Kaiser Daily HIV/AIDS Report s 2-6 Apr 2001

--
Sachs to Announce Plan for 'Massive New Effort' Aimed at Fighting
AIDS in Africa

Harvard economist Jeffrey Sachs is expected to announce today an "un-
precedented" coordinated effort to combat AIDS in Africa, the Phila-
delphia Inquirer reports. The United Nations, U.S. government offi-
cials, the European Union, African governments, the World Health Or-
ganization, the World Bank, pharmaceutical companies and private
foundations, such as the Bill and Melinda Gates Foundation and the
Rockefeller Foundation, have been discussing the plan -- which calls
for US$ 6 billion a year from industrialized nations -- "privately
for months," the Inquirer reports. Nearly half of the money raised
would go toward the purchase of antiretroviral medications for more
than 10% of the estimated 25.3 million HIV-positive Africans, while
the rest would be used to "greatly accelerate" HIV prevention pro-
grams in Africa. Drugs would be "carefully" distributed using the
continent's existing medical infrastructure and possibly a network of
HIV prevention trial sites recently established by the National In-
stitute of Allergy and Infectious Disease, the agency responsible for
coordinating AIDS trials in the United States, in South Africa, Zam-
bia, Zimbabwe, Malawi, Tanzania and Uganda. Drug therapies would also
be "closely monitored," most likely using a system of "direct[ly] ob-
served therapy," which involves volunteers visiting patients at home
to observe them taking their medications. The "proposed assault" on
AIDS would be the largest campaign ever waged against a single dis-
ease anywhere in the world and would also include plans for improving
treatment of tuberculosis and malaria. Today's announcement by Sachs,
who is director of the Harvard Center for International Development
and a consultant to the project, will offer the first details of the
program, including the estimated number of Africans who will receive
medication, the cost of the plan and the size of donations needed to
subsidize the proposed programs.

U.S. Involvement

The announcement is also "aimed at influencing the Bush administra-
tion to take the lead" in supporting the effort. It "remains to be
seen" whether the administration will fully support the effort, but
the Inquirer reports that Secretary of State Colin Powell is said to
be "receptive to the relief program." The needed U.S. contribution is
projected to be about US$ 2 billion a year, well above the current
US$ 260 million the government currently spends on AIDS in Africa.
Most of that money goes toward HIV prevention efforts and care of
people affected by the epidemic, such as AIDS orphans. "Almost none"
goes toward the purchase or distribution of antiretroviral medica-
tions. Sen. Bill Frist (R.-Tenn) is working on a budget amendment to
increase U.S. funding for African AIDS programs, but does not cur-
rently have a dollar amount. "The U.S. will come in strongly and
rightly. The current line they are taking is absolutely right. They
are giving warm encouragement and waiting to see what will happen,"
an unnamed WHO official said. Italy and Great Britain have already
come out in favor of an international fund for AIDS medicines. U.N.
officials hope to have "specific financial commitments" from the
United States and other G7 nations by their July meeting in Italy.

Why Now? What's Changed?

The new proposal was made possible by the recent price reductions
from the world's major pharmaceutical companies, according to the In-
quirer. The price cuts have turned what was once thought to be "hope-
less" into a "do-able, if ambitious, treatment effort," the Inquirer
reports. Most patients will be given a three-drug combination ther-
apy, projected to cost US$ 500 per patient annually. U.N. agencies
have reached a "consensus" that in exchange for the price reductions,
the pharmaceutical industry's patent rights will be protected in
their "core markets" in the West. The plan now hinges on funding.
"The beginning and end of this is U.S. money. The drug companies are
not going to solve the problem on their own. This has finally come
down to the bottom line of whether the taxpayers will help do that,"
Sachs said last week. The consortium hopes to have a "concrete plan"
prepared in time for the U.N. General Assembly's special session on
the AIDS epidemic at the end of June (Collins/Warner, Philadelphia
Inquirer, 4/4).

