The World Health Organisation's goal to provide AIDS drugs to 3 million infected people by 2005 is unlikely to be met, the organisation's Africa director, Ebrahim Malick Samba, said during a visit to Uganda. "The 3 x 5 is coming," Samba said, "but not as soon as expected." Samba said that while the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNICEF and bilateral partners were "keen" to support the program, some would be fulfilling their promises of support later rather than sooner. "You learn that people are more generous verbally than when it comes to giving," he said.

Government is considering posting medical doctors at sub-county level in a wider strategy aimed at delivering effective health services in villages. The state minister for primary health care, Dr. Alex Kamugisha, said this at a health workshop at Kolping House in Masindi town recently. "The rate at which mothers and children are dying is unacceptable and that is why the Government is working hard to reduce the distance to health facilities," he said.

The World Health Organisation will provide financial support to the Kenya Government's proposed national health insurance scheme to ensure its success. Outgoing WHO Africa Regional Director, Dr Ebrahim Malick said the Government had in the last one year put in place health sector policies that had attracted donor support.

Thirteen people in the Eastern Cape have died from cholera and more than a hundred had to be treated in hospital for the disease after a recent outbreak. The provincial government has promised the affected communities emergency medical resources to stop the spreading of the disease. Monwabisi Goqwana, the health MEC, flew to Sebeni in Ntabankulu, one of three affected villages, to confirm the outbreak. Goqwana appealed to the community not to blame the deaths on witchcraft.

Two of the world's most powerful medical organisations have been accused of medical malpractice for knowingly promoting useless drugs that have led to the deaths of hundreds of thousands of children. The World Health Organisation and the UN Global Fund, which was set up to buy drugs for poor countries, have allocated millions of dollars to malaria medicines that are no longer effective against the disease, a group of specialists said. They claim negligence by the two organisations contributed to a rising death rate from malaria, which has doubled in a decade in some parts of Africa because of growing resistance to older drugs.

Parents the world over usually find it difficult to talk to their children about sex, even if they are growing up in a country like Botswana, with one of the highest HIV rates on the planet. Embarrassment over discussing matters related to sex and the stigma surrounding those that are HIV-positive is helping to drive the pandemic. It is a challenge the Botswana government hopes to overcome, and this week opened the latest voluntary HIV testing facility in Molepolole, about 50 km outside the capital, Gaborone.

A pilot project in Rwanda on the prevention of mother-to-child HIV infection has registered a high rate of acceptance and has helped improve the chances of HIV positive mothers giving birth to HIV negative children, the UN Children's Fund (UNICEF) reported on Tuesday. Rwanda is one of eight pilot countries in eastern and southern Africa to have participated in the project in 1999, involving trials for use of antiretrovirals (ARVs) to minimise the possibility of HIV infection from mother to child.

Ten percent of South African youth are infected with HIV and young women, often forced into unwanted sex, are the worst affected, according to a new survey. The survey of 12,000 youths aged between 15 and 25, who were interviewed by the reproduction health research unit of Johannesburg's respected Witswatersrand University, showed that one in 10 youths had contracted the virus that can lead to Aids, SAFM radio reported.

The Kenyan government plans to continue to lobby the U.S. government to try to gain additional money for its donor-funded antiretroviral drug distribution program, the Financial Times reports. Kenyan Health Minister Charity Ngilu in February said that the government hopes to provide free antiretroviral drugs to 140,000 HIV-positive individuals by 2005. She also said that the government has adopted the World Health Organisation's 3 by 5 Initiative to combat HIV/AIDS.

Africa faces huge political and humanitarian challenges. Sixteen countries are stricken by war or serious instability; the shadow of genocide looms over central Africa; while natural and man-made disasters threaten the lives and livelihoods of millions of Africans. International structures for peace and security and the delivery of humanitarian assistance have so far failed to prevent enduring crisis across the continent. Hopes of new models for ‘African solutions to African problems’ have suffered severe setbacks in the last few years. The essays in this book address the various challenges faced by Africa.

A deal giving cheaper Aids drugs to the developing world is being made available to hundreds of thousands more patients. Previously available in 16 countries in the Caribbean and Africa, the deal will now cover up to 122 nations. The agreement is with five drug manufacturers and five firms which make Aids and HIV diagnostic tests. ActionAid said the move was positive but warned the cost of drugs would still be too high for poor countries.

This comparative study assesses the readiness and ability of six African countries - Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe - to respond to the HIV/Aids epidemic. The key issues addressed are: Is the allocation to health, as a per cent of total government expenditure, sufficient? Is enough allocated to deal with HIV/Aids, given the magnitude of the problem.

