July 8th 2000 - Durban South Africa International AIDS Conference


Activist response to Boehringer Ingelheim's drug donation announcement

AIDS activists offered a critical response to the first of an expected flurry of announcements from pharmaceutical companies of amorphous or spurious drug donation schemes. Yesterday, Boehringer Ingelheim released a statement announcing a five-year nevirapine donation program (brand name: Viramune) to developing countries for prevention of perinatal transmission of HIV-1.

The release states that Boehringer Ingelheim believes "that our initiative...will help make an impact on the HIV/AIDS epidemic," but provides no structure or timeline for implementation and no details for involvement with participating governments -- common characteristics of drug company announcements of donations, which ultimately offer very little medication for very few people.

Further, Boehringer Ingelheim acknowledges that "providing Viramune is only one component of making prevention of HIV-1 mother to child transmission possible in the developing world," but refuses to offer affordable nevirapine as treatment for HIV infected adults.

"Boehringer Ingelheim intends to give pregnant women two doses of nevirapine and nothing more-when there are treatments available that could extend their lives," said Joe West of ACT UP. "The only acceptable program must provide a clear plan for treatment to women and other infected family members, as well as assurance of medical follow up and treatment for mothers and babies."

An announcement of a donation, with no plan at all for providing for the care of the mother or child is completely unethical. Multiple issues are not substantially addressed, including informed consent, voluntary counseling and HIV testing, and breastfeeding.

ACT UP offers no support for this program unless and until acceptable responses are provided to these concerns:

- Any ethical MCT prevention program must be part of a comprehensive program for treatment of HIV positive women, children, and other family members. Boehringer Ingelheim's announcement makes no mention of the need to connect HIV prevention in newborns to access to HIV treatment for adults, resulting in countless needless deaths of both parents and orphans.

- As one of five participating companies in the UNAIDS/Big Pharma 'partnership initiative,' Boehringer Ingelheim has revealed the lack of coordinated effort from the 5 participating companies. Rather than providing a substantial plan for improving nevirapine access for treatment--not only prevention--the Boehringer Ingelheim announcement proves that the UNAIDS initiative is nothing but smoke and mirrors that holds no significant promise for any real provision of combination therapy.

- A donation scheme must not be allowed to obscure efforts to increase access through means such as compulsory licensing and parallel importing. Any country doing generic production or importation of nevirapine must not be excluded from this offer, if it is indeed genuine. "To save lives, including those of children born to HIV positive mothers, we need widespread access to combination therapy, requiring broad coordination between companies," said Laura McTigue of Health GAP Coalition. "They're not even talking to each other, they had their day in the sun with their announcements, and they've all gone home. Drug donation announcements are no substitute for verifiable and sustainable public health measures to increase access."

"These announcements raise the hopes of millions of people with HIV worldwide. When drugs do not materialize, or programs are so small as to have virtually no impact, people with AIDS are left with despair instead of treatment," said Julie Davids of ACT UP. "In addition, community leaders in Kenya and Uganda have reported that the UNAIDS announcement in May created tension between doctors and patients: people with HIV and their families heard of rumored discounting but were still unable to access medicine and concluded that local doctors were getting free or cheap drugs but holding out at a higher price to make a profit. "Announcements follow announcements and each actor tries to keep its image clean but the reality of people living with HIV/AIDS remains the same," said Gaelle Krikorian of ACT UP Paris. "It is imperative for countries to find their own solutions, by using generic medications produced by national drug companies, by building up regional markets, and by purchasing from suppliers that offer reasonable prices."






"HIV/AIDS drug prices will be reduced by more than 85%". This announcement was made by five of the biggest drug companies together with the United Nations Joint Programme on AIDS (UNAIDS) and the World Bank. In its release, UNAIDS was more cautious and claimed that "a new dialogue has begun between five pharmaceutical companies and United Nations organizations to explore ways to accelerate and improve the provision of HIV/AIDS-related care and treatment in developing countries". Should treatment activists in South Africa and across the world welcome this announcement? Yes. But, only with caution and scepticism.

Every 10 minutes a person with HIV/AIDS in Southern Africa will die. These deaths are premature and unnecessary. Why? Because there are medications that can and will keep adults and children with HIV/AIDS alive, healthy and productive for many years. Children are orphaned daily yet, with medicines their parents can live to take care of them. Price and excessive profits by drug companies denies poor people access to health. Activists and health care workers are not alone in taking this stand. Last week, James Wolfensohn, president of the World Bank told the Wall Street Journal the leading US business newspaper: "With the prices so high, there was little incentive for the governments to build the health infrastructure to provide care". Real price reductions will allow governments, international agencies, the private sector and civil society to rapidly develop infrastructure to provide treatment.

It is the responsibility of our government to lead the struggle for price reductions and the development of infrastructure to ensure that children and adults with HIV/AIDS receive life-saving treatments. The South African government with other African countries should set up a team to plan and negotiate real drug price reductions, access to testing and monitoring equipment, additional clinical and health care infrastructure support from the UN, the World Bank and the drug companies. International public opinion will support such action. Therefore, the drug companies are trying to take control of the agenda. To ensure access to HIV drugs for the majority of people, we must carefully assess what they propose.

