Editorials Address Recent Proposals Concerning Drug Access, HIV/AIDS Prevention

Much ink has been devoted in newspapers across the country to the issue of anti-AIDS drug access in the past week. A variety of editorials and columns have commented on the World Health Organization/World Trade Organization summit in Norway and the different proposals by Jeffrey Sachs and Bill Gates to increase access to HIV drugs and prevention in Africa. Excerpts from the editorials appear below:

• Johannesburg Business Day: Columnist Simon Barber writes in Business Day that the proposal put forth by Sachs and other Harvard University faculty members "offers South Africa a badly needed opportunity to show leadership in an area where hitherto it has embarrassed itself" (Barber, Business Day, 4/11). Sachs' plan calls for developed nations to donate $4.1 billion per year to an international fund that would spend the money on prevention programs and antiretroviral drugs for one million Africans. Sachs proposed expanding the program to three million people by the fifth year, bringing the annual bill to $6.3 billion ( Kaiser Daily HIV/AIDS Report, 4/5). South Africa is in a prime position to be a pilot for this initiative, Barber writes, adding, "Which African nation is better placed than South Africa to be the proving ground for strategies, techniques and protocols for the rest of the continent to be perfected?" The country would greatly benefit from the Harvard plan, he writes, since the program would give the nation access to both funding and medicine. Barber notes, however, that donor countries are likely to provide "strong resistance" to the plan, which could end up producing "yet another global bureaucracy dishing out taxpayers' money according to its own whims and subject to little accountability." But while the Harvard proposal "isn't perfect," treatment "has to be part of the mix," he concludes (Barber, Business Day, 4/11).
• Newsday: Sachs and Gates "need to sit down and talk" about their differing views concerning how to best address the HIV/AIDS crisis in Africa, a Newsday editorial states. Two days after Sachs issued his proposal, Gates and a number of other foundations expressed concern that the Harvard plan focused too much on treatment and not enough on prevention. If members of the Gates and Sachs camps "are not careful, they could ignite a destructive scuffle for dollars between treatment advocates and prevention backers," the editorial states. The editorial says that prevention and treatment are "complementary and equally necessary." Prevention is "the best and cheapest way" to fight the spread of HIV, while treatment encourages people to get tested and counseled about living with the disease, the editorial notes. The editorial concludes, "Resources are too scarce, AIDS moves too fast, and neither treatment nor prevention by itself is an ideal answer. This battle requires teamwork" (Newsday, 4/10).
• Newsday: It's "a different universe" today compared to only nine months ago, with HIV/AIDS in Africa being given noticeable attention in the press, in academia and by members of Congress, columnist Joseph Dolman writes in Newsday. Dolman cites the WHO/WTO summit, the Harvard proposal and Sen. Bill Frist's (D) "laudable push" for boosts in funding for global HIV/AIDS programs as evidence that "we're out of Fantasyland and into something real." However, Dolman notes that many of these initiatives contain flaws and that the medical infrastructure in many developing nations will need to be built "from the ground up." He calls for a combination of prevention and treatment efforts to fight the epidemic in Africa and other poor countries (Dolman, Newsday, 4/11).
• Australian Financial Review: "The rules on global trade and their impact on the world's poorest populations are under intense scrutiny," and this week's WHO/WTO summit "is the direct result," investigative journalist Ray Moynihan writes in an Australian Financial Review op-ed. The summit, which brought representatives from drug companies, AIDS groups, NGOs and international agencies together to brainstorm possible strategies for making anti-AIDS drugs more affordable for developing nations, broached "one of the toughest questions in global health care ... [h]ow to save patients, and protect patents," he states. Moynihan says that "[i]ndustry sources in Australia" predicted that the summit would produce "significant expansion in ... private/public partnerships." The meeting might also prompt some pharmaceutical companies to pull out of the lawsuit filed by 39 drug firms against the South African government, Moynihan writes. He concludes, "At a political level, the fight for access to drugs in some ways demonstrates the changing dynamics of power in the new, globalized environment. In a few short years, AIDS activists and NGOs like Oxfam and Doctors Without Borders have mounted a campaign that has spurred action by the most profitable companies and the most powerful regulators in the world" (Moynihan, Australian Financial Review, 4/7).
• Nation: The recent offers by Merck & Co. and Bristol-Myers Squibb to cut the prices of AIDS drugs for developing nations does not illustrate "a change of heart on the part of 'Big Pharma,'" but is instead "an attempt to preserve patent rights by diffusing international pressure for generic manufacturing," a Nation editorial states. The editorial notes that it is "[r]evealin[g]" that neither Merck nor Bristol-Myers has pulled out of the lawsuit pending in South Africa against the country's 1997 Medicines and Related Substances Act, which would permit South Africa to obtain cheaper AIDS drugs through compulsory licensing and parallel importing. Even if developing nations received financial assistance to help them cover the "high patent-protected prices" of the medicines, "such a course would lock them into exclusive trade agreements with multinationals and put them at the continual mercy of Western foreign aid budgets," the editorial states, adding that each time a new treatment was developed, Africa would have to renegotiate new price reductions. The editorial says that if the solution to drug access problems lies in manufacturing generic medicines, then "circumventing existing international patent regulations is a necessity." The editorial also suggests that NIH give drug patents owned by the U.S. government to WHO, which could then monitor generic manufacturing. In addition, the government could "do away with patents altogether" and fund all research and development for medicines, instead of shouldering most of the cost and allowing drug firms to "exploit" the research, the editorial states. The editorial concludes, "Whatever the recourse, and despite the well-publicized gestures by multinational pharmaceutical companies, the solutions to Africa's AIDS epidemic lie in sustainable competitive drug production, not momentary self-interested charity" (Nation, 4/9).
• Newark Star-Ledger: "Tackling" the HIV/AIDS crisis in developing nations will require "a huge outlay of money and medicine" and "a commitment to start," and both must be provided "soon," a Newark Star-Ledger editorial states. Providing affordable drugs for poor countries "does not have to be a financial disaster for the pharmaceutical industry ... [a]s long as vigorous measures are in place to prevent significant smuggling of discounted drugs back to wealthy nations," the editorial notes. The editorial states that competition from generic drug makers is prompting some drug firms to reanalyze their pricing systems. The editorial concludes, "The drug companies are beginning to realize that they must take a risk in the face of the growing AIDS disaster. If compassion for the victims is not reason enough, self-interest is" (Newark Star-Ledger, 4/8).