--
Conference to Address Children Orphaned by AIDS Begins in Uganda

The Eighth International Society of Women and AIDS in Africa Confer-
ence (SWAA) began Monday in Kampala, Uganda, with this year's summit
focusing on children orphaned by the epidemic. Titled "Children and
AIDS: Challenges and Strategies to Cope," the five-day conference
will examine the epidemiology of HIV in children, the reduction of
mother-to-child transmission, health care for HIV-positive children,
"child-headed households" and social support systems for children af-
fected by the virus (Agence France-Presse, 4/3). Conference Chair Dr.
Margaret Muganwa said, "The conference is a call for Africa to under-
take a critical appraisal of its HIV/AIDS priorities and re-focus in-
terventions and strategies to stop HIV/AIDS among and on behalf of
our children, the next generation" (Muganwa speech, 4/2). Col Sec,
director of country and regional support for UNAIDS, added, "There
are orphans on [the] streets, orphans only with one parent, or or-
phans who are heading households. All this is really a disaster." Sec
said that many orphans become "vulnerable to infection" as a result
of sexual abuse, others "suffer from neglect" after their parents
die, and some can "find themselves living with already over-burdened
relatives." Janet Museveni, wife of Ugandan President Yoweri
Museveni, opened the conference. Tanzanian first lady Anna Mkapa and
Nigerian first lady Stella Obasanjo are also attending the event
(Agence France-Presse, 4/3).

--
Cecilia Snyder
mailto:[email protected]

Kaiser Daily HIV/AIDS Report - Mon, 2 Apr 2001
----------------------------------------------

* Merck AIDS Vaccine Slows Progression to AIDS in Monkeys, Does Not
Prevent Infection
* Poor Nations' Health Systems Must Be Built Up to Benefit from
Cheap, Available Drugs
* South African Women Note Country's 'Frankness' in Discussing Sexu-
ality, HIV/AIDS
* Nigeria Faces 'Dilemma' in Discussing Safe Sex
* Kenyan Minister Claims to Have Healed Thousands of AIDS Patients,
New York Times Reports

--
Merck AIDS Vaccine Slows Progression to AIDS in Monkeys, Does Not
Prevent Infection

Merck & Co. scientists announced yesterday at an AIDS conference in
Keystone, Colo., that a common cold virus has proven to be an "effec-
tive vehicle to deliver a potent anti-AIDS vaccine to monkeys," the
Philadelphia Inquirer reports. At a closed-door meeting on "AIDS Vac-
cines in the New Millenium," scientists announced that the vaccine,
delivered in "disarmed" adenovirus, did not block HIV infection nor
rid the body of infection, but suppressed the virus to levels "too
low to be detected," allowing HIV-infected monkeys to remain healthy
for more than a year (Collins, Philadelphia Inquirer, 4/2). Twenty-
one monkeys were infected with an "especially nasty" combination of
HIV and simian immunodeficiency virus, the monkey counterpart to HIV.
The virus "quickly" manifested and generated 100 million virion cop-
ies per cubic centimeter of blood. Of the six control monkeys that
were not given any vaccine, five developed AIDS-like illnesses and
four have died, according to John Shriver, Merck's director of vac-
cine research. None of the monkeys given the adenovirus vaccine have
developed any "AIDS-like" illnesses and the amount of virus in the
bloodstream has been reduced to about 500 copies per cubic centime-
ter. Shriver warned that the studies are "very early," and that it is
"impossible to predict" whether any of Merck's experimental vaccines
will work in humans (Sternberg, USA Today, 4/2).

