"You can tell the people that if they succeed in killing me,
that I forgive and bless those who do it.
Hopefully, they will realize they are wasting their time.
A bishop will die, but the church of God,
which is the people will never perish”
"A church that suffers no persecution
but enjoys the privileges and support of
the things of the earth - beware! is not the true church of Jesus Christ."
From a letter to President Carter:
"You say that you are Christian.
If you are really Christian,
Archbishop Oscar Romero
please stop sending military aid
to the military here,
because they use it only to kill my people."
Combination therapy (HAART) revolutionzed
the fight against AIDS in the US
With deaths dropping 84% in the developed world
However, in the late 1990’s
these drugs cost $10,000-15,000 per year!
Why so expensive?
Companies seek to recoup research costs
And make profits while medicines are
under patent
Companies seek to recoup research costs
And make profits while medicines are
under patent
US drug patents give 20 years of protection,
but they are applied for before clinical trials,
so the effective life of a drug patent
tends to be 7-12 years.
$10,000 to $15,000 per year is
not very affordable if you are
one of the 2.6 billion—
40% of the world’s population—
living on less than US$2 a day.
2007 Human Development Report (HDR) United Nations Development Program
Five years after HAART therapy
was introduced in the West,
<8,000 people in all of sub-Saharan Africa
were receiving the life-saving drugs
Avert.org
A few nations (not the poorest)
Took leadership roles in dealing
With this crisis
A few nations (not the poorest)
Took leadership roles in dealing
With this crisis
In 1996 the government of Brazil pledged provide
free combination antiretroviral treatment by the end of the year.
It said it would spend up to $45 million/year
on protease inhibitors
.
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
This made a big difference!
By 2000 the number of people living with HIV in Brazil
was less than half that once predicted
and the number of AIDS deaths plummeted 50%
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
This made a big difference!
By 2000 the number of people living with HIV in Brazil
was less than half that once predicted
and the number of AIDS deaths plummeted 50%
"It makes a lot of sense to look at what Brazil is doing...
Something they're doing is working." Mbulelo Rakwena, South Africa's ambassador to Brazil
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
Big Pharma also made some concessions
In 1996 Glaxo Wellcome cut the price of AZT by 75%
after a trial in Thailand showed it was safe and effective
at preventing mother-to-child transmission
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5
This was still much too expensive
For patients in the developing world!
In 1996 Glaxo Wellcome cut the price of AZT by 75%
after a trial in Thailand showed it was safe and effective
at preventing mother-to-child transmission
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5
Big changes required two things
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Get Cheaper drugs by avoiding patent protection
Round 1, 1999
South Africa passed legislation
that enabled local companies
to manufacture or import
HIV/AIDS drugs at a fraction
of the price of patented drugs.
The US argued that this
undermined patent rights.
BBC News (1999) ' Africa AIDS drug trade dispute ends', September 18
The Pharma Empire strikes back
39 major pharmaceutical
companies prosecuted
the South African government
for this legislation.
International pressure eventually affected this
Patent litigation in 2001
International pressure eventually affected this
Patent litigation in 2001
Major pharmaceutical companies withdrew their
challenge of South African legislation after protests
by the European Parliament and a petition against
the action was signed by 300,000 people
from over 130 countries
Get Cheaper drugs by avoiding patent protection
Round 2, 2001
The Indian drug company Cipla
offered to make AIDS drugs
available at sharply reduced prices
(<$1 per day!) to Doctors without Borders
(Medecins Sans Frontieres)
Kumar S. (2001) 'Indian company offers low cost AIDS drugs', the Lancet, 357:616 February 24
This spurred changes in pricing
By Big Pharma
In essence it was a price war
and patients won
Not everyone was impressed by Pharma’s offer
''…a victory, but a small one,
much like an elephant giving birth to a mouse'’
Doctors without Borders (Medecins Sans Frontieres )
Generics mean the price of
antiretroviral medication in
resource-poor countries
continues to plummet
A year’s first-line drugs
can now be bought
for as little as $92.2
Towards Universal Access: Scaling up priority
HIV/AIDS interventions in the health sector",
WHO, 2008
Generics mean the price of
antiretroviral medication in
resource-poor countries
continues to plummet
A year’s first-line drugs
can now be bought
for as little as $92.2
In 2007, generics accounted for 57% of the
$131 million PEPFAR spent on anti-AIDS drugs.
Towards Universal Access: Scaling up priority
HIV/AIDS interventions in the health sector",
WHO, 2008
WHO
Prices of antiretroviral medication in
the developed world remain high due to
“Tiered pricing”
Drug prices are calculated using formulas
based on average income per head
Prices of antiretroviral medication in
the developed world remain high due to
“Tiered pricing”
Drug prices are calculated using formulas
based on average income per head
"Preferential pricing is the only way we can
meet both conflicting needs in the fight against AIDS.
