TCS Daily

Whose Responsibility

By Richard Tren - July 1, 2005 12:00 AM

The innovative drug company Bristol Myers Squibb and its charitable foundation, the Bristol Myers Squibb Foundation have just announced a $40 million program to create a pediatric AIDS treatment corps for Africa.

UN-AIDS estimates that there are more than 2 million children living with HIV/AIDS in Africa and they require specialized treatment, so the move is a welcome one. Yet, typically the company has come under fire for not doing enough and for protecting its innovative drugs with patents. Although these criticisms are largely incorrect and somewhat churlish, it is appropriate to question the role that drug companies play in long term AIDS treatment in Africa.

Bristol Myers Squibb considers that its new program, which will be run in conjunction with Baylor College of Medicine, will treat approximately 80,000 children over the next five years and will send 250 trained doctors to Africa. These doctors will in turn train other doctors and will hopefully improve the treatment that patients receive. The drug company has, since 1999, spent approximately $150 million dollars in 10 African countries in an attempt to improve treatment and access to AIDS treatment. Other drug companies are also involved in treatment programs, such as the Accelerated Access Initiative which has secured treatment for around 333,000 people, mostly in Africa.

One advocacy group, The Global AIDS Alliance reacted to the announced by pointing out how limited it was, in that it would only treat 3% of the children who will die during the five years. The Global Alliance's Dr. Paul Zeitz went on to berate Bristol Myers Squibb for not funding whole medical schools in Africa and for not allowing generic drug companies to produce generic copies of their drugs.

Concurrently, the Brazilian government has inflated the war of words over AIDS drug prices in that country and has further threatened to issue a compulsory license so that a local company can produce generic copies of Abbott's AIDS drug, Kaletra. And to give drug company executives even more sleepless nights, The New York Times ran an editorial on June 27 criticizing the U.S. administration's policy of not buying cheaper generic versions of AIDS drugs, which would, they maintain, allow many more people to access treatment.

There are several troubling aspects to these varied criticisms.

While it may be true that Bristol Myers Squibb's new initiative may not be at a scale to treat all African children living with HIV/AIDS, it would be almost impossible for any single company or even government to do this. A fundamental aspect of the drug company's treatment programs is that they are set up to be sustainable for the long term and do not attempt to provide treatment unless that treatment can be accessed properly, with support from the community and good clinical management. Perhaps B-M-S could throw more money at the African AIDS problem and treat more children, but with the poverty, lack of medical infrastructure, to say nothing about the lack of electricity in many places, it is doubtful that this could be sustained for any length of time.

The World Health Organization dreamt up the target of treatment 3 million people by the end of 2005 and it is now increasingly clear that that target will be missed. The WHO tried to blame South Africa, India and Nigeria for this, but the real issue is that the target was completely unrealistic in the first place and in effect was regarding people that needed good care and careful treatment as mere numbers, rather than patients. Expecting Bristol Myers Squibb to suddenly treat all the children in Africa is not only unrealistic, but it would also compromise those children's health in not sustaining what is in reality chronic long term care.

But in any event, funding clinics and training doctors is not B-M-S's core competence. The job of B-M-S and the other innovator drug companies is to develop new medicines and to make sure that they work. Berating them for not spending more on medical schools is a cheap shot when one considers the enormous benefit that they bring in new, effective therapies. Also, one has to ask why so many African governments, with billions of dollars of aid transfers over the past 40 years, haven't done more to build their own medical schools and improve healthcare themselves.

Drug resistance is emerging in Africa and some patients need to move to second line therapy. The reason that it hasn't advanced as quickly as it did in rich countries is probably a function of the relatively slow roll out of drugs. As and when treatment is scaled up resistance will surely spread and then second and third line therapies will be needed.

And so when the Brazilian government, with the support of The New York Times, attacks the drug patent system, one wonders where the new medicines are going to come from. Finding long term solutions to Africa's AIDS problem needs ongoing research into new therapies. But turning AIDS into an unprofitable public affairs headache is hardly the best way to incentivize that research.

B-M-S understandably wants to get as much good media coverage for its treatment programs. Children in Africa, though, would be better off if it were concentrating more on developing new drugs. Those children would also be better off if the WHO were to be more realistic about treatment targets and if African governments started taking their role in healthcare and in development generally more seriously.

Richard Tren is a director of the South Africa-based health advocacy group Africa Fighting Malaria.


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