Report 1 from Jules Levin

Keynote Lecture: From Talk to Action in Fighting AIDS in Developing Countries
     Jeffrey D. Sachs, Harvard Univ. Ctr. for Intl. Development, Cambridge, MA

A Call To Arms To Implement A Program Suggested by Sachs to Provide HAART To Africa & The Developing World: which organizations & individuals are willing to undertake this initiative described below

I was told Sachs' talk was similar to the one he delivered in Durban at the World AIDS Conference, which I hadn't heard. Sachs proposed a plan for providing HAART to Africa and other developing nations stricken by AIDS. He said the drug companies are willing to provide HAART at their cost and the nations are willing to offer HAART to their stricken citizens. He said the main missing ingredient is the money to buy the drug and to implement the program. He said the USA could lead the wealthy nations of the world in providing the $1-3 billion necessary to provide HAART to 1-3 million people.

He said if every person in the US, Europe & Japan paid $3 per year in a tax, this money could be raised. He said that in the past ten years the Western wealthy nations & international institutions such as the World Bank have been pitiful in their attempts to provide money for this problem. He said the drug companies are prepared to offer HAART at cost and that the cost of manufacturing a 2 NRTI-1 NNRTI regimen is $500 to the drug companies. He said the new Republican Administration is friendly to the drug companies and could put together such a program.

So what are the challenges facing such an ambitious idea? He suggested that first you would have to set up a pilot program to test the effectiveness of HAART in a specific place in Africa. You would have to provide a clinic and whatever is necessary to initiate & continue treatment. This means providing viral load & CD4 testing, and additional blood monitoring. This would mean addressing the need of adherence and patient education. In the US we have provided adherence & patient education and we still have a massive treatment failure rate. But Sachs said this was not a reason not to provide drug, and I agree.

Of course, we would have to realize that provision of drug is an ongoing committment forever. And of course there are many other challenges. After setting up a pilot program for 1 million people, which he estimated might take a year to implement, then you could expand to 2-3 million people.

So what are the next steps? Organizations or individuals willing to commit themselves would have to approach the Bush Administration to convince them to undertake leadership of such a plan. This is a challenge but one could could be met. The pharmacological industry and dedicated activists could possibly agree to work together to meet such a goal. Sachs also recommended that a bargain would have to be made with the drug companies. In return for supplying HAART at cost they should receive complete patent protection for their drugs. He said this was a fair agreement and a win-win situation for all. And I agree. So who out there is willing to start an initiative??

Program Abstract:

From epidemiological, medical, and humanitarian points of view, the international response to the HIV/AIDS pandemic in the developing world has been utterly inadequate. The heaviest burden of HIV/AIDS lies in the world's poorest countries, where impoverishment and bankruptcy of governments mean that financial resources are unavailable to control the pandemic. The international donors, including rich-country governments and international agencies, have so far failed to mobilize adequate financial resources to assist the impoverished countries.

As a result, the pandemic has spread with little effective control; more than 30 million people have been left without access to anti-retroviral therapies; and more than 10 million children have been orphaned. The situation will continue to worsen dramatically without a change of strategy. A properly funded international control effort would have the following features:

First, it would be comprehensive, including measures for prevention, treatment (including HAART), and support for communities hard hit by the pandemic. Pilot projects demonstrate the feasibility of successful HAART programs even in the poorest of the poor societies.

Second, donor funding for control programs in poor countries would be provided by grants rather than loans, and would be made available in a flexible manner subject to appropriate scientific review.

Third, it would necessarily rely on procurement of anti-retroviral drugs from the pharmaceutical companies at prices that are above production cost but that are substantially discounted relative to market prices in the high-income country markets. Ideally, this would rely on a voluntary discount policy by the major pharmaceutical companies.

Nonetheless, given the life-and-death circumstances now prevailing in the world's poorest countries, options for drug procurement from generics producers must certainly not be excluded, and are permissible under international patent and trade law. The total level of donor support necessary to introduce such a comprehensive effort may be estimated at around $7.5 - $10 billion per year. This would permit millions of people in the very poorest countries to receive HAART, and would also finance the scaling up of other needed interventions. It would be readily affordable by the high-income countries, as it would constitute less than 0.05% of gross national product of these countries (now close to $24 trillion annually).