Aids In The Developing World
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45968
Access to HIV/AIDS drugs in the developing world The AIDS epidemic is often considered the most serious we have ever faced. Since its beginning in the 1970s HIV/AIDS has spread all over the world. In 2007 it was estimated that approximately 33 million people were living with HIV, and in that year alone over two million people died from the virus, while another 2.5 million people were infected (World Health Organization & UNAIDS, 2007). While many of the developed countries have been successful in slowing the spread of the disease, most developing countries have seen it spin almost out of control. Only about 8% of the world population live in sub-Saharan Africa and yet they suffer two-thirds of all HIV/AIDS cases (Kalipeni et al., 2004). A global effort to inform and educate the public on how to decrease the risk of infection has been largely successful, especially in the developed world. It is essential to the fight against the epidemic to provide as many people with treatment as possible, for many different reasons. This has been incredibly difficult, especially in the developing world and only approximately 31% of the people who need access to antiretroviral therapy in the world have it (World Health Organization (WHO), 2008). People in the developing countries have had problems accessing the drugs they need due to high prices set by pharmaceutical companies, poverty and lack of efffective health care systems. In order to combat the HIV/AIDS crisis in developing countries, cooperation from pharmeceutical companies in order to provide greater and more cost effective access to antiretroviral drugs, change in global trade rules, abolishion of structural adjustment programs, debt relief, and the political will of the governments of those developing nations is necessary. Not everyone agrees on the best ways to adress the AIDS problem. Many claim that prevention measures only should be the main focus of the battle and that antiretroviral treatment is not cost effective in countries with limited budgets (Moatti et al, 2008). Jefferis et al (2008) and Moatti et al (2008) argue that while preventative measures are very important, providing treatment to as many people as possible is essential to long term success. Infected people who have regular access to medication live longer, they are able to work more and are less of a burden on the health care system. Providing the medications necessary to prevent mothers from passing the disease on
1
45968 to their children has generally been considered a preventative measure, but Luo et al (2000) argue that universal treatment is equally important, because while the children do not get infected, they will be orphaned before long if their parents do not have access to treatment. It would add further financial burdens on governments to take care of all these orphans. Governments should therefore strive to combine prevention and treatment in their efforts to tackle this epidemic. For example, Brazil has already shown that this is not only economically feasible but also successful (Biehl, 2006). While in 1998, the government had spent $300 million on antiretroviral drugs, they saved $500 million in other areas. At the same time the number of reported AIDS deaths fell by 35% and demand for treatment in hospitals fell by 40% (Biehl, 2006, p. 215). Most developing countries have not been able to implement similar policies because their access to antiretroviral medication has been limited. Generally the problem is a question of cost. Most people in the developing world cannot afford to pay for their own medication, and for the most part their governments consider providing them with free access to be too expensive. Although prices have fallen in recent years due to increased pressure by non-governmental organizations and public outrage they are still prohibitively expensive (Craddock, 2004). The pharmaceutical companies claim that their prices are so high because they are expensive to develop, they need the money to finance more research, and the markets in most developing countries are too small. However, Petryna et al. (2006) point out that much of the research has been financed by the governments of the companies in question and that the diseases afflicting the developing countries are neglected by them for the most part. The World Trade Organisation’s (WTO) many agreements includes the Agreement on the Trade-Related Aspects of International Property Rights (TRIPS) which provides companies with strict international property rights. This also applies to the pharmaceutical companies. They can now place a 20 year long patent on their drugs and put any price on them they like. The WTO did however add a clause which allows governments to implement compulsory licencing and parallel imports in case of a medical crisis (WHO, 2001). Several countries have already made use of this loophole in order to produce patented AIDS drugs for their national markets and import cheaper drugs from other countries (Craddock, 2004). The pharmaceutical companies have not been pleased with how this development has forced them to 2
