Children, Victims of AIDS

AFRICAN children with HIV/AIDS should not be denied life-saving medication just because they cannot afford it. This was the Lent 2004 message from the Vatican, and it went further. The Vatican criticised pharmaceutical companies which make huge profits from anti-AIDS drugs and urged them to make low-cost medication available. “The Holy See has undertaken initiatives to exert pressure on large pharmaceutical industries in order to lower prices,” said Archbishop Paul Josef Cordes, president of the Pontifical Council Cor Unum, at a press conference on 29 January to launch the Lenten message.

Genocide
 
The overall theme was hardships faced by children, but there was a special focus on Africa, where the AIDS pandemic is causing immense suffering and affecting the continent’s development prospects. Many African children have been infected from birth, in a transfer of the HIV virus from their mothers, which could have been prevented with drug treatment.
Fr. Angelo D’Agostino, an American Jesuit priest who founded the Nyumbani Village in Nairobi, also spoke at the January press conference. Nyumbani is home to about 100 children whose ages range from newborn to twenty-years-old and who have the HIV virus. He spoke of his many years of experience with HIV-positive children, an overwhelming number of whom are orphans, pointing out that “in the early days we averaged two or three deaths a month but, since the advent of anti-retroviral medications, that has dropped drastically so that for all of 2003 we had not a single fatality”. He said the anti-retroviral drugs are partly donated by the Brazilian government, but some have been bought on the open market. In the community-based program serving a further 1,000 HIV-positive orphans, “we suffer seven or eight deaths each month because we do not have the funds to pay the unaffordable prices demanded by the big international drug companies”. He pointed out that at least 400 people die every day in Kenya because of AIDS.
Fr. D’Agostino underscored that AIDS is a killer in Africa because of “the genocidal action of the drug cartels who refuse to make the drugs affordable in Africa even after they reported a $517 billion profit in 2002”. He felt that, by comparison, being HIV-positive in Europe and North America is not a death sentence – it is more like having a chronic disease – because good access to drug treatment has greatly improved life expectancy. A doctor in Kenya for two decades, he said “the lack of social conscience of these capitalist enterprises is a moral problem”, as they could “save the lives of 25 million Africans infected with the HIV virus in sub-Saharan Africa”. He appealed to the media to report the tragedy and inspire a response in Christians, civil society and the pharmaceutical industry in particular.
There are at least 11 million AIDS orphans living in sub-Saharan Africa according to estimates by UNAids, the joint United Nations programme on HIV/AIDS. No sub-Saharan country could cope with the current number of orphans who have become street children, according to Fr D’Agostino. “It would cost just $7 billion to save the lives of the 25 million sub-Saharan Africans who are HIV-positive and otherwise doomed,” he said. The Vatican has organised financial support for the HIV-positive children he works with by issuing a special Vatican postage stamp, the proceeds from which will go directly to the Nyumbani Village. The stamps, due in circulation in May, are expected to raise €500,000 ($629,000).

More affordable

In 2001, six major pharmaceutical firms did agree to cut the cost of AIDS medications to third world countries. This was after intense international lobbying by groups supporting AIDS victims and a meeting between the firms and both UN and World Health Organisation representatives. The companies, including Pfizer and Glaxo Smithkline, said they would speed up price reductions and allow aid agencies to distribute drugs. The cost of AIDS medication in Africa would come down to a fraction of the cost in developed countries – around $600, compared to around $15,000 in the West. Yet, the reality is that this reduced cost is still beyond the means of most Africans with HIV/AIDS, especially the children.
The following year, two major pharmaceutical companies – GlaxoSmithKline and Boehringer-Ingelheim, who own more than half of the world AIDS drug market – announced that they would allow production of three of their anti-retrovirals by generic companies in South Africa. Some commentators felt the move, however, simply aimed at preventing campaigners from taking the case to the South African Competition Tribunal. Had the Tribunal heard it, the two companies would have been forced to defend their pricing, and therefore would have had to reveal their true production costs and profit margins.
The companies certainly haven’t demonstrated the generosity they could easily afford. In March this year, the international medical humanitarian organisation Doctors Without Borders/Medecins Sans Frontieres (MSF), complained publicly about the multinational pharmaceutical company, Merck & Co. More than 16 months after this company announced it would reduce the price of its first-line AIDS drug Stocrin (efavirenz, EFV) to less than $1 per day in developing countries, the offer had failed to materialize. MSF felt that EFV – among the anti-retrovirals recommended by the World Health Organisation for first-line treatment – is a critical component of anti-retroviral combination therapy, particularly for patients co-infected with HIV and tuberculosis.