We can refinance our high research and development costs
for innovative, new treatments by the established
price system in industrialised countries and can
offer affordable medicines to patients in poor countries
who otherwise cannot afford antiretroviral medication"
- Alessandro Banchi, chairman of Boehringer
“Tiered pricing”
In reality
aids.about.com/b/2006/03/08/how-much-do-hiv-drugs-cost.htm
Updated March 2008
Patent issues continue to linger over the process
In 1995 TRIPS - The Agreement on Trade Related
Aspects of Intellectual Property Rights
was accepted by all members of the
World Trade Organization
Because its implementation will have a huge impact on
generic drug production, most developing countries
(e.g. India) were given a 10-year transition period.
Least developed countries have until 2016.
Avert.org
Patent issues continue to linger over the process
Since 2003 TRIPS has contained a waiver that
allows ''compulsory licenses'' to be issued to
override specific patent restrictions.
With these, countries that suffer a serious health crisis
but are unable to produce drugs at home
can import generics from other nations
In 2002 WHO created a list of preferred AIDS drugs
As part of its list of ESSENTIAL medicines
WHO also issued guidelines for when to start treatment:
Stage 1 asymptomatic
Stage II moderate weight loss and mild infections
Stage III severe weight loss, chromic diarrhea or fever, TB, etc
Stage IV wasting syndrome or severe opportunistic infections
Would you be happy with this if you were the patient?
Stage 1 asymptomatic
Stage II moderate weight loss and mild infections
Stage III severe weight loss, chromic diarrhea or fever, TB, etc
Stage IV wasting syndrome or severe opportunistic infections
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Public pressure grew to find
Funds to help poor patients
"If we can get cold Coca Cola and beer to every remote corner of Africa, it
should not be impossible to do the same with drugs." - Joep Lange, the
President of the International AIDS Society
Many players came together
To push for more money
The World Health Organisation
created the first global target for
ARV treatment access in 2003.
It called for 3 million people in developing countries
to have access to treatment by the end of 2005,
meeting 50% of estimated need.
Congress and the President
Put US dollars behind the effort
President George W. Bush signs the United States
Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 =up to $15 billion over 5 years
As of September 2007,
PEPFAR estimates that it helped provide
ART to approximately 1,445,500 people
Public health experts and nonprofit organizations
have questioned some aspects of
PEPFAR programs, including requirements
mandating that one-third of prevention spending
be directed towards abstinence-only programs.
Progress began well,
but failed to accelerate.
At the end of 2005
only 1.3 million people
in low- and middle-income
countries
were receiving drugs,
40% of the target.
Not surprisingly, progress
was uneven in different
parts of the world. Only
three African nations Botswana, Namibia and Uganda met their 50% targets.
If at first you don’t succeed….
July 2005
The Group of Eight (G8)
(Canada, France, Germany, Italy, Japan, Russia,
the UK and the US) pledged to work toward
universal access to antiretroviral (ARV)
treatment worldwide by 2010.
July 2005
The Group of Eight (G8)
(Canada, France, Germany, Italy, Japan, Russia,
the UK and the US) pledged to work toward
universal access to antiretroviral (ARV)
treatment worldwide by 2010.
Two months later,
all United Nations Member States endorsed this goal
by committing themselves to:
"Developing and implementing a package for HIV prevention,
treatment and care with the aim of coming as close
as possible to the goal of universal access
to treatment by 2010 for all those who need it"
In 2006, UNITAID
an international drug purchase facility
was established to ensure a stable source
of funding for drugs to fight HIV/AIDS,
malaria and tuberculosis.
This IS making
a difference
"3 by 5 has helped to mobilize political and financial
commitment to achieving much broader access to treatment.
This fundamental change in expectations is transforming
our hopes of tackling not just HIV/AIDS,
but other diseases as well." Dr Lee Jong-wook, WHO Director-General
This IS making
a difference
The trend is good but there is a long way to go
Avert.org
The trend is good but there is a long way to go
Avert.org
The trend is good but there is a long way to go
WHO
The trend is good but there is a long way to go
WHO
97% of those treated are receiving 1st line drugs
WHO
What about those resistant to this combination?
WHO
Second line drugs are much more expensive
WHO
The US must continue to lead in this effort
The US must continue to lead in this effort
On July 30, 2008, President Bush signed into law
H.R. 5501, the Tom Lantos and Henry J. Hyde
United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act.=
up to $48 billion to combat the three diseases,
including:$39 billion for: •
PEPFAR bilateral HIV/AIDS programs