45968 lower their prices to keep up with the market. They have made several attempts to stop other countries, such as South Africa, from being able to do this, with lawsuits and threats of trade restrictions. However, public outrage has often been successful in thwarting these attempts (Bond, 1999). In Brazil good progress has been made in providing infected people with medicines. Brazil has managed to create a large pharmaceutical industry and develop many of their own medicines with compulsory licencing of US patented drugs. As a result, the US tried to put trade restrictions on them, though eventually the two countries reached an agreement. Brazil is now unable to export these much cheaper alternative drugs out of the country, so other developing countries can not make use of their lower prices (Biehl, 2006). The high prices set up by the pharmaceutical industry is only one side of a very complicated issue. In the 1980s the International Monetary Fund (IMF) and the World Bank started giving out loans to developing countries to help them deal with the financial crisis that developed after the price of oil rose. These loans were not given unless these countries agreed to follow Structural Adjustment Programmes (SAP) designed by the IMF and the World Bank. The conditions they were forced to meet included paving the way for foreign investments, trade liberalization, focus on export industries, currency devaluation, tax increases and
reductions in government
spending (Lurie et al, 2004, 206). Most of the countries who took up these SAPs did not experience Increased poverty and unemployment followed and, due to cut backs in government spending on health, life expectancy fell, infant mortality rates rose, and infection rates of many diseases increased. As a consequence the AIDS epidemic became almost impossible for these countries to handle (Lurie et al. 2004). The majority of the developing world is still having economic troubles today, so that even if they wanted to provide their people with free or less expensive access to antiretrovirals, they are not be able to do so easily. The problem, therefore is a combination of lack of money and high prices. Providing access to antiretrovirals has not been wholly impossible. The government of Botswana decided that health care was an important part of their road to development and they began their national antiretroviral therapy programme in 2002. As of 2005 close to 56,000 people were receiving therapy, out of the estimated 84,000 who needed it (WHO, 2005). Botswana is a very poor country and the proportion of the nation living with HIV/AIDS is estimated to be between 25 and
3
45968 30% (WHO 2008). It is clear that with enough political will it is possible for even the poorer nations to react to this epidemic and make a change. Despite the success the programme has not been perfectly executed. While the government has purchased the medication and has the will to deliver it to those in need, the country‘s lack of infrastructure often makes this task difficult. There is a considerable lack of doctors, with only about 40 per every 100,000 people, and many people are forced to travel long distances distances for consultations and their perscriptions (Miles et al, 2007). This is a common problem in many developing countries, since economic structural problems have led to uneven access to primary health care, lack of qualified health care professionals, and insufficient distribution systems for drugs (Moatti et al, 2008, S64). In order to encourage governments to go down this road there also needs to be social mobilization. Prevention measures include education and spread of knowledge about the disease and how to prevent it. This has been successful in many countries. However, in some countries information on treatment has been lacking. If the people do not know that proper treatment exists they are not likely to demand that they recieve it. Therefore, in order to create social mobility and demand, imparting the information to the people is crucial. There are undoubtedly many possibly solutions to consider. First and foremost there has to be a will to change, both within individual governments and on a global scale. A big step to take would be to ease the poverty of the developing nations. SAPs need to be adjusted to fit better within the cultures and economic situations of each country, if not abolished all together. Debt relief or adjustment would go a long way to increase government budgets so that more can be spent on health care, education and other basic needs. That would free up a great deal of financial resources so that free or inexpensive antiretrovirals could be provided. The trade rules of the WTO need to be adjusted so that they benefit the developing world more. Increased pressure on the pharmaceutical companies to develop more ethical practices and lower prices is also important. Even if all these changes were to take place, they still may not help unless there is the political will within the nations to direct their efforts at HIV/AIDS prevention and treatment. Governments must take the steps necessary to implement improved health care programmes and provide better access to these programmes. Eradication of the prejudice and stigma often associated with HIV is essential, and should be a part of all 4
45968 efforts to battle the epidemic. This could be combined with an education programme aimed at disease prevention and providing information on how to obtain treatment for those who are infected. The many problems and issues mentioned here above are not insurmountable. With a global effort and cooperation between nations and non-governmental organizations, many of the problems faced by developing countries today could be addressed. With cooperation between the developing nations, the WTO and the IMF, agreements could be made that would alleviate their poverty and allow them to improve their health care systems. A focus on the AIDS crisis should play a large role in such efforts. The WHO could provide the pharmaceutical companies with incentive to lower their prices and increase research into tropical diseases, by for example offering to help with financing. To sum up, it is clear that whatever steps will be taken in the future must involve cooperation between the WTO, the WHO, the IMF, the pharmaceutical companies, and the nations of both the developing and the developed world.
