Harvard African AIDS Plan Announced, U.S. Asked to Contribute One-Third of Cost

Anointing AIDS "the modern world's greatest pandemic," a group of 128 Harvard faculty members yesterday publicly endorsed a 32-page proposal for fighting AIDS in sub-Saharan Africa and other developing regions, USA Today reports. The study, written by economist Jeffrey Sachs, head of Harvard's Center for International Development, calls for a "rapid scaling-up of AIDS treatment in the poorest and hardest hit countries of the world," Sachs said yesterday in a phone conference announcing the proposal (Sternberg, USA Today, 4/5). Sachs estimates that with the new discounted drug prices that major pharmaceutical companies are offering for developing nations, the annual cost of treating and monitoring one patient on antiretroviral medications would be around $1,120. "It's time to put money behind the effort," Sachs said (Warner/Collins, Philadelphia Inquirer, 4/5). "There is a tremendous interest in this catastrophe right now ... in something being done about it," Harvard medical professor Bruce Walker said. "People don't want this on their conscience that we were sitting by and letting a whole continent die when there was action we could take to prevent it," he continued, citing the fact that medical care has turned AIDS from a "death sentence" to a "manageable chronic disease" for many in the U.S. (DeYoung, Washington Post, 4/5). The plan calls for the establishment of a "global trust fund," administered by UNAIDS and the World Health Organization, to cover the "staggering" expense of the drugs. To treat one million HIV-positive Africans a year would cost $1.12 billion for the first three years, Sachs estimated. An additional $3 billion a year would be needed to fund prevention programs and treatments "other than antiretroviral therapy," bringing the total annual cost to $4.1 billion. Sachs proposed expanding the program to three million people by the fifth year, bringing the annual bill to $6.3 billion (Zimmerman, Wall Street Journal, 4/5). The proposal says that the cost of the program is one wealthy nations can "easily afford to pay" and asks the United States to foot a third of the bill.

Unanswered Questions
According to the Washington Post, now that drug prices have been lowered, the new proposal brings two issues to the forefront of the debate over the world AIDS crisis: whether "impoverished" nations with "virtually no" health care infrastructure can "safely and effectively" administer the "complex" medicine regimens and whether the wealthy nations of the world have any "moral or economic justification" for not supplying funds to purchase and distribute the drugs in developing nations. The proposal provides a "fairly detailed outline" for treatment, the Post reports (Washington Post, 4/5). Medication distribution would be modeled after a program called directly observed therapy, which involves monitors observing patients taking their medicines every day. This approach has been used successfully in tuberculosis treatment. Walker called the plans "DOTs-HAART" and said family members or "village elder[s]" can be trained as monitors in hard to reach rural areas. Although the DOTs approach has been successful in many areas, WHO announced last week that TB deaths are at an all-time high and multi-drug resistant strains of the bacteria have appeared due to patients not completing their courses of therapy. Sachs said that the failure of TB control efforts is "primarily" attributable to "inadequate donor support" for the purchase and distribution of the drugs (Garrett, Newsday, 4/5).

United States' Financial Role
In yesterday's conference call, Sachs asked the Senate to approve "at least" $1.5 billion for the trust fund when it tackles budget issues this week. The Post reports neither Congress nor the Bush administration are "likely to favor" turning all U.S. AIDS funding over to an outside organization, nor are they likely to put forth such a large amount of money. The United States currently spends $460 million on global AIDS efforts. Secretary of State Colin Powell has said he will ask Congress for a 10% increase in that figure, and Sen. Bill Frist (R-Tenn.) is drawing up a budget amendment to provide "substantial new funding -- far beyond what Powell has suggested," but his figure is not likely to be as high as Sachs' request (Washington Post, 4/5). Sachs called Powell's suggested increase "grossly insufficient," saying that amount could be "quite disastrous" (Knox, "All Things Considered," NPR, 4/4).

Name Brand or Generic?
The proposal does not address the "controversial" issue of generic drugs, the Philadelphia Inquirer reports. The major pharmaceutical companies offered their recent round of discounts after "political pressure," partly resulting from generic drug makers' offers to undercut their prices. Dr. Anne Valerie-Kaninda, medical director for Doctors Without Borders, "urged" Sachs and others to include the generic makers in the plan. "If we keep [generics] out of the loop to supply these drugs, we are losing a key negotiating tool" for lower prices, she said (Philadelphia Inquirer, 4/5). However, Sachs acknowledged that patent protection was a "subsidiary goal" of the proposal. "Secondary to saving lives is that we should try ... to ... preserve the incentives of what is one of the most -- if not the most -- innovative sectors in the world economy," he said (Washington Post, 4/5). Major drug companies said yesterday that they support Sachs' plan. "We can do our bit, which is reducing [the] costs of providing the medicine, but [additional] funding is required," GlaxoSmithKline spokesperson Nancy Pekarek said. Greg Reaves, spokesperson for Merck, agreed that an "insurgence of international aid and support" will be needed to ensure the plan's success (Philadelphia Inquirer, 4/5).