April 16, 2001

HIV Drugs Too Costly in Africa

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In the AIDS ravaged villages of South Africa and other developing countries — which house over 90 percent of the world’s infected population — drug treatments are scarce and unaffordable, and doctors often have little choice but to send their patients home empty-handed.

That’s why the international medical aid agency Doctors Without Borders/Medecins Sans Frontieres (MSF) is acting to get 39 pharmaceutical companies, which are suing the South African government, to drop their case.

For more than three years, the pharmaceutical industry has blocked a law signed by former South African President Nelson Mandela that would make medicines more affordable to patients, according to Kris Torgeson, director of communications for MSF.

During that period, 400,000 South Africans have died of AIDS-related causes.

“For a doctor to send home patients to die is unethical. There’s no reason why these companies can’t do more to help the developing countries,” Torgeson said.

The pharmaceutical companies claim that Mandela’s law would infringe on their patent rights to the drugs.

Since February, five top companies have given up some ground, however. By slashing drug prices to the near factory cost of $600 per person per year, AIDS medications have come within the reach of many Africans for the first time.

The current treatment, though not a cure, is a triple drug cocktail called “highly active antiretroviral therapy,” that contains anti-HIV life-prolonging medications.

The cost for the therapy in the United States is in the order of tens of thousands of dollars.

Yet with health care benefits in South Africa at an average of $20 per capita, the cheaper drugs are still too costly for the nation to provide to the poor in public hospitals, according to Dr. John Moore, professor of microbiology and immunology at the Joan and Sanford I. Weill Medical College.

“Even when the pharmaceutical companies agree to sell the drugs at the factory cost, the prices are still impossibly out of range for most South Africans,” Moore said.

The solution is far from simple and little will change unless prices keep falling and donors come forward to help pay for drugs and health system improvements, according to Amir Attaran, director of the Commission on Macroeconomics and Health at Harvard University.

Attaran was one of several signatories of a statement, released earlier this month, which called for “the widespread availability of antiretroviral treatments to HIV-infected persons in poor countries.”

Characterizing the issue as “the biggest public health crisis [for developing countries] in 600 years,” Attaran argued that, ultimately, subsidies from rich economies are needed to bring the cost down to the only affordable one for many of Africa’s HIV-infected people — free.

“We have a powerful ethical obligation to keep these people alive, ” Attaran said. “The bottom line is that someone needs to pay and only the rich countries of the world can.”

Attaran’s research suggested that the 1998 monetary contributions from the rich economies of the world totaled about $70 million — roughly the same amount of money that it takes to build seven miles of highway in the U.S.

“That’s a sickeningly small contribution,” Attaran said.

Fatema Gunja ’01, who has followed the situation in South Africa, agreed that pharmaceutical companies are an easy scapegoat.

“Huge parts of the international community have a responsibility here, and the pharmaceutical companies are only one small part,” Gunja said.

Under pressure from activist organizations, such as MSF, the Bush administration announced last week that it will seek a $688 million increase in Health and Human Services spending on AIDS, emphasizing research to develop a vaccine and international efforts to combat the virus.

However, the Bush administration has yet to issue an official response to the drug company case in South Africa, which will resume trial on Wednesday.

“$688 million is just pennies in the pockets of the Bush administration,” Gunja said. “The U.S. hasn’t even started to do what it needs to do.”

To draw attention to their cause, MSF is encouraging college students around the world to sign a petition, asking the pharmaceutical companies to drop the lawsuit.

Additionally, this month MSF plans to prescribe the drugs for free at a public clinic near Cape Town, in what appears to be the first pilot program of its kind in South Africa.

The solution is not a simple one, however, and African government officials agree that, even if the drug prices are cut to zero, the health systems must be upgraded, before the drugs can be safely distributed in public hospitals.

The South African national health system, which was neglected under apartheid, still struggles to vaccinate children and track tuberculosis patients, according to a study published by The New York Times.

Of the 25 million people infected with HIV in sub-Saharan Africa at the end of 2000, 4.8 million are still in need of treatment, the United Nations estimated.

Fifteen-year-olds in South Africa have a greater than 50 percent chance of dying of HIV-related causes if infection rates are not cut, according to UN AIDS figures.

While South Africa is a seriously afflicted country, it is not the worst, according to Moore. In Botswana, for example, over 40 percent of the adult population is infected with HIV or AIDS.

“We need treatment, education and prevention signs,” Moore said. “It’s a simple moral problem. We’d better do something soon or else, before we know it, there are going to be an awful lot of bodies around.”

Archived article by Jennifer Roberts