Using the Gag Gene

The vaccine is an improved version of one detailed by company scien-
tists last year. Working with "relatively new" knowledge of the in-
teraction between HIV and the human immune system, researchers became
"convinced" that an effective vaccine "must" stimulate the release of
CD8+ cells, or "killer T cells," specific immune cells that can "seek
out" HIV-infected cells and "destroy" them, thereby "squelching the
virus' ability to replicate and spread." Researchers learned that
proteins produced by three of HIV's major genes stimulated a killer T
cell response, but the gene known as gag was the most effective
stimulator. Researchers first injected monkeys with the genes alone,
an approach called "naked DNA," but the genes alone were not generat-
ing the "strong response" for which researchers had hoped. Last year,
researchers "stitched" the genes into a deactivated adenovirus, which
is unable to cause colds. Researchers hoped they could "harnes[s]"
the adenovirus' "natural viral action" to deliver the DNA to immune
cells in order to trigger the release of the killer T cells (Wald-
holz, Wall Street Journal, 4/2). Adenovirus was chosen because it
typically invades dendritic cells, cells that play a "pivotal" role
in immune response because they "pick up" invading viruses and
"alert" other immune cells into response. They are found in all parts
of the body, including mucosal cells in the vagina, making them "po-
tentially very important" in fighting sexual transmission of HIV
(Philadelphia Inquirer, 4/2). In all, researchers tested five vac-
cines, each containing the gag gene. In addition to the adenovirus
vaccine, one vaccine used gag in vaccinia virus, the virus used in
the original smallpox vaccine, and three vaccines used the naked DNA
approach with or without booster shots of adjuvants. The naked DNA
approach with a booster of an adjuvant called CRL-1005 produced an
immune response "similar" to but "less dramatic" than the adenovirus
vaccine.

'Good Stuff' Down the Road

"This [research] is the manifestation of what we in the field have
been saying: We have good stuff in the pipeline," Anthony Fauci, di-
rector of the National Institute of Allergy and Infectious Diseases,
said. Two other research groups -- one at Emory University and one at
Harvard Medical School -- have achieved "similar" results, but the
Merck project is the only one to use a "cell-mediated immunity" ap-
proach (Brown, Washington Post, 4/2). Merck's vaccine is still in the
early stages and faces "at least" three years of safety trials before
it can move into large-scale efficacy trials, which may take an addi-
tional three to five years to complete. Merck plans to continue test-
ing the adenovirus vaccine and the naked DNA/adjuvant approach, as
well as an approach that "prime[s]" the immune system with naked DNA
before administering the adenovirus, which yielded the study's "best"
results. Small human trials are being conducted in several U.S. medi-
cal centers to determine whether "double inoculation" is safe. The
ultimate goal of HIV vaccine research is to block the virus from
"ever taking hold," John Moore, a vaccine researcher at Weill Medical
College-Cornell University, said. But researchers have not determined
how to produce an antibody response to "stimulate" the necessary com-
bination of "neutralizing antibodies" and killer T cells (Wall Street
Journal, 4/2). A vaccine that prevented infection would still "likely
have a major effect on the spread of the virus" because epidemiologi-
cal evidence shows that people with lower viral levels are "less
likely" to transmit the virus (Philadelphia Inquirer, 4/2).

--
Poor Nations' Health Systems Must Be Built Up to Benefit from Cheap,
Available Drugs

The benefit of getting more and cheaper AIDS drugs for poorer nations
could be derailed unless those countries' public health systems are
strengthened, American and African experts say, the New York Times
reports. Representatives of American foundations and African health
officials say that "ineffective distribution or misuse" of the drugs
could lead to new strains of drug-resistant HIV. The Times reports
these concerns in advance of two "major" meetings to be held in Af-
rica this month that will highlight drug distribution and use, among
other issues surrounding the pandemic. African experts and American
donors will meet April 18 to April 20 in Kampala, Uganda, and an Af-
rican regional meeting on AIDS will be held from April 25 to April 27
in Abuja, Nigeria. In addition, a special "high-level" U.N. General
Assembly session on AIDS will take place in June.