5
45968
Bibliography Biehl, J., 2006. Pharmaceutical governance. In: A. Petryna, A. Lakoff & A. Kleinman, eds. 2006. Global pharmaceuticals: ethics, markets, practices. Durham: Duke University Press, pp. 206-239. Bond, P., 1999. Globalization, pharmaceutical pricing and South African health policy: managing confrontation with U.S. firms and politicians. International Journal of Health Services, 29 (4), pp. 765-792. Craddock, S., 2004. AIDS and ethics: clinical trials, pharmaceuticals, and global scientific practice. In: E. Kalipeni, S. Craddock, J. R. Oppong & J. Ghosh, eds., 2004. HIV & AIDS in Africa: beyond epidemiology. Massachusetts: Blackwell Publishing Ltd., pp. 240-251. Jefferis, K. et al., 2008. Macroeconomic and household-level impacts of HIV/AIDS in Botswana. AIDS, 22 (suppl. 1), pp. S113-S119. Luo, C., 2000. Strategies for prevention of mother-to-child transmission of HIV. Reproductive Health Matters, 8 (16), pp. 144-155. Lurie, P., Hintzen, P. & Lowe, R. A., 2004. Socioeconomic obstacles to HIV prevention and treatment in developing countries: the roles of the International Monetary Fund and the World Bank. In: E. Kalipeni, S. Craddock, J. R. Oppong & J. Ghosh, eds., 2004. HIV & AIDS in Africa: beyond epidemiology. Massachusetts: Blackwell Publishing Ltd., pp. 204-216. Miles, K., Clutterbuck D. J., Seitio, O., Sebego, M. & Riley, A., 2007. Antiretroviral treatment roll-out in a resource constrained setting: capitalizing on nursing resources in Botswana. Bulletin of the World Health Organization, 85 (7), pp. 555560. Moatti, J. P., Marlink, R., Luchini, S. & Kazatchkine, M., 2008. Universal access to HIV treatment in developing countries: going beyond the misinterpretations of the ‘cost-effectiveness’ algorithm. AIDS, 22 (suppl. 1), pp. S59-S66. Petryna, A. & Kleinman, A., 2006. The pharmaceutical nexus. In: A. Petryna, A. Lakoff & A. Kleinman, eds. 2006. Global pharmaceuticals: ethics, markets, practices. Durham: Duke University Press, pp. 1-32. World Health Organization & UNAIDS, 2007. AIDS epidemic update [online]. Available at: http://www.who.int/hiv/data/en/index.html [Accessed 16 June 2009]. World Health Organization, 2001. Globalization, TRIPS and access pharmaceuticals. WHO Policy Perspectives on Medicines, [online] Available at:
to 3.
http://www.who.int/medicines/publications/policyperspectives/en/index.html [Accessed 16 June 2009].
6
45968 World Health Organization, 2005. AIDS/HIV treatment: Botswana [online] Available at: http://www.who.int/countries/bwa/en/ [Accessed 16 June 2009]. World Health Organization, 2008. AIDS/HIV epidemiological fact sheet: Botswana [online]. Available at: http://www.who.int/countries/bwa/en/ [Accessed 16 June 2009].