Medecins Sans Frontieres reported on Wednesday that by mid-March 40,000 people had been vaccinated against meningitis in the western district of Batangafo, in the Central African Republic. The ongoing vaccination drive was launched on 8 March in collaboration with the Ministry of Health and includes protection against measles. MSF reported that all 59,000 people over two years old in Batangafo and neighbouring rural areas, some 386 km north the nation's capital, Bangui, were being vaccinated.

Efforts to end hunger in Africa by 2020 can achieve results if governments focus on raising agricultural productivity, food experts said at the weekend. At the closing of a food security conference in the Ugandan capital, Kampala, on Saturday, delegates called on African leaders to prioritise increased agricultural production, noting that food security was a "human rights issue".

Ugandan President Yoweri Museveni has renewed his appeal to the West to open up its market so as to enable Africa to achieve food security. "You cannot talk about total food security for Africa without talking about the need for Africa to gain access to rich western countries’ agricultural markets. Can we have food security when we are competing on an unequal playing field with these nations? When they flood our markets with finished agricultural products that have been manufactured from our raw materials?" he posed to delegates attending an international meeting on food security.

A majority of South Africans point to the government for "doing little to stop the spread of HIV/AIDS" in the country, according to a survey conducted by the Washington Post, the Kaiser Family Foundation and Harvard University, the Post reports. Researchers interviewed in person 2,961 people - including 1,715 black South Africans, 612 white South Africans, 364 South Africans of mixed race and 265 Indians living in South Africa between Sept. 29, 2003, and Nov. 7, 2003.

Ethiopia has launched a National Partnership Forum Against HIV/AIDS to coordinate a multi-sectoral response to the disease, highlight the government's commitment and bring together a wide range of partners to avoid duplication of efforts, according to an AllAfrica report. A statement from the foreign ministry quoted President Girma Wolde-Giorgis, who launched the forum on Wednesday, as saying: "We should be able to discharge our historical responsibility of saving the generation from HIV/AIDS."

As expected, South Africa last Thursday began the rollout of its national antiretroviral drug distribution program at five hospitals in Gauteng province, SAPA/SABC News reports. The South African Cabinet in November 2003 approved a plan for the program, which aims to provide antiretroviral drugs to 1.2 million people - or about 25% of the country's HIV-positive population - by 2008. Gauteng is the first of the country's nine provinces to begin dispensing drugs under the government's program.

Under a new project co-sponsored by the World Health Organisation announced Friday, physicians and researchers across the globe will have free online access to the results of the latest clinical trials in reproductive health, infectious diseases, vaccines and other medical fields. As of Friday, all randomized controlled trials - considered the best way to compare the success of various methods of disease prevention or treatment - that receive approval from the WHO ethics review board will be assigned a number and catalogued under a register set up by WHO and an independent publishing house, London-based Current Controlled Trials Ltd. The International Standard Randomized Controlled Trial Number Register will for the first time make readily available research about neglected diseases, many of which disproportionately affect the poor in developing countries.

In May 2003, at its annual World Health Assembly, the World Health Organisation (WHO) announced a modest proposal: that it would provide the technical and organisational support to provide 3 million people in poor countries with antiretroviral treatment by the year 2005.

This "3-by-5 initiative" was minor in one sense, in that it would provide treatment to only about 5 percent of those in need. But in another sense, it was a major step forward, particularly because the WHO proposed a novel manner of delivering the anti-HIV medicines: combining the drugs into a "fixed-dose regimen", a combination pill containing three drugs in one capsule, allowing an infected person to take only one pill twice per day for a complete HIV-treatment regimen. Fixed-dose combinations are cheaper and easier to take than the existing HIV treatment protocol; taking two fixed-dose combination pills a day for a year costs $140 per patient, compared to about $600 per year for the normal regimen of six pills per day [1].

Previous excuses used to deny patients in poor countries access to antiretrovirals centred around two common arguments: that poor persons could not adhere to complex medication regimens and would therefore improperly take the drugs leading to drug-resistant forms of HIV, and that the infrastructure in poor countries is insufficient to support complex HIV care [2, 3].

Yet those who continue to state these excuses are almost universally unfamiliar with the public health and biomedical data accumulated over the last several years, which definitively demonstrates that in the most resource-poor settings - including the poorest place in the western hemisphere (the central plateau of Haiti) and the slums of southern Africa (such as the Khayelitsha township in South Africa) - antiretroviral treatment has been delivered with higher adherence, extraordinary success rates and no evidence of drug resistance [4-9]. The success of these interventions has resulted in the exportation of these models throughout the world - and physicians everywhere are now waiting for the necessary medications to arrive.