In a statement yesterday, Project Inform, one of the oldest and most respected HIV/AIDS treatment education organisations in the US identified "at least three critical issues not clearly addressed in the public statements made by the companies:

Do the price reductions come without strings or are they conditional upon the participating country's agreement to give up their rights to other treatment access mechanisms? Does the proposed agreement cover only older, first generation AIDS drugs or also the newer, more effective and easier-to-use therapies? Will companies offer different discounts adjusted to the economic realities of individual countries?" Drug companies must not be allowed to use the United Nations to protect their excessive profits, or, to stop governments from buying good quality generic equivalents at the lowest possible price. The companies involved in this initiative with the United Nations are Glaxo Wellcome, Bristol Meyers Squibb, Roche, Merck and Boehringer Ingelheim "The Big Five".

The Nobel Prize-winning group Médecins Sans Frontières (Doctors Without Borders) provided figures to the South African Parliament last week. Between 1997 and 1999, sales on two of the Glaxo Wellcome anti-Aids drugs - less production costs, reached $694-million (about R4,858-billion) for AZT and $1,453-billion (about R10-billion) for 3TC. Bristol Meyers Squibb (BMS) made $379-million (about R2,653-billion) on ddI and $1,136-billion (about R7,552-billion) for d4T. These are drugs that were mainly developed by universities and the US government, therefore research and development costs to the companies are minimal.

The same drugs AZT, 3TC, DDI and D4T can be produced in Thailand, India, Brazil and Canada at lower prices than the 85% price reductions on offer. But in Thailand, Bristol Meyers Squibb has used every means possible to prevent that government from making anti-HIV drugs available to its people. Take Nevirapine (NVP) made by Boehringer Ingelheim a single dose of this drug is particularly effective in preventing mother-to-child transmission. It is also very cheap. But, its price can be reduced by more than half through generic competition. Boehringer Ingelheim's price is R32.26 and a good quality generic manufacturer in India Cipla sells the same drug at less than R15.00. Doctors Without Borders stated that "This agreement does nothing to stimulate countries' rights to produce or import inexpensive quality drugs, an important part of the long-term solution to improving access to essential medicines."

But these are facts and figures. They affect people with HIV/AIDS directly. Last week, the Treatment Action Campaign (TAC) welcomed the UNAIDS and "Big Five" announcement at Parliament but warned that drug companies should not tie the hands of governments against finding the lowest possible prices. It asked Parliament to provide data on the patents and prices for all drugs to treat opportunistic infections and all anti-retrovirals. So far, drug companies have only mentioned anti-retrovirals.

Christopher Monaka told the Parliamentary Committee that he has thrush. Conradie Hospital did not have Diflucan produced by Pfizer because of the costs. No other drug would help his thrush. He spoke of the Pfizer campaign and explained that while the donation for cryptococcal menigitis was welcome, people with thrush were excluded. Health care workers frustrated at lack of resources were not treating people with HIV/AIDS with dignity. Christopher Monaka asked the government to ensure that Pfizer reduce the price of Diflucan from R36.50 to less than R4.00 per 200mg capsule before 1 July 2000. "Every day many people died because they do not have access to the drug."

Sindiswa Godwana said that she was unemployed. She said the majority of people in South Africa were poor and in the hospitals people with HIV were not even receiving multivitamins. She gets them from her support group but most support groups don't even have access to vitamins. She told the Parliamentary Committee that they needed to ensure that opportunistic infections were properly treated and anti-retroviral drugs were made available. She argued that this would be possible if government forced drug companies to lower their prices. "Why was the government waiting?"

Fagmida Miller explained that she was on a clinical trial. Her viral load was undetectable and her health was good. This was the only way that she could get treated for HIV. She asked the government to ensure that clinical trials are properly conducted. Every adult and child with HIV/AIDS should have access to treatment. No-one should be excluded because of poverty or for any other reason.

The drug companies' announcement shows that the effort of treatment activists in South Africa and across the world has been necessary. But, success will depend on further mobilisation. Therefore, the Treatment Action Campaign (TAC) and HealthGap Coalition in the United States have won the endorsement for a Global March for Treatment at the International AIDS Conference in Durban on 9 July 2000 from Cosatu, Nactu, Fedusa, Sangoco, Jubilee 2000 and many other organisations. The march will be preceded by a joint conference of MSF and the TAC on improved access to drugs in developing countries. Government must lead on this issue. We all know the drug companies are profiteering and that people die
because drug costs are too high. Criticism is not enough; leadership and action from government will ensure that the announcement by UNAIDS and the Big Five becomes a reality and that people in poor countries receive HIV treatments.


Zackie Achmat the chairperson of TAC has HIV and he refuses to take anti- retroviral medication until it is available in the public sector. For information on the conference or march contact: msf-tac@mweb.co.za or (TAC) 031 3043673 or 011 403 0390.


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