For those interested, this is from the Financial Times Interactive.

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Aids, drugs and Africa
Industrialised nations and pharmaceuticals companies have a duty to tackle
disease in the continent, says Jeffrey Sachs
Published: February 12 2001 20:45GMT | Last Updated: February 12 2001 20:54GMT


 There is perhaps no starker divide between rich and poor than that of public
health. The rich are living longer and more healthily than ever, while the
poor are increasingly falling victim to Aids, malaria, tuberculosis and other
emerging and re-emerging diseases. The situation is intolerable, yet the
world has failed to take the appropriate steps. Talk alone will not solve the
problems. Money, political will, wise stewardship by the pharmaceutical
companies and good science from the world's experts will all be needed. The
first step is to realise that the public health crisis in the poor countries,
especially in Africa, is inter-national public enemy number one. Without
progress on Aids and the other diseases, economic development itself will be
blocked in much of the world. Second, it must be recognised that poor
countries need financial help to fight disease. The poorest countries have
annual incomes of just $250 a person. Even public health spending of 5 per
cent of gross national product, more than most impoverished countries can
achieve, amounts to only $12.50 a person a year - grossly insufficient to
tackle the multiple health crises. Africa would probably need between $10bn
and $20bn a year from inter- national donors for disease control but it
receives less than $1bn. Third, pharmaceutical companies should make their
miracle drugs for Aids and other killer diseases available at production cost
to the poorest countries. In rich countries, the drugs are sold at far above
production cost. Price competition is limited by the patents held on the new
drugs. This system spurs innovation but it prices the drugs out of the reach
of the poorest countries. The drug companies have recently signalled a
willingness to sell their life-saving drugs at a small mark-up over
production cost to international donor agencies as long as intellectual
property rights are respected; the drugs are properly used; and they are not
reimported into the developed countries' markets. Fourth, any international
donor efforts should be based on fundamental precepts of scientific merit,
transparency and independent review and evaluation. Many donor projects get a
bad name because they are poorly designed, lack the necessary scientific
basis and are not subjected to a scientific peer review that can detect
errors in design or implementation. These four basic points can guide us to
workable mechanisms for a large-scale assault against the killer diseases in
impoverished regions. Take Aids. There are an estimated 24m Africans infected
with HIV, of which about 4m-6m have advanced Aids. UNAIDS, the joint United
Nations programme on HIV/Aids, estimates that about $3bn will be needed for
prevention and community support, focused on programmes to support safe sex;
the use of anti-retroviral drugs to block transmission from mother to child
at birth; and support for millions of orphans. For those already suffering
from Aids, special combinations of anti-retroviral drugs can prolong life and
dramatically reduce the burden of the disease. Parents with Aids can thereby
stay in the workforce and children are spared the tragedy of becoming
orphaned. Yet the drugs have been too expensive for poor African governments
or families to buy and donors and drug companies have not yet devised ways to
get the drugs to the poor who need them. Moreover, unless treatment is
available, prevention programmes will not work. Victims of Aids will not come
forward. To treat victims, however, will require donor funds combined with
the leadership of the pharmaceutical industry. Drug companies sell their
anti-retroviral drugs in developed countries for about $10,000 a year, though
production costs are about $500 per year. The drug companies have no
customers for their products in Africa at these high prices and they would
lose nothing by offering to sell them to the donor agencies at cost. The
agencies would then make them available for free to the poorest countries.
Several companies have signalled their willingness to pursue this step but
donor countries have not yet stepped forward to close the deal. We also need
to know more about the best protocols for treating Aids in the poorest
countries. The World Health Organisation and UNAIDS should co-ordinate this
massive effort, drawing on the world's scientific community. I estimate that
the cost of the overall Aids effort would be about $5bn during the next
couple of years and would rise to perhaps $10bn as the coverage of treatment
was expanded. This should be part of a co-ordinated disease control effort
for Africa of $10bn -$20bn a year. But with 1bn rich people in the developed
countries, this would amount to only $10-$20 from each - an irresistible
bargain to save millions of lives a year. The writer is director of the
Centre for International Development at Harvard University







Hamjatta - Kanteh
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