Medilinks - Cheaper HIV/AIDS drugs in Africa

Cheaper drugs for HIV/AIDS in Africa
by John Kiwanuka Ssemakula, March 21, 2001

The high cost of drug treatment for People living with HIV/AIDS (PHAs) in Africa is headline news once again. But this time the story is different, pharmaceutical companies under intense public criticism and political pressure, as well as competition from generic drug manufacturers in Brazil and India have caved in. They have agreed to sell their HIV/AIDS drugs at or below cost. Merck and Co recently announced a reduction in prices, in response Bristol Myers Squib also announced it “would sell two drugs for a combined $1 a day, a price it said was below cost. In addition, the patent for Zerit, rights to which are owned by Yale University and Bristol-Myers, will be made available at no cost to treat AIDS in South Africa”

So why have the drug companies finally agreed to reduce prices and operate at a loss? To quote the Bristol-Myers Executive Vice-President "We seek no profits on AIDS drugs in Africa, and we will not let our patents be an obstacle" Some cynics have said it is only a public relations exercise in response to the recent bad publicity. The pharmaceutical companies will not be making money, but neither will they lose money, because they don’t sell in Africa anyway. Nonetheless in the fight against HIV/AIDS a lowering of prices is welcome gesture however hollow.

This is good news indeed! Drug cocktails while not a cure for HIV/AIDS have substantially reduced the AIDS death rates in the developed world. The expectation is that they will have the same effect in African countries. But reducing prices is only part of the story. There are a number of questions that need to be addressed and a number of hurdles that need to be met to ensure that the life saving drugs reach the intended recipients.

How much will the drugs actually cost the consumer?
Bristol-Myers said Videx and Zerit would be made available at 85 and 15 cents a day”, equal to $1.00 day. Not very expensive you might say, but this adds up to $365.00 dollars a year as a minimum. A significant amount for the majority of the HIV/AIDS patients in nations where the average yearly income ranges from US$180-$400.

Educating the consumer
Antiretroviral drugs are taken as a cocktail, and they must be taken everyday without fail. Sufferers taking these drugs must follow a rigorous regimen and stick to it to ensure the maximum effect of the drugs. Patient compliance in long illnesses with long treatment times has often been shown to be poor. Another factor that may lead to non-compliance and breaking the rigorous pill-taking routine are the often unpleasant or debilitating side effects of the drugs used in combating HIV/AIDS. The danger is that patients will interrupt their treatment allowing resistance to the drugs to develop. Educating patients about what to expect when they start taking the drugs will be very important to ensure they stick with rigorous treatment schedules, and prevent the creation of drug-resistant strains that would spread worldwide.

How will they be delivered to the recipients?
Many countries in Africa still have poor under developed health infrastructure. At the same time an increasing number of PHAs are found in rural areas that are difficult to reach, and where traditionally the delivery of healthcare has been inadequate. Unless there is an increased investment in the improvement of the health infrastructure, governments will be unable to distribute life saving drugs.

How widely available will they be, who will get them?
With an acknowledged limited supply of drugs available, who will be prioritized? Will the distribution be in favour of urban areas, over rural areas that are more difficult to reach? There is the danger that the traditional divide of urban over rural areas will assert itself, and in reality only the rich will have access to these drugs. Priority for treatment must go to those with the greatest risk of transmitting infection such as HIV-infected pregnant women, sex workers.

Can a constant supply be assured?
In order for PHAs to benefit from the recent reduction in prices there must be an equitable distribution network and the supply must be maintained continuously. This is important for two reasons. Firstly, a constant supply will ensure that there will be no break in the PHAs schedule of treatment, reduce the possibility of drug resistance emerging which would render the drugs ineffective. Secondly a continuous supply prevents shortages that may lead to an increase in price and exploitation by unscrupulous persons wishing to make a profit (pharmaceutical companies notwithstanding).

The reduction in prices by the pharmaceutical companies while welcome is not enough. Even at $1.00 a day the drugs will still be too expensive for the majority of people suffering with HIV/AIDS in Africa. Greater subsidies are required, but the savings to African nations and the rest of the world will be incalculable. Taking TB as an example, TB drugs were thought to be too expensive, until studies showed that they were highly cost-effective relative to the costs of hospitalisation, relapse, and emergence of drug resistance. At the same time greater investment in the improvement of the healthcare infrastructure is also required otherwise distribution of the drugs will fail. It is also equally important to make sure treatment efforts do not take priority over HIV/AIDS prevention programs using education and safe sex practices. Drug treatments are only one part of the battle against HIV/AIDS, and the battle is still far from over.