The WHO's generic combination pill would have improved and simplified treatment to the point where these models would have been even easier to adopt in most resource-poor settings.

Why had a combination pill not been designed before? Because HIV treatment requires a number of different types of medications, and these types are patented by different companies in the US and UK. Ideal combination pills could not be produced when one company owned the patent to a necessary chemical and another company owned the patent to a secondary component.

The patents, of course, are believed to be necessary to give inventors a fixed monopoly time in a marketplace to recoup costs on research and development (R&D). Yet, again, data demonstrate that such costs are recouped well in advance of the 20-year patents that the US Trade Representative is pushing on poor countries through bilateral and regional trade agreements [12].

And the R&D claim ignores the fact that most AIDS drugs were produced through public financing (even through the clinical trials stages), and 85% of the basic and applied research for the top five selling drugs on the market were produced through taxpayer funding [13].

According to the industry's own tax records (obtained from the Securities and Exchange Commission), Merck last year spent 13% of its revenue on marketing and only
5% on R&D, Pfizer spent 35% on marketing and only 15% on R&D, and the industry overall spent 27% on marketing and 11% on R&D [14].

Meanwhile, all of sub-Saharan Africa constitutes only 1.3% of the pharmaceutical market, so as one former pharmaceutical executive put it, allowing generics to enter this market would result in a profit loss to the patent-based industry equivalent to "about three days fluctuation in exchange rates" [15, 16].

But the drug industry's fight for monopoly patent rights in this market and middle-income country markets is serious, as the growing inequality in poor countries under the context of neoliberalism increases the market-share for more expensive patent-based drugs among the elite [17].

With all of this data accumulating, it would seem self-evident that the WHO's move to make a generic combination pill would not face much opposition. In reality, the new US AIDS "Czar", Randall Tobias, the former CEO of Eli Lilly, has almost totally undermined the WHO plan.

While he and the White House initially pledged to support the initiative, no monies have flowed to date, and Tobias appears to be waiting until the program completely collapses from financial instability [18].

Ironically, when President Bush claimed to pledge $15 billion to global AIDS efforts during the State of the Union Address last year (none of which has actually been apportioned to date), he quoted the price of the WHO generic pill as a basis for claiming that the US would support drug treatment for HIV-infected persons, since such treatment has become more affordable [19]. It now appears that the US will only pay if US patent-based pharmaceutical manufacturers are given the money - an effective subsidy of an already heavily-subsidized industry that is taxed at only one-third of the rate of other equivalent industries [13, 18].

While the pharmaceutical industry has been lobbying the White House throughout this week to undermine the WHO initiative, Tobias has publicly stated that his concerns are not about the industry's interests, but about the safety of generics and the prospect that cheaper AIDS drugs would be smuggled illegally into Northern countries. "We need to have principles," he told the US Congress this week, "standards by which the purchase decisions can be made" [1].

The WHO has taken care of the safety standards concern by inspecting and making a list of "approved" generics whose safety standards meet international guidelines [20]. But the US Department of Health and Human Sciences has now convened a conference in Botswana on March 29 that will question the WHO's approval process, drawing in "experts" from the patent-based industry to claim that the process every major academic public health expert in the field has supported is somehow inadequate and unsafe [18].

The smuggling claim is more complex; while the company GlaxoSmithKline did have a shipment of AIDS drugs diverted from Sierra Leone early last year, it was later found that the shipment was partly still in Europe and simply mis-warehoused by GSK, and that the smuggling of the rest of the drugs took over a year for GSK to discover [21].

Indian generic manufacturers have been shipping drugs for over two decades without a single case of "diversion", and the fact that generics create new formulations and new pill shapes, colours and boxes makes it easier for customs officials to detect any form of diversion, as they would for any other type of illegal smuggling [22]. The EU has passed a customs regulation to assist in preventing any future diversion; while the US could do the same. Taking care of the problem this way would ironically undermine Mr. Tobias' own arguments.

It appears clear that Randall Tobias' agenda is not driven by data or rational thought, but by the industry whose combined soft- and hard-money campaign donations top the list of contributors in the US election cycle [23].
Shining a light on the Czar's activity may begin to expose his practices to scrutiny and - as was done when he and the US Trade Representative tried to undermine a WTO accord for generic drug procurement earlier this year - may prevent disintegration of an important public health initiative [24].

* Sanjay Basu is at the Yale University School of Medicine.
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* Click on the link below for a list of reading materials and references.

* Visit the Advocacy and Campaigns section of Pambazuka News to read more about the March 29 meeting in Botswana where activists fear that generic medicine treatment will be discredited.