Preparing for Wide Use

The Times reports that while countries such as Uganda and Senegal
have been "leader[s]" in strengthening their public health and infor-
mation systems, "many countries in Africa and Asia do not have simi-
lar services" (Crossette, New York Times, 4/1). In Malawi, for exam-
ple, there are only two doctors per 100,000 people, the Boston Globe
reports (Donnelly, Boston Globe, 4/1). The Associated Press reports
that the African continent would have to "undergo a construction
revolution" before a comprehensive drug administration program could
begin, building roads to remote villages and laboratories to analyze
blood samples. "Most people do not even have enough food to help them
digest AIDS drugs, or a clean glass of water to wash down the pills,"
the Associated Press adds (Associated Press, 4/2). But the Globe
notes that there no formal plans to build such an infrastructure yet
exist, adding, "No one has an accurate cost estimate. There is no
country-by-country analysis of what needs to be done. In fact, there
is no analysis of what needs to be done in even a single country in
sub-Saharan Africa" (Boston Globe, 4/1).

Fears of Resistance

In addition, the Times reports that many public health officials are
concerned that people need to be taught to take the "new AIDS drugs
correctly," which could be a "big burden" to governments and local
health authorities. Dr. Gordon Perkin, director of the global health
program of the Seattle-based Bill & Melinda Gates Foundation, said,
"There's a lot of concern about compliance -- that if you don't get
large numbers of people taking [the drugs] consistently and cor-
rectly, you risk the probability of getting a resistant strain of HIV
emerging. Just like antibiotics" (New York Times, 4/1). Resistant
strains could also emerge if African governments temporarily run out
of money to buy medicines, the Associated Press reports. "You'd be
better off taking the money that you'd use making antiretrovirals
available across the country and pouring it into prevention programs
across the country," Dr. Robert Carter, an American working in Zam-
bia, said, adding that focusing so much attention on medicating all
AIDS patients is "simply irresponsible" (Associated Press, 4/2).

'Opportunity for Corruption'

Arthur Mbanefo, Nigerian ambassador to the United States, also said
there exists a "great opportunity for corruption in making, selling
or distributing AIDS drugs." According to experts in Nigeria, studies
have found that over-the-counter sales of pills often are "fraudulent
or substandard." Furthermore, organizers of the U.N. special session
say they "want to move the conference beyond the issues of drug
prices and accessibility." Penny Wensley, Australian ambassador to
the United Nations, said, "There's no doubt that access to drugs is
important for huge numbers of people who are suffering from HIV/AIDS
and are currently unable to afford them. But we have to deal with
this in a comprehensive and sustainable manner. At this special ses-
sion, we've got to galvanize the community, we've got to mobilize re-
sources." She added, "We have to look at distribution systems. We
have to look at health infrastructure, and we have to look at quality
control. We have to make sure that there are continuing incentives
for research" (New York Times, 4/1).

--
South African Women Note Country's 'Frankness' in Discussing Sexual-
ity, HIV/AIDS

A "sexual revolution" in South Africa is "underway," with more South
Africans realizing the need to discuss sex and HIV/AIDS openly, mem-
bers of the Women's Health Project of South Africa told activists
gathered in Boston Thursday. The Boston Globe reports that Ndivhuwo
Selinah Masindi, one of the group members, said that religious groups
in South Africa "have realized that [counseling] abstinence is not
effective." Group member Zanele Hlatshwayo added that South Africans
have a "sense of empowerment" that resulted from the end of apart-
heid, giving many in the country a feeling that "anything is possi-
ble, including reducing HIV." However, the resulting "frankness"
about sexuality and fighting HIV are "lacking" in the United States,
Hlatshwayo said. "I expected the United States to be even more open
about issues of sexuality. ... I'm surprised. I find Americans very
conservative," she said. Masindi added that Americans "shrink away"
from "certain words" associated with sexuality. The members of the
women's health project hope to spur women to "have control over and
decide freely and responsibly on matters related to sexuality." In
their native South Africa, the women are currently focused on trying
to "prod" the country's criminal justice system to "deal effectively"
with sex crimes (Mishra, Boston Globe, 3/30).