7
Access to HIV/AIDS drugs in the developing world The AIDS epidemic is often considered the most serious we have ever faced. Since its beginning in the 1970s HIV/AIDS has spread all over the world. In 2007 it was estimated that approximately 33 million people were living with HIV, and in that year alone over two million people died from the virus, while another 2.5 million people were infected (World Health Organization & UNAIDS, 2007). While many of the developed countries have been successful in slowing the spread of the disease, most developing countries have seen it spin almost out of control. Only about 8% of the world population live in sub-Saharan Africa and yet they suffer two-thirds of all HIV/AIDS cases (Kalipeni et al., 2004). A global effort to inform and educate the public on how to decrease the risk of infection has been largely successful, especially in the developed world. It is essential to the fight against the epidemic to provide as many people with treatment as possible, for many different reasons. This has been incredibly difficult, especially in the developing world and only approximately 31% of the people who need access to antiretroviral therapy in the world have it (World Health Organization (WHO), 2008). People in the developing countries have had problems accessing the drugs they need due to high prices set by pharmaceutical companies, poverty and lack of efffective health care systems. In order to combat the HIV/AIDS crisis in developing countries, cooperation from pharmeceutical companies in order to provide greater and more cost effective access to antiretroviral drugs, change in global trade rules, abolishion of structural adjustment programs, debt relief, and the political will of the governments of those developing nations is necessary. Not everyone agrees on the best ways to adress the AIDS problem. Many claim that prevention measures only should be the main focus of the battle and that antiretroviral treatment is not cost effective in countries with limited budgets (Moatti et al, 2008). Jefferis et al (2008) and Moatti et al (2008) argue that while preventative measures are very important, providing treatment to as many people as possible is essential to long term success. Infected people who have regular access to medication live longer, they are able to work more and are less of a burden on the health care system. Providing the medications necessary to prevent mothers from passing the disease on
1
45968 to their children has generally been considered a preventative measure, but Luo et al (2000) argue that universal treatment is equally important, because while the children do not get infected, they will be orphaned before long if their parents do not have access to treatment. It would add further financial burdens on governments to take care of all these orphans. Governments should therefore strive to combine prevention and treatment in their efforts to tackle this epidemic. For example, Brazil has already shown that this is not only economically feasible but also successful (Biehl, 2006). While in 1998, the government had spent $300 million on antiretroviral drugs, they saved $500 million in other areas. At the same time the number of reported AIDS deaths fell by 35% and demand for treatment in hospitals fell by 40% (Biehl, 2006, p. 215). Most developing countries have not been able to implement similar policies because their access to antiretroviral medication has been limited. Generally the problem is a question of cost. Most people in the developing world cannot afford to pay for their own medication, and for the most part their governments consider providing them with free access to be too expensive. Although prices have fallen in recent years due to increased pressure by non-governmental organizations and public outrage they are still prohibitively expensive (Craddock, 2004). The pharmaceutical companies claim that their prices are so high because they are expensive to develop, they need the money to finance more research, and the markets in most developing countries are too small. However, Petryna et al. (2006) point out that much of the research has been financed by the governments of the companies in question and that the diseases afflicting the developing countries are neglected by them for the most part. The World Trade Organisation’s (WTO) many agreements includes the Agreement on the Trade-Related Aspects of International Property Rights (TRIPS) which provides companies with strict international property rights. This also applies to the pharmaceutical companies. They can now place a 20 year long patent on their drugs and put any price on them they like. The WTO did however add a clause which allows governments to implement compulsory licencing and parallel imports in case of a medical crisis (WHO, 2001). Several countries have already made use of this loophole in order to produce patented AIDS drugs for their national markets and import cheaper drugs from other countries (Craddock, 2004). The pharmaceutical companies have not been pleased with how this development has forced them to 2
