By Shipra Prakash
7 July 2008 [MEDIAGLOBAL]: When a powerful earthquake hit south-west China in May, a human catastrophe seemed to be unfolding. 87,000 people were confirmed dead or missing and more than 5 million were left homeless.
Surely the magnitude of the China earthquake confirms that there is no bigger disaster. But the International Federation of the Red Cross and Red Crescent Societies (IFRC) say otherwise.
The humanitarian organization launched its 2008 World Disasters Report last week, and warned that the AIDS epidemic is to be classified as a ‘disaster’ in some countries.
The figures certainly show that the disease has a will of its own: 25 million deaths since the first cases of AIDS were brought forward in 1981, 2.5 million contracted the disease last year, and 33 million currently living with HIV.
“The Report calls it a disaster for those who live in countries in sub-Saharan Africa with a large incidence of HIV and for global vulnerable populations who are marginalized,” Bernard Gardiner, Unit Manager of the HIV/Aids Global Program at the IFRC, told MediaGlobal.
Prevalence rates in sub-Saharan Africa reach 20 percent and as a consequence, childcare, education and health will be disastrously affected in the long run.
Dr. Liesbet Ohler works in the Medecins Sans Frontieres (MSF) clinic in Mathare, a slum in Nairobi, Kenya. She expressed her frustration about the lack of effective medical tools to treat patients like Charles, who died at the age of two and a half.
“Charles was HIV positive and also infected with tuberculosis (TB). Here in Kenya, like elsewhere in Africa and throughout the developing world, we are struggling to treat and diagnose HIV/AIDS, including in children struggling with TB,” she explained.
It is broadly recognized that those infected with HIV happen to be particularly susceptible to TB. According to the Stop TB Partnership, TB is the primary cause of death for those infected with HIV in Africa.
“About 50 percent of people living with AIDS will develop TB,” Sarah Rimmington, an Attorney with Essential Action’s Access to Medicines Project, told MediaGlobal.
The Stop TB Partnership advocates integrated TB and HIV prevention and diagnostic and treatment services to treat people living with HIV.
But MSF claims that multidrug-resistant TB (MDR-TB) is increasing worldwide and less than 10 percent who need treatment don’t get it.
MDR-TB does not respond to standard treatment because of resistance to the first-line drugs isoniazid and rifampicin.
Patents keep the prices of drugs to treat the disease high. “Treating MDR-TB is expensive because it often requires the purchase of patented drugs,” Rimmington said.
It’s a familiar story: the cost of drugs is a solid barrier to treatment.
Last month, the Access to Medicine Foundation launched the Access to Medicines Index, a comprehensive listing of the pharmaceutical companies that have worked the most to increase access to medicines for all. The Index is based on data derived from critical criteria such as whether companies permit the sale of generic versions of their patented drugs, how much they donate and how much research on neglected diseases they do.
GlaxoSmithKline (GSK), a United Kingdom based pharmaceutical company, came on top of the list. GSK is recognized for its work on TB: in January GSK and the TB Alliance announced that their joint research program for the treatment of tuberculosis would be renewed for another 3 years. It was first initiated in 2004. Both fund 15 to 25 scientists committed to TB and Malaria research at GSK’s Tres Cantos facility in Spain.
But the conflict of interest between pharmaceutical companies and the needs of developing countries has not died a swift death.
Brazil injected new life in its campaign for improving access to essential medicines for patients in 1996 when the Brazilian Congress passed a law that requires the government to provide antiretroviral (ARV) treatment to anyone infected with AIDS at no charge.
And since the passing of the law in 1996, activists in Brazil have not been idle. In 2007, the country authorized a compulsory license that allowed for the purchase of a generic version of Efavirenz, a second-line AIDS drug, although Merck, a United States pharmaceutical company and manufacturer of the drug, offered to price it at a third of the original cost. Brazil rejected the offer on the grounds that it was seeking an even cheaper price.
Under Brazilian law and the World Trade Organization’s (WTO) rules, a compulsory license can only be granted in a health emergency or if the pharmaceutical company abuses its pricing.
At the time, Merck warned that Brazil’s action could discourage pharmaceutical companies from investing in treatments for diseases that are prevalent in the developing world. Merck’s dire warning is echoed by MSF. The medical humanitarian organization maintains that the killer diseases of AIDS and TB are not being given the attention they deserve.
Charles died because he could not be treated with one of the most common types of ARV drugs, as he was less than 10kg. Neither could he be given the most common replacement drug, as it interacts with TB treatment. Dr. Ohler blames the dearth of research and development in HIV and TB.
MSF calls AIDS a neglected disease, because very little research on the needs of those infected with the virus in developing countries is done by pharmaceutical companies.
“There is research being done on HIV/AIDS, but it targets the development of new drugs for Western countries,” Ellen‘t Hoen, Director of Policy Advocacy at MSF’s Campaign for Access to Essential Medicines, told MediaGlobal.
“AIDS drugs are needed for children in developing countries, but few Western countries require such drugs for children,” she added.
Thus pharmaceutical companies are not motivated to pursue research in the area due to the lack of financial incentives. But if AIDS is a neglected disease, its equally deadly partner, TB, should be considered to be almost ignored.
“TB research has been abandoned by the pharmaceutical companies,” Hoen said.
Yet the GSK’s and the TB Alliance’s joint research program on TB in GSK’s facility in Spain proves that TB research has not been completely abandoned by pharmaceutical companies. Even if it may not account for much, another step in the long, winding road that can lead to better TB medicines has been taken.