--
Nigeria Faces 'Dilemma' in Discussing Safe Sex

A conflict over radio advertisements alerting Nigerian youth to the
"dangers" of unsafe sex illustrates that Nigeria "still struggles
with straight talk about sex," Agence France-Presse reports. In
March, a series of radio commercials aimed at informing young people
about the consequences of unsafe sex were pulled from the air after a
complaint by the state-run Advertising Practitioners Council of Nige-
ria. The council objected to the ads' "near-the-knuckle language,"
stating that the commercials violated a broadcasting code that barred
broadcasts "offensive to public feeling ... or disrespectful to human
dignity." After talks among the health ministry, government officials
and the nongovernmental organization that co-sponsored the campaign,
the advertisements are expected to be aired again soon but with some
of the language "toned down," ministry officials said. However,
Rhythm FM, a Lagos-based radio station, earlier this year began air-
ing its own safe-sex campaign by opening and ending its news broad-
casts with a series of warnings about HIV/AIDS. Jacob Akinyemi-
Johnson, a spokesperson for the station, said, "We have a responsi-
bility as a radio station for enlightening the community. AIDS is a
plague that could wipe out an entire generation of Nigerians." He
said that the "difficulties" surrounding the subject of sex in Nige-
ria could be "overcome." "[P]eople understand what we are saying," he
said. However, the country's "cultural ... sensitivities" and "power-
ful" Islamic and Roman Catholic traditions make the open discussion
of sex a "dilemma," Agence France-Presse reports (Cunliffe-Jones,
Agence France-Presse, 3/30).

--
Kenyan Minister Claims to Have Healed Thousands of AIDS Patients, New
York Times Reports

Thousands of Kenyans with HIV/AIDS are seeking the assistance of the
"charismatic" Rev. John Nduati and his Church of God's Power to heal
them, the New York Times reports. Nduati, a Protestant minister who
says he began healing people at age 10, claims that he has cured
thousands of Kenyans -- residents of a nation that "has become noto-
rious for AIDS quackery" -- of AIDS, the "mainstay of his ministry."
Of Kenya's 29 million residents, about 2.3 million have HIV, the
Times reports. On a recent Sunday, 161 people with HIV came to a ser-
vice, seeking healing. During the service, Nduati healed Francis Ma-
nene, a 41-year-old with AIDS, saying, "You are mighty and wonderful
and there is no other God like you. This brother has a bad disease.
He would like to be healed. Change him from positive to negative, and
he will live to glorify your name." Nduati "dismisses any suggestion
that the healing is not real" and claims he can produce hundreds of
people with documentation proving their healing. He added that "his
credibility [is] bolstered by the fact that his services [are] free."
He said, "I want this country to be like Switzerland. Free from cor-
ruption and free from criminals. ... If I were supported, I [would]
reach the whole world. And they [would] be healed" (Fisher, New York
Times, 4/1).

--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.

Kaiser Daily HIV/AIDS Report - Fri, 6 Apr 2001
----------------------------------------------

* US Senate Approves Additional $700 Million Over Two Years to Fight
HIV/AIDS in Developing Nations

* IAVI, U.S. Biotech Firms, Indian Manufacturers Collaborate to De-
velop AIDS Vaccine

* Annan Gets Continued Price-Reduction 'Assurances' from Six Drug
Makers at 'Secret' Meeting in Amsterdam

* Editorials Weigh in on Cheaper Drug Access in Developing World

--
US Senate Approves Additional $700 Million Over Two Years to Fight
HIV/AIDS in Developing Nations