Reaction stalled

Every time drug prices come down, more people can afford treatment, but for the poorest, no price will be affordable. In this context, governments of both developing and developed countries must meet the costs. This means more international funding to fight AIDS. Yet, in March this year, UN and World Health Organisation officials said that a UN plan to provide three million HIV-infected patients in Africa with anti-retroviral drugs by 2005 was in danger of collapsing owing to lack of funds. Some countries, particularly the US, were balking at supporting the project, AIDS experts said, partly because the plan intends to use a form of medicine called fixed-dose combination anti-retroviral drugs whose use is opposed by large pharmaceutical companies. These drugs combine two or more active ingredients in one pill, thereby reducing the number of tablets an AIDS patient must take each day. Fixed-dose drugs are also cheaper. Taking two fixed-dose combination pills a day for a year costs $140 per patient, compared to about $600 per year for six pills per day.
So, there has been a shortfall in funding for the project, dubbed Three by Five, because it hopes to provide drugs to three million people by 2005. Only the UK, Sweden and Spain had provided money to date, officials said. “If Three by Five fails, as it surely will without the dollars, then there are no excuses left, no rationalisations to hide behind; there will only be the mass graves of the betrayed,” said Stephen Lewis, the UN Secretary-General’s special envoy for HIV/AIDS in Africa.

Patent problems

One snag in providing the cheaper fixed dose combination anti-retrovirals is that some of the ingredients are under patent to interests in the rich countries. Much of the underlying research comes out of academic institutions funded by government grants, but much of the development work is by pharmaceutical companies, which will not invest in research and development without incentives: in this case the patent system, which rewards a company that develops a successful drug with a 20-year marketing monopoly. The economic incentive is the freedom to charge what the market will stand, and invest in what gives the highest return, rather than in what maximises healthcare benefits.
Some governments, such as South Africa, India, and Brazil, have allowed other companies to infringe foreign patents and produce their own versions of AIDS drugs, in many cases at substantially lower prices. Major pharmaceutical companies responded to those pressures in 2001 by substantially lowering the prices of their drugs in selected countries. Thirty-nine of them also sued the government of South Africa in an effort to protect their patents, but the lawsuit was dropped dramatically amidst international outrage that profit was so clearly given priority over saving lives.
On 1 January 2005, the Trips agreement on intellectual property rights will come into force in most World Trade Organisation countries. It is based on enforcing patent rights worldwide as a mechanism to reward innovation. Many non-governmental organisations are campaigning for Trips to be modified regarding healthcare. They point to the November 2001 Doha declaration of the World Trade Organisation that health is more important than intellectual property.

Costs reduction

Pfizer is a large multinational corporation that manufactures a drug called Diflucan, which is effective in treating many bacterial infections including deadly cryptococcal meningitis, which is often associated with AIDS. Pfizer has until recently charged a fairly high price for the drug, because many Americans and their health insurance companies can afford it. In addition, Pfizer also sells other highly profitable drugs like the antibiotic Zithromax, Lipitor for cholesterol, Zoloft for depression, and Viagra for impotence. In light of this, AIDS activists and developing country governments have asked: why can’t companies like Pfizer cover the cost of AIDS drugs with the profits they make on other drugs? Critics also believe that companies could charge much less for their drugs if they spent less on marketing and advertising, which by some estimates is nearly three times the amount they spend on drug research and development.
In 13 African countries, the HIV infection rate exceeds 10 percent of the population; and in South Africa, Botswana, and Zimbabwe, over a quarter of the adult population is HIV-positive. Most Africans cannot begin to afford to buy the drugs that could extend their lives or prevent children from being infected by their mothers. In most cases their governments are also too poor to pay for the medications. The financial cost must be brought down or the human cost, particularly in Africa, will continue to mount. According to the Pope’s Lenten message, “humanity cannot close its eyes in the face of so appalling a tragedy”.