Healthy Skepticism Library item: 280

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Publication type: news

8,000 Deaths a Day
Washington Post 2004 Mar 26

Full text:

THE BUSH administration deserves credit for invigorating the fight against the global AIDS pandemic, which inflicted some 5 million new HIV infections last year. But its strategy has two defects. Not enough of the expanded AIDS budget is going through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was up and running before the U.S. program and has a track record of disbursing money quickly. At the same time, the administration is taking a tortuous approach to AIDS treatment. Rather than back the use of unpatented “generic” medicines made by foreigners, it appears keen to find excuses to procure patented drugs from U.S. firms.

Generic AIDS drugs cost perhaps a quarter as much as patented rivals, even after the latter have been discounted, according to the medical charity Medecins Sans Frontieres. Using the expensive option, and therefore treating fewer patients, is perverse, given the scale of the pandemic. Of the 40 million people living with HIV, some 6 million are considered to be in urgent need of treatment, but only 400,000 are receiving it. At $500 per patient per year, which is the low end of the range for patented medicines, it would cost nearly $3 billion per year to buy drugs for all who need them, and billions more to deliver the medicine and monitor treatment. And that’s before counting the cost of spreading safe-sex or abstinence messages, not to mention the cost of caring for AIDS orphans. In his State of the Union address last year, President Bush promised to boost spending on international AIDS to $3 billion annually. That’s a huge increase, but not enough to cover drugs that are four times the price of generics.

Generic drugs are also easier to administer. Because they operate outside U.S. intellectual-property laws, makers of generic drugs can copy the ingredients of patented AIDS drugs and combine them into a single pill. For people with HIV, this can mean taking two pills a day instead of a cocktail of six patented tablets. The simplification makes it easier for patients to take the pills as they are supposed to, reducing the speed at which drug resistance develops.

The administration says that it is concerned that generic drugs may not be safe and that it wants to procure drugs reviewed by a stringent regulatory agency such as the Food and Drug Administration. Generic versions of AIDS drugs are barred from the United States by patent law, so they do not have FDA certification. However, doctors at the World Health Organization have published a list of generic drug makers that produce the drugs to acceptable standards, and other donors have sufficient confidence to buy and distribute their tablets. If the administration does not trust the WHO, it should dispatch inspectors immediately to generics factories.

But instead, it is sponsoring a conference next week to discuss principles on which combination pills should be evaluated. This seems like a digression. Meanwhile AIDS is killing more than 8,000 people a day.