world" (BBC News, 12/1). He added, "The 'three by five' campaign is the kick-start to that effort. It is the engine that will drive us forward and expand access to treatment very rapidly. The world desperately needs this." U.N. Secretary General Kofi Annan said, "The epidemic continues its lethal march around the world, with few signs of slowing down," adding, "We must work even harder to match our commitment with the necessary resources and action" (BBC News, 12/1).
UNAIDS Executive Director Peter Piot in an interview with Jackie Judd, Kaiser Family Foundation Senior Visiting Fellow and former correspondent with ABC News, said that he believes "success is possible" in the fight against the HIV/AIDS epidemic. Piot discusses prevention efforts, the campaign against stigma and discrimination, expansion of access to treatment, including WHO's "three by five" plan, and what he hopes will be accomplished by World AIDS Day next year. The interview is available online.
Additional information on World AIDS Day -- including webcasts; access to studies and key facts; and links to resources and organizations around the world -- can be found online on kaisernetwork.org.