45968 lower their prices to keep up with the market. They have made several attempts to stop other countries, such as South Africa, from being able to do this, with lawsuits and threats of trade restrictions. However, public outrage has often been successful in thwarting these attempts (Bond, 1999). In Brazil good progress has been made in providing infected people with medicines. Brazil has managed to create a large pharmaceutical industry and develop many of their own medicines with compulsory licencing of US patented drugs. As a result, the US tried to put trade restrictions on them, though eventually the two countries reached an agreement. Brazil is now unable to export these much cheaper alternative drugs out of the country, so other developing countries can not make use of their lower prices (Biehl, 2006). The high prices set up by the pharmaceutical industry is only one side of a very complicated issue. In the 1980s the International Monetary Fund (IMF) and the World Bank started giving out loans to developing countries to help them deal with the financial crisis that developed after the price of oil rose. These loans were not given unless these countries agreed to follow Structural Adjustment Programmes (SAP) designed by the IMF and the World Bank. The conditions they were forced to meet included paving the way for foreign investments, trade liberalization, focus on export industries, currency devaluation, tax increases and
reductions in government
spending (Lurie et al, 2004, 206). Most of the countries who took up these SAPs did not experience Increased poverty and unemployment followed and, due to cut backs in government spending on health, life expectancy fell, infant mortality rates rose, and infection rates of many diseases increased. As a consequence the AIDS epidemic became almost impossible for these countries to handle (Lurie et al. 2004). The majority of the developing world is still having economic troubles today, so that even if they wanted to provide their people with free or less expensive access to antiretrovirals, they are not be able to do so easily. The problem, therefore is a combination of lack of money and high prices. Providing access to antiretrovirals has not been wholly impossible. The government of Botswana decided that health care was an important part of their road to development and they began their national antiretroviral therapy programme in 2002. As of 2005 close to 56,000 people were receiving therapy, out of the estimated 84,000 who needed it (WHO, 2005). Botswana is a very poor country and the proportion of the nation living with HIV/AIDS is estimated to be between 25 and
3
45968 30% (WHO 2008). It is clear that with enough political will it is possible for even the poorer nations to react to this epidemic and make a change. Despite the success the programme has not been perfectly executed. While the government has purchased the medication and has the will to deliver it to those in need, the country‘s lack of infrastructure often makes this task difficult. There is a considerable lack of doctors, with only about 40 per every 100,000 people, and many people are forced to travel long distances distances for consultations and their perscriptions (Miles et al, 2007). This is a common problem in many developing countries, since economic structural problems have led to uneven access to primary health care, lack of qualified health care professionals, and insufficient distribution systems for drugs (Moatti et al, 2008, S64). In order to encourage governments to go down this road there also needs to be social mobilization. Prevention measures include education and spread of knowledge about the disease and how to prevent it. This has been successful in many countries. However, in some countries information on treatment has been lacking. If the people do not know that proper treatment exists they are not likely to demand that they recieve it. Therefore, in order to create social mobility and demand, imparting the information to the people is crucial. There are undoubtedly many possibly solutions to consider. First and foremost there has to be a will to change, both within individual governments and on a global scale. A big step to take would be to ease the poverty of the developing nations. SAPs need to be adjusted to fit better within the cultures and economic situations of each country, if not abolished all together. Debt relief or adjustment would go a long way to increase government budgets so that more can be spent on health care, education and other basic needs. That would free up a great deal of financial resources so that free or inexpensive antiretrovirals could be provided. The trade rules of the WTO need to be adjusted so that they benefit the developing world more. Increased pressure on the pharmaceutical companies to develop more ethical practices and lower prices is also important. Even if all these changes were to take place, they still may not help unless there is the political will within the nations to direct their efforts at HIV/AIDS prevention and treatment. Governments must take the steps necessary to implement improved health care programmes and provide better access to these programmes. Eradication of the prejudice and stigma often associated with HIV is essential, and should be a part of all 4
45968 efforts to battle the epidemic. This could be combined with an education programme aimed at disease prevention and providing information on how to obtain treatment for those who are infected. The many problems and issues mentioned here above are not insurmountable. With a global effort and cooperation between nations and non-governmental organizations, many of the problems faced by developing countries today could be addressed. With cooperation between the developing nations, the WTO and the IMF, agreements could be made that would alleviate their poverty and allow them to improve their health care systems. A focus on the AIDS crisis should play a large role in such efforts. The WHO could provide the pharmaceutical companies with incentive to lower their prices and increase research into tropical diseases, by for example offering to help with financing. To sum up, it is clear that whatever steps will be taken in the future must involve cooperation between the WTO, the WHO, the IMF, the pharmaceutical companies, and the nations of both the developing and the developed world.
