Aids quick-fix won't save Africa
Dr John Kilama
Short-term relief followed by long-term disaster is not sound policy.
Nonetheless, that could be a result of the Aids strategy being contemplated by
the World Health Organisation, which on December 1 - World Aids Day - announced
a plan to treat 3-million people with HIV/Aids by 2005.
The WHO is proposing that billions of dollars be spent on increasing access
to anti-retroviral drugs. That is a noble intention.
However, it may not be the most cost-effective way to stem the tide of
HIV/Aids: it may even be counterproductive.
Let's be clear. Reducing the cost and increasing the supply of medicines to
the poor is a good thing. But on its own it is not enough. Nor should it be
today's priority. The roots of Africa's health care crisis run far deeper and
broader than a mere shortage of drugs. Spending billions on drugs is likely to
prove a disappointing waste.
In fact, without vast improvements to Africa's health-care infrastructure, it
could even make things worse.
For years well-intentioned people have claimed that Africa's Aids problem has
been aggravated by patent owners charging too much for medicines. In reality,
few antiretroviral drugs have ever been on patent anywhere in Africa and there
is no evidence to suggest that treatment has been any more accessible in
countries with little or no patent
protection, such as Mozambique or Somalia, than in countries where patents are
in force.
Moreover, for several years the manufacturers of anti-retroviral drugs have
offered their products at very steep discounts or even for free.
Nonetheless, activists continue to concentrate on this debate. The mistaken
belief that increasing the supply of drugs will, of itself, control Africa's
Aids epidemic has, unfortunately, become received wisdom.
Pharmaceutical companies are being pressured to voluntarily license drugs to
local suppliers. If they don't comply, the activists demand that governments
impose compulsory licences depriving the drug developers of any right to benefit
from their investment.
By making the research-based pharmaceutical companies the scapegoat for the
Aids crisis, activists have done the people of Africa a disservice, diverting
attention from the realities of the situation as well as undermining investments
in new drug development.
The hefty discounts and free medicines offered to poor countries by most
companies suggest that profits from the developing world are not an essential
part of their business strategies. But there is a real threat that drugs subject
to compulsory licences in developing countries could undermine profits and the
incentive to develop new drugs.
In the past year, several large hauls of Aids medicines produced by the
patent owners and intended for sale at low prices in Africa have found their way
back to Europe. If this can happen to medicines that are under reasonably strict
controls, it isn't difficult to imagine what will happen when the drugs are
being produced and distributed by organisations that hold no allegiance to the
company that developed them.
Developing a new drug is an expensive business, estimates put it at between
$500 million (R3,2-billion) and $1-billion (R6,5-billion). If companies can't
recoup returns from the few drugs that they actually get to market, then they're
unlikely to make that investment.
Worryingly, there is growing evidence that drug companies are reducing their
investment in anti-retrovirals - the number of new drugs in development has
fallen almost 30% in the past three years. Though Aids can't be cured, it is
treatable, sometimes for years, but only if new drugs emerge for the large
number of patients who build up resistance to their current regime of anti-retrovirals.
What Africa really needs is investment in its healthcare infrastructure. It
needs to guarantee that patients comply with the requirements of their
treatment. This involves both patient education and training programmes to help
healthcare professionals and para-professionals monitor and promote compliance
in rural areas. Yet Africa currently
lacks the personnel and the infrastructure to do this.
There simply aren't enough hospitals and clinics, especially in rural areas,
to ensure effective delivery of medicines. Even those that do exist face severe
staff shortages, often lacking qualified healthcare professionals.
Poor roads and transportation also hinder drug delivery. In Nigeria, huge
consignments of drugs expired due to lack of effective controls and delivery
procedures. Meanwhile, Botswana's world-class treatment programme, run by a
partnership between pharmaceutical company Merck and the Gates Foundation, faces
continuing difficulties due to a dearth of health workers and the
slower-than-expected pace of building clinics,
laboratories and drug warehouses.
Africa also needs adequate regulatory supervision: formal mechanisms which
ensure that drugs are not adulterated by the time they reach patients. African
countries already suffer from dangerously high levels of drug counterfeiting, in
some locales more than 80% of drugs are fake. Poor quality drugs are a threat to
patients and will spread drug
resistance.
The majority of the funds currently earmarked for Aids treatment should be
spent on long-term programmes to address these essential facets of healthcare
infrastructure.
Without such infrastructure, drugs, whatever the price, will be ineffectual,
even counterproductive.
The WHO must be careful not to be seduced into squandering billions on a
fashionable, but unobtainable, quick-fix solution.
Prevention of HIV/Aids used to be the WHO's priority. And for good reason:
the only way really to control the epidemic is through education and prevention.
In Uganda, my home, the government has halved the HIV infection rate in a
decade through prevention.
More information:
Dr John Kilama, from Uganda, is the President of Global Bioscience
Development Institute www.gbdi.org
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