The
new all-American plan for HIV/AIDS in Africa
with
Emi Maclean, in The Washington Spark [July 2005]
The announcement of the U.S. Presidents Emergency Plan for
AIDS Relief (PEPFAR) was met with both eagerness and skepticism
when it was first announced by President Bush during the 2003 State
of the Union address. The plan promised, for the first time, a commitment
to attack the deadly AIDS scourge with more than just measures of
prevention. Explicitly, PEPFAR promised $15 billion over five years
to provide care and treatment for HIV/AIDS in fifteen severely affected
countries. Activists, medical professionals, and the HIV affected
expressed concern about what was left unsaid, however.
As plans have solidified, at least on the front lines of the epidemic,
skepticism has now largely overtaken much of the initial eagerness.
Take the 15th International AIDS Conference held in Bangkok, for
example. Randall Tobias, still fresh in the newly created shoes
of U.S. Global AIDS Coordinator, faced a furious crowd.
The view from the speakers platform was largely obscured by
a foamy sea of white HES LYING placards. (Check
out his speech and subsequent interview on www.kaisernetwork.org).
Those close to the epidemic are most critical of the plans
allegiance to industry interests, its threat to comparable multilateral
initiatives, and its insistence on forcing a controversial moral
agenda.
Sharonann Lynch, at the Health Global Access Project (GAP, www.healthgap.org),
typifies the view taken by many experts on both sides of the equator:
What the Office of the Global AIDS Coordinator describes as
innovative strategies [
] are instead incredibly short-sighted
and simplistic.

The Big Pharma Agenda
The skepticism of those affected by the disease is not surprising.
The Pharmaceutical Research and Manufacterers of America (PhRMA)
is the most powerful lobbying group in the U.S., exerting significant
influence over the U.S. trade and domestic policy agenda.
There have been few attempts to hide Big Pharma influence within
PEPFAR. Tobias himself, who was sworn in with the rank of Ambassador
in October 2003, was voted Pharmaceutical Industry CEO of
the Year by the Wall Street Journal in 1995 when he was Chairman,
President, and CEO of the pharmaceutical giant Eli Lilly.
One of the most consistent criticisms of PEPFAR is its reliance
on patented drugs rather than less expensive generic antiretroviral
drugs (ARVs), already proven to be effective and in use in parts
of the developing world, including India and Brazil. Health Action
International (HAI, www.haiweb.org)
founder Wilbert Bannenberg estimates that the branded products required
by PEPFAR cost, on average, thrice that of equally good generic
alternatives.
Pharmaceutical companies have fought fiercely to prevent the approval
of generic drugs for use in the developing worldtoughening
intellectual property protections in bilateral and multilateral
trade agreements and challenging country attempts to produce or
distribute generic drugs for their populations.
PEPFAR funds can only be used to purchase and distribute drugs
that have been approved by the U.S. Food and Drug Administration
(FDA). The Bush administration contends that this is for safety
and quality purposes. In 2004, the FDA announced an expedited process
to approve some antiretroviral therapies so that high quality
drugs can be made available.
However, critics argue that the obstacles posed by intellectual
property laws should not delay the use of generic drugs in countries
where the AIDS epidemic is raging. It is the World Health
Organization, and not the US Food and Drug Administration, which
has the mandate to set international standards for quality, safety,
and efficacy read a Médecins Sans Frontières
statement in May 2004.
One African organization that has been outspokenly critical of
PEPFAR is the Nairobi-based Ecumenical Pharmaceutical Network (EPN,
www.epnetwork.org). As EPNs
Dr. Eva Ombaka points out, PEPFAR's insistence on FDA approval
for all medicines purchased and the Buy American' requirement
for medicines other than ARVs, causes needless delay in making life-saving
drugs available.
EPNs criticism goes deeper than just inefficiency, however.
For one, having different brands of the same drugs leads to wasteful
complications for already overburdened healthcare systems. Of further
concern is the fate of small domestic industries, since the insistence
on FDA-approved drugs will threaten the existence of tried-and-tested
drug supply chains. (Many African countries currently locally produce
low-cost drugs against opportunistic infections associated with
HIV/AIDS). In the long-run, the eventual suspension of PEPFAR may
leave a veritable chasm in its wake.

Conclusion
Over the last two decades, Africa has of course not stood limply
by in the face of the AIDS pandemic. Unfortunately, PEPFAR is staunchly
unilateral, to the extent that it will likely undermine other international
and local efforts. Its implementation promotes the extensive use
of U.S. skills, personnel and institutions to the detriment of readily
available local expertise, often with a greater understanding of
relevant issues in their local contexts. There must be lessons
to be learnt locally rather than exporting methods from developed
countries, says Associate Professor Billy Futter in the Faculty
of Pharmacy at Rhodes University in South Africa.
Under the circumstances, its hard for anyone not to be suspicious
of the influence of pharmaceutical giants, who stand to benefit
greatly from the arrangement. Mr. Bannenberg is not alone in believing
that Tobias is going for the Big Pharma agenda. What this
world really needs is a global collaboration. Does PEPFAR,
then, do more harm than good? No, Mr. Bannenberg told
the Spark, we definitely need all the help we can get in Africa."
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