TWN Info Service on Health Issues (August 06/1)

23 August 2006

Lack of universal access to HIV/AIDS drugs threatens lives

As standard drugs cease to work for people with HIV/AIDS, the need for ‘second-line’ drugs is rising. However, these are costly and remain beyond the reach of many. At the 16th International AIDS Conference in Toronto, activists and civil society groups blasted pharmaceutical firms for not lowering drug prices at the cost of people’s lives.

The following article reports on the AIDS conference in Toronto.

With best wishes
Evelyne Hong

As AIDS Drugs Fail, Few Have Any Alternative

By Stephen Leahy, IPS, Toronto, 18 August 2006

While modest gains have been made in lowering the cost of many life-saving HIV/AIDS drugs, these formulas no longer work for a growing number of people, who now need so-called "second-line" drugs that are still priced far out of reach.

Thanks to generic competition and sustained pressure from AIDS activists, the annual cost of standard antiretroviral (ARV) medications has fallen from 10,000 dollars to about 140 dollars per patient per year in countries like South Africa. Several different ARVs must be taken daily to keep the HIV virus at bay, and they often have serious side effects.

At the 16th International AIDS Conference here in Toronto, which ends Friday, Abbott Laboratories was the big pharmaceutical corporation in activists' crosshairs because of the 500 to 2,200-dollar price for its ARV called Kaletra.

"People before profits... Abbott where are you... Save people's lives!" chanted protesters in front of the media centre Thursday.

Kaletra is a second-line therapy, meaning it is used when first-line or standard drugs cease working or have serious side effects. The need for second-line drugs is rising, with up to four percent of HIV sufferers requiring them, according to the World Health Organisation. That number is expected to rise as more people develop resistance after years of taking first-line treatments.

Kaletra is the most prescribed drug in this category and costs 7,500 dollars per year in the United States. It also must be used in conjunction with other anti-AIDS medications.

At the opening of the Toronto conference, Abbott announced that 69 countries in Africa and other poor countries could buy the drug at a special price of 500 dollars per person per year. India, Pakistan and Vietnam and 40 others will pay 2,200 dollars a year per patient.

But activists say that even 500 dollars a year is too expensive, and the 2,200-dollar cost is totally out of reach for most people.

"This is an essential drug that many people need now across Africa. It has to be made more accessible," said Francois Venter, president of the Southern African HIV Clinicians Society.

The Kaletra price reduction is a result of years of lobbying by civil society groups, including People Living with HIV/AIDS and Médecins Sans Frontières (MSF - Doctors Without Borders).

More importantly for developing countries, Abbott recently began selling a newer form of the drug called Aluvia that does not require refrigeration. Although available in North America and Europe, Aluvia has not been registered for use in other parts of the world, activists claimed in a statement.

"It (Aluvia) is the perfect drug for Africa because it doesn't need refrigeration, doesn't have to be taken with food and has fewer side effects," said Matthew Kavanagh of the Student Global AIDS Campaign.

"Given Abbott's massive profits, we think they could find enough people to fill out the forms and register the drug in African countries," Kavanagh said.

According to the company, such registrations are already underway. "We are awaiting approval for use in 12 African countries," said Jennifer Smoter, director of public affairs for Abbott International, based in the U.S. state of Illinois.

Drug registration has to be done country by country and Abbott is trying to register the drug in many countries, including in Latin America, Smoter told IPS.

Regarding the 500-dollar price-tag for Aluvia, she said: "That's what it costs to make the drug. Abbott makes no profit at the 500-dollar price."

The manufacturing process is much more complex for second-line drugs and a special proprietary technology has to be used so that it does not require refrigeration, she said.

"Abbott prefers to invest in increasing its manufacturing capacity rather than working with companies that make generics," Smoter added.

Big pharma wasn't the only target -- the conference organisers were also chided for not publicly pressuring governments to do more.

Doctors Without Borders blasted public health officials for having "their heads in the sand" over costly and unavailable second-generation AIDS drugs needed abroad as resistance rises among the poor now treated with cheap generics.

In Kenya, for example, MSF pays 1,400 dollars per patient per year for a second-line regimen, compared to only 200 dollars for first-line drugs. And in middle-income countries, the price difference is even greater, the group says. In Guatemala, a second-line regimen costs 6,500 -- 28 times more than the first-line treatment.

"Ensuring affordability of newer medicines is the only way to ensure long-term quality care for people with HIV/AIDS in the developing world," said Alexandra Calmy of MSF's Campaign for Access to Essential Medicines in a statement.

Amid the hundreds of scientific papers on vaccines, new treatment methods and infection prevention strategies discussed at the conference, access to existing antiretrovial (ARV) drugs in general continues to be a major issue.

More than 35.5 million people in the developing world are living with HIV, while only 1.6 million are being treated, Kevin De Cock, director of the HIV/AIDS Department at the World Health Organisation, told the conference.

The much-touted "3 by 5" programme -- three million people in treatment by 2005 -- failed to reach its target and De Cock refused to predict when the target would be reached. "It depends on the funding levels, among other things," he said.

Activists say the solution is to simply lower the price of the drugs so everyone can be treated.

"Universal access to drugs is the way to go and excuses about funding and lack of infrastructure are just excuses to do nothing," said Sipho Mthathi, general secretary of the Cape Town, South Africa Treatment Action Campaign (TAC), which lobbies for treatment for people with HIV and to reduce new HIV infections.

"With enough political will we have seen that these drugs can be delivered to people who need them," Mthathi told IPS.

Governments will have to pressure big pharmaceutical companies to make their drugs available at cheaper prices or help other firms make generic versions, she said.

"Brazil and India could be making more of the generic ARVs but have backed off because of pressure by big pharma companies," Mthathi said.

Experts have said that the big pharmaceutical corporations' refusal to license their ARVs to generic competition for use in developing countries over a decade ago led to millions of needless deaths. The generic industry in India, South Africa and Brazil eventually forced dramatically lower prices in early 2000.

However, groups like MSF note that there is still a "burdensome drug-by-drug, country-by-country decision-making process" under World Trade Organisation rules, which also grant 20-year patents for new drugs.

All the media attention at the conference around celebrity donors like Bill Gates, whose foundation just pledged 500 million dollars to the Global Fund to Fight AIDS, TB and Malaria, allows countries to avoid their responsibilities, says Mthathi, who stood before a sign reading: "We are not here to celebrate AIDS".