TCS Daily

World AIDS Daydreams and Nightmares

By Roger Bate - December 1, 2003 12:00 AM

World AIDS Day is upon us again and much of the news is dire. Not only are there over 42 million cases around the world, with over 28 million deaths already, it appears that AIDS may be striking again in America. The Centers for Disease Control says that there has been a 5% increase in diagnoses in the past four years.


Black Americans are ten times more likely to have the disease than whites and, according to CDC director Dr. Julie Gerberding, "the HIV epidemic in this country is not over; more often than not the face of HIV in this country is black or Latino. Fighting HIV in America is as urgent as it was more than two decades ago when the epidemic began." Fortunately only about 40,000 Americans get the disease every year, with at most a million currently infected.


Private Sector Delivers the Goods


The drugs industry went to work very early and within 4 years of the disease's discovery in 1983, the first drug was developed to combat the Human Immunodeficiency Virus (HIV) that causes AIDS. Now over 16 years later there is an amazing array of 80 drugs which have been approved for treating AIDS and the opportunistic infections that thrive in those with the disease.


Figures out last week from U.S. industry group PhRMA showed that there are another 83 drugs or vaccines in development. Superficially the news is undoubtedly good. However, dig a little deeper and disturbing trends emerge. With the continuing attacks on drug company patents and the pricing of their AIDS drugs, the trend in drug development is actually downwards. More important than the number of drugs in development is the number of companies working on AIDS drugs, which has fallen by nearly 30% in the past five years. This should be a shocking statistic, but it seems to be ignored by most commentators. At a time when the disease is taking hold of parts of Asia, has destroyed large swathes of Africa, and is even creeping back in America, the environment for companies to work on AIDS is so bad that more are leaving the research field.


The Size of the Problem


As I mentioned in a column on China recently, according to Nicholas Eberstadt, a Harvard University demographer and a colleague of mine at AEI, China may have as many as two million cases already, yet its official figures say one million. Eberstadt's research shows that Russia and India may also be underreporting, either willfully or in ignorance. It is quite possible that there will be 100 million cases worldwide by the end of 2010.


All health specialists hope that an HIV vaccine can be developed soon. Without such a vaccine it may not be possible to halt the "spread of HIV," commented Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, and a key advisor to President Bush. It is encouraging that there are 15 vaccines in development, and none has so far failed its trial.


Hopeful Signs


One vaccine is designed to induce different types of immune responses, enhancing the overall immune system. The first dose primes the body to induce cellular immunity, while the booster dose induces neutralizing antibodies. Another vaccine candidate combines DNA snippets from the AIDS virus with a protein that boosts an immune response. The aim is not to prevent infection but to limit the damage the virus causes. These and the other candidates are exciting prospects but seasoned vaccine experts admit that the likelihood of success is slim. HIV changes so rapidly that even announcing partial success is premature. Furthermore, detectable HIV resistance to one drug occurred within weeks of its introduction in 2001. Resistance always occurs but to develop so rapidly is extremely worrying. It's one of the reasons that HIV drugs are given in a triple drug cocktail, so that the HIV has a far harder time adapting to all three simultaneously. It is simply a matter of statistics. The odds on resistance developing simultaneously to three drugs at once is many millions of times lower than developing to one drug alone.


Resistance obviously affects the bottom line for companies since spending hundreds of millions of dollars developing a drug or vaccine that is possibly going to be useless in months does not make economic sense. Some firms are spending as much as $300 million a year just on HIV vaccine research, and many hundreds of millions more on drug development. It has to be asked is that a good investment in the current climate?


Groups like Doctors Without Borders, Oxfam and Act Up have largely changed lately tactics and are attacking the lack of governmental and aid agency financial support for AIDS drug delivery. But they still attack corporate "greed" whenever the mood takes them. The result is that every year companies (especially small biotech ones) escape the no-profit zone that AIDS research has become. Over 80 companies were working on AIDS research five years ago, today the number is 60.


AIDS claims more victims every year. Sooner or later, says Professor Eberstadt, it will take hold of China and India. Perhaps only then will corporations be able to make enough money from the disease by having enough moderately wealthy customers. Or perhaps if more insured Americans get the disease then companies can justify spending more on AIDS research. Both scenarios are depressing, but that is unfortunately the reality of working in an area where the righteous media pundits and political commentators believe that profit is a dirty word.


Roger Bate is a visiting fellow at the American Enterprise Institute in Washington DC and a Director of health advocacy group Africa Fighting Malaria.


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