5
45968
Bibliography Biehl, J., 2006. Pharmaceutical governance. In: A. Petryna, A. Lakoff & A. Kleinman, eds. 2006. Global pharmaceuticals: ethics, markets, practices. Durham: Duke University Press, pp. 206-239. Bond, P., 1999. Globalization, pharmaceutical pricing and South African health policy: managing confrontation with U.S. firms and politicians. International Journal of Health Services, 29 (4), pp. 765-792. Craddock, S., 2004. AIDS and ethics: clinical trials, pharmaceuticals, and global scientific practice. In: E. Kalipeni, S. Craddock, J. R. Oppong & J. Ghosh, eds., 2004. HIV & AIDS in Africa: beyond epidemiology. Massachusetts: Blackwell Publishing Ltd., pp. 240-251. Jefferis, K. et al., 2008. Macroeconomic and household-level impacts of HIV/AIDS in Botswana. AIDS, 22 (suppl. 1), pp. S113-S119. Luo, C., 2000. Strategies for prevention of mother-to-child transmission of HIV. Reproductive Health Matters, 8 (16), pp. 144-155. Lurie, P., Hintzen, P. & Lowe, R. A., 2004. Socioeconomic obstacles to HIV prevention and treatment in developing countries: the roles of the International Monetary Fund and the World Bank. In: E. Kalipeni, S. Craddock, J. R. Oppong & J. Ghosh, eds., 2004. HIV & AIDS in Africa: beyond epidemiology. Massachusetts: Blackwell Publishing Ltd., pp. 204-216. Miles, K., Clutterbuck D. J., Seitio, O., Sebego, M. & Riley, A., 2007. Antiretroviral treatment roll-out in a resource constrained setting: capitalizing on nursing resources in Botswana. Bulletin of the World Health Organization, 85 (7), pp. 555560. Moatti, J. P., Marlink, R., Luchini, S. & Kazatchkine, M., 2008. Universal access to HIV treatment in developing countries: going beyond the misinterpretations of the ‘cost-effectiveness’ algorithm. AIDS, 22 (suppl. 1), pp. S59-S66. Petryna, A. & Kleinman, A., 2006. The pharmaceutical nexus. In: A. Petryna, A. Lakoff & A. Kleinman, eds. 2006. Global pharmaceuticals: ethics, markets, practices. Durham: Duke University Press, pp. 1-32. World Health Organization & UNAIDS, 2007. AIDS epidemic update [online]. Available at: http://www.who.int/hiv/data/en/index.html [Accessed 16 June 2009]. World Health Organization, 2001. Globalization, TRIPS and access pharmaceuticals. WHO Policy Perspectives on Medicines, [online] Available at:
to 3.
http://www.who.int/medicines/publications/policyperspectives/en/index.html [Accessed 16 June 2009].
6
45968 World Health Organization, 2005. AIDS/HIV treatment: Botswana [online] Available at: http://www.who.int/countries/bwa/en/ [Accessed 16 June 2009]. World Health Organization, 2008. AIDS/HIV epidemiological fact sheet: Botswana [online]. Available at: http://www.who.int/countries/bwa/en/ [Accessed 16 June 2009].
7
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