The Senate passed by voice vote yesterday an amendment to the budget
proposal that would allocate an additional $700 million over the next
two years to fight HIV/AIDS in developing nations, the Philadelphia
Inquirer reports. The measure would boost total U.S. funding for in-
ternational HIV/AIDS efforts to $1.1 billion by 2003, with the "bulk"
of the new funding going to countries in sub-Saharan Africa that have
"developed clear plans to combat the epidemic" (Collins/Warner,
Philadelphia Inquirer, 4/6). The amendment calls for increases of
$200 million in fiscal year 2002 and $500 million in FY 2003, with
the new funding to be taken from the budget surplus. This year's
budget for international AIDS initiatives is about $460 million, but
the House has made "[s]imilar calls for doubling AIDS spending," the
Washington Post reports (DeYoung, Washington Post, 4/6). A spokesper-
son from the State Department declined to comment on the funding in-
crease, but said that the Bush administration plans to "propose an
increase in spending on the global epidemic in its 2002 budget," with
details to be disclosed later this month (Philadelphia Inquirer,
4/6). Secretary of State Colin Powell has asked for a 10% increase in
the department's global AIDS funding (Washington Post, 4/6).

International Fund

The amendment, sponsored by Sen. Bill Frist (R-Tenn.), would place
foreign aid for HIV/AIDS into an "international fund," which would
also contain contributions from other developed nations, private
foundations and "possibly even private corporations," the Inquirer
reports. The money in the fund, which would be overseen by interna-
tional monitors, would go toward the bulk purchasing of antiretrovi-
ral drugs "at greatly discounted prices." The proposal "does not
specify" how much of the new funding will go toward purchasing AIDS
drugs, but Frist added that "drugs alone are not enough," and called
for the expansion of HIV prevention programs and a greater number of
medical clinics and staff. Frist, chair of the Senate Foreign Rela-
tions subcommittee on African affairs, said, "Americans have always
been among the first to tackle the most difficult challenges of the
times. We must do no less when confronted with perhaps the worst in-
ternational health crisis since the bubonic plague ravaged Europe 600
years ago." He added that community-based organizations in Africa are
likely to be the "linchpin of success" in fighting the epidemic. The
United States currently spends about $260 million annually to fight
HIV/AIDS in Africa (Philadelphia Inquirer, 4/6). The spending in-
crease will bring the country "a considerable distance toward meeting
its part" of the United Nations' recommendation of $3 billion to $5
billion from wealthy nations to fight the spread of the disease in
Africa (Washington Post, 4/6). Harvard economist Jeffrey Sachs, how-
ever, said that the proposed spending increases are "not enough." On
Wednesday, Sachs outlined a plan, supported by United Nations agen-
cies, that calls for the United States to provide $1.5 billion per
year "immediately," with that contribution rising to $3.3 billion per
year over three years (Philadelphia Inquirer, 4/6).

--
IAVI, U.S. Biotech Firms, Indian Manufacturers Collaborate to Develop
AIDS Vaccine

U.S. and Indian researchers are "embarking on a bold experiment" to
determine if "reasonably priced AIDS vaccines" may be tested and
manufactured in developing countries without violating patents from
companies in developed nations, the Wall Street Journal reports. The
International AIDS Vaccine Initiative is negotiating a deal to permit
Serum Institute of India Ltd. to manufacture a vaccine using patented
vaccine-making technology developed by U.S. biotech firm Therion Bio-
logics Inc. "free of charge." At the same time, U.S. biotech company
Chiron Corp. is "scouting" for an Indian partner to assist with the
funding and development of an AIDS vaccine that is close to human
trials. Chiron may contract a $30 million technology-transfer fee
with either Shantha Biotechnology or Biological Events Ltd. to help
fund Chiron's initial vaccine research costs.

Avoiding a 'Battle'

IAVI President Seth Berkley is hoping for an AIDS vaccine to be si-
multaneously introduced in rich and poor countries, an unprecedented
move. "By investing in U.S. companies, and acting as a broker between
them and developing-world companies, IAVI is trying to avoid some of
the bruising battles over prices and patents that have enveloped
AIDS-treatment drugs recently," the Wall Street Journal says. For In-
dia, working with the United States on AIDS research may help "boost"
its goal of becoming a biotechnology power, and provide a way to stop
a disease that has infected 3.7 million Indians. U.S. biotech compa-
nies' ability to combine research efforts with those in India is
beneficial because vaccine research and production costs are lower,
and the country is a "fertile ground" for human clinical trials, as
the disease is rapidly spreading. However, researchers face a "sensi-
tive political issue" with human testing in India, and there is no
guarantee that the vaccines will work or be more effective than those
produced by other firms.

Protecting Technology

The Wall Street Journal reports that "protecting a technology while
spreading it isn't easy," as it can "leak out" to other manufacturers
or be applied to make other vaccines. But Indian officials and vac-
cine makers are aiming to convince foreign companies that they can be
trusted with the use of patented technologies, as long as the uses
are restricted. South Africa is also seeking an intellectual property
agreement with Chiron to grant it the right to make the vaccine for
southern Africa. For firms that are hesitant to transfer technology
for security concerns, IAVI has formed a "social venture capital"
fund that invests research and development funds in three biotech
companies, including Therion, and two academic institutions. Rather
than asking for monetary returns, IAVI requires its partners to price
the vaccine at a low cost for poorer countries while no limit is set
on prices for richer countries. IAVI retains the right to solicit
bids from other manufacturers in developing nations "to put teeth in
the agreement" (Schoofs/Pearl, Wall Street Journal, 4/6).

--
Annan Gets Continued Price-Reduction 'Assurances' from Six Drug Mak-
ers at 'Secret' Meeting in Amsterdam

U.N. Secretary-General Kofi Annan yesterday received "high-level as-
surances" from the chief executives of six of the world's "most pow-
erful" pharmaceutical firms that they would continue to "accelerate"
price reductions on AIDS medications for the developing world, the
Wall Street Journal reports. In return, the United Nations will not
take part in the "escalating crusade" against patent protection, the
Journal reports, calling this a "crucial concession." In a post-
meeting interview Annan said, "We affirmed to [the CEOs] that the in-
tellectual property regime is essential if companies are going to
have the incentive to do the research to produce effective medicines
for these diseases." Annan met for three hours yesterday with offi-
cials from Abbott Laboratories, Bristol-Myers Squibb, Boehringer
Ingelheim, Pfizer, Roche Holding and GlaxoSmithKline in Amsterdam on
"very short notice." Merck & Co. was "[n]otabl[y]" absent from the
meeting. Company executives had planned on attending but decided
against it on Wednesday night when lawyers warned them that "any talk
about specific pricing might be seen as price fixing" (Freedman, Wall
Street Journal, 4/6). The meeting was kept "secret" from reporters,
who were told a dinner with Dutch Queen Beatrix was the only commit-
ment on Annan's schedule (AP/Milwaukee Journal Sentinel, 4/6). World
Health Organization Director Gro Harlem Brundtland and UNAIDS Execu-
tive Director Dr. Peter Piot also took part in the meeting (UNAIDS
release, 4/5).

The Agreement

The pharmaceutical companies agreed to negotiate drug prices with the
50 "least-developed" countries as a group -- "abandoning the lengthy
process of cutting deals for AIDS drugs with each country individu-
ally," a process criticized as "slow and unwieldy," the Journal re-
ports. In an agreement reached in May, five leading drug companies,
excluding Abbott and Pfizer, agreed to reduce prices in Africa by 80%
to 90% on a country-to-country basis. Yesterday's agreement will also
extend the price reductions to developing nations outside of Africa,
as well as to "certain private, non-governmental agencies and employ-
ers" (Wall Street Journal, 4/6). Upon his return from Amsterdam
Thursday night, Abbott CEO Miles White said, "We want to focus our
efforts on those areas where there is no health care or little access
to health care. [Annan] wanted to make sure we aren't limiting our-
selves to Africa. The fact is, we are not" (Japsen, Chicago Tribune,
4/6).

A 'Personal Priority'

According to the AP/Milwaukee Journal Sentinel, the meeting was a
"signal that Annan is deepening his personal involvement in combating
AIDS in poor countries, before an AIDS summit this summer in New
York." Fighting AIDS "has become my personal priority," Annan said
(AP/Milwaukee Journal Sentinel, 4/6). But even with yesterday's pro-
gress, Annan failed to "exact specific pricing concessions that he
had hoped for." One meeting participant said Annan wanted "more com-
mitments" on pricing, but "none of [the drug company representatives]
wanted to talk about that because they are all a little spooked, es-
pecially the American companies, about antitrust." Annan said he was
"satisfied" with yesterday's results and denied that "specific pric-
ing concessions" were on his agenda. He also said he will conduct
"periodi[c]" meetings with the drug company officials to "review
their progress" over the coming months (Wall Street Journal, 4/6).
The meeting came on the heels of the announcement Wednesday of a
"massive" anti-AIDS plan to be "spearheaded" by the United Nations
and WHO. Harvard economist Jeffrey Sachs unveiled the basics of the
multi-billion dollar plan Wednesday. The proposal will be presented
at the special meeting of the U.N. General Assembly on AIDS in June
(Farley, Los Angeles Times, 4/6).

--
Editorials Weigh in on Cheaper Drug Access in Developing World

The quest to improve access to cheaper AIDS drugs in sub-Saharan Af-
rica continues to prompt responses from news sources across the
United States. The following is a sample:

* Newsday:
"Credit the world's pharmaceutical industry for finally slashing
prices on anti-HIV drugs in southern Africa. True, it acted in part
to polish its image and to protect its patents, but never mind. If it
is willing to supply medicine at close to cost in impoverished na-
tions where the epidemic is rampant, then rich nations such as the
United States should be willing to keep paying retail prices -- which
help underwrite research and development work," a Newsday editorial
says. But even with drug discounts, "larger" problems for drug dis-
tribution remain. The editorial asks, "First, how can Africa afford
drugs supplied even at cost? Second, who will administer the highly
complicated regimens to ensure that they are used safely?" The edito-
rial points to Harvard economist Jeffrey Sachs' plan announced ear-
lier this week that calls for donor nations to supply about $1.1 bil-
lion per year to a global trust fund to purchase drugs for about one
million Africans at cost and then distribute them in monitored plans
throughout the region. Although this plan is not without flaws, "it
should at least ignite a global conversation on how best to stave off
a looming holocaust," the editorial concludes (Newsday, 4/6).

* MSNBC.com:
Dr. Arthur Caplan, director of the Center for Bioethics at the Uni-
versity of Pennsylvania, writes in an op-ed, "If drugs are credited
with transforming HIV from an almost certain death sentence to a
chronic, manageable disease in developed nations, isn't it our moral
duty to make sure that people in the poorest countries hardest hit by
the AIDS epidemic have access to these same medications?" Maybe not,
he says, explaining that drugs "don't get to the heart of the AIDS
epidemic." Caplan continues, "Simply throwing drugs at countries that
have no educational or public health programs will not slow the
spread of the disease. Unless drug distribution is linked to public
health campaigns, AIDS will not be stopped. And the high cost of
drugs means that eventually, the patience of drug companies and their
shareholders for giving the medications away will run out and the me-
dia will get bored with the story of people in far-away lands dying
in droves for want of medications." Instead, those dying of AIDS in
poor nations need a "solid health care infrastructure" where they can
receive "a clean bed to lie in and safe water to drink," in addition
to donated drugs (Caplan, MSNBC.com, 4/4).

* Washington Post:
Although encouraging announcements of large drug price cuts have been
issued by drug giants over the last several weeks, a Washington Post
editorial says that the "industry needs to move further." While some
firms have "yet to offer serious discounts," other announcements
"have proved less significant than they seemed," as drug makers at-
tached so many conditions to the discounts that they "made almost no
difference." The editorial continues, "Still, the industry is getting
to the point where responsibility for the next step will fall to the
Bush administration and other leading governments," for even at dis-
counted rates "the cost of AIDS drugs exceeds the ability of poor
countries to pay, and the cost of the clinics and training necessary
to deliver the drugs makes the challenge even tougher" (Washington
Post, 4/2).

--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.

--
Cecilia Snyder
mailto:[email protected]