[procaare] South Africa Could Lead By Example in Adopting Harvard's AIDS Plan

[Holly Ladd <hladd@usa.healthnet.org>]

South Africa Could Lead By Example in Adopting
Harvard's AIDS Plan

Business Day (Johannesburg)
April 11, 2001
Posted to the web April 11, 2001

Simon Barber
Johannesburg

The Harvard blueprint for delivering AIDS treatment to African and other poor countries
which cannot afford it offers South Africa a badly needed opportunity to show leadership
in an area where hitherto it has embarrassed itself.

The plan calls for the creation of a multibillion-dollar trust fund to purchase
antiretroviral medicines and finance the complex array of interventions needed to ensure
they are safely prescribed and provided.

The fund is a good idea, but there is going to be strong resistance in donor countries to
establishing what threatens to be yet another global bureaucracy dishing out taxpayers'
money according to its own whims and subject to little accountability.

Even if that resistance can be overcome, the funds' key purpose, as envisaged by the
Harvard plan's instigator, Jeffrey Sachs, is bound to generate hostility among funders.

The theory is that if resources are pooled, they can be spent on initiatives chosen
objectively rather than because they happen to fit the narrow skill sets of donors' pet
nongovernmental organisations The powerful pets do not approve.

To have any real chance of getting off the ground, the plan must be enthusiastically
endorsed by those countries to which it aims to channel support. Unfortunately, its
conceivers, coming from Harvard and thus thinking themselves to be the best and cleverest
people on the planet, have given this aspect less attention than it needs.

SA could, if it put its mind to it, greatly enhance the prospect of the scheme becoming a
useful reality by coming up with its own plan for using funds should they become
available.

Sachs is not talking about simply dumping antiretroviral cocktails, acquired from the
makers at cost, on African countries. Initially, what the proposal envisages is a massive
on the-ground research programme.

At the moment, antiretroviral treatment is going to about 10000 a tiny, elite minority of
the 25million Africans believed to be infected with HIV. The lucky few, like Judge Edwin
Cameron, enjoy health care of developed world standards, including regular tests and
checkups to ensure they are receiving optimal prescriptions.

The truth is, no one knows for sure whether the highly active antiretroviral therapy
regimen that has slashed AIDS mortality rates in the rich countries will be as effective
in, say, rural KwaZulu-Natal, even assuming the latter had adequate clinical facilities.

A huge body of knowledge and experience has to be collected.

Under the conditions that obtain in most of Africa, which drug combinations work best, and
at what stage of the disease should they be administered? What is the best way of making
sure patients take their pills in the prescribed manner? What is the most cost-effective
way of testing patients' blood to see whether the treatment is working or needs modifying?

Other essential questions concern the interplay between treatment and prevention. Does
availability of the former complicate the latter by making HIV seem survivable? Or does
the notion that HIV is not an automatic death sentence make it easier to convince people
to be tested?

Inasmuch as treatment reduces the level of HIV in a patient's blood stream, and those
levels correlate with the likelihood of transmission, might not the drugs in and of
themselves lower infection rates?

The only way to get answers is to start treatment on a large, but carefully monitored,
scale, the quicker the better. Which African nation is better placed than SA to be the
proving ground for strategies, techniques and protocols for the rest of the continent to
be perfected?

Government's objection to public provision of highly active antiretroviral therapy appears
to be that the expense of the drugs and delivering them responsibly will crowd out
investment in poverty reduction and public health improvement for the 90% of the
population that is not HIV-positive.

It would also be a crippling recurrent cost because, at this stage, the drugs are not a
cure but palliatives that must be taken for life.

These points are fair, and would give government a reasonable excuse, if it so chose, not
to respond to the multinational drug firms' offers of discounted highly active
antiretroviral therapy components.

If there was a chance of obtaining highly active antiretroviral therapy drugs free, as
well as funding to develop the infrastructure to administer them on sound scientific and
public health principles, and if these resources were available on terms that allowed SA
to determine their best use without sovereignty eroding strings, surely then it would be a
mistake to turn one's back.

SA's distorted health delivery desperately needs upgrading. The AIDS epidemic can and
should be used to win the required donor funding. The Harvard plan, if SA were prepared to
play in a lead role in seeing it implemented, offers an opportunity to access both funding
and medicines.

Of course, there are those who think Harvard, which makes money from its patents, is in
cahoots with the drug companies to preserve the intellectual property rights.

The deal, they say, is that the companies will sell to the fund at cost and, in return,
the donors will stand firm on the World Trade Organisation agreement on intellectual
property.

The Harvard plan isn't perfect. Yet treatment has to be part of the mix.

Too many Africans upon whom the fabric of society depends are dying in those years of
their lives when they are most needed.

They should not when they could be treated at no cost to themselves or the state have to
die because someone with an alien agenda questions the motives of those who would help
them.

Copyright (c) 2001 Business Day.
Distributed by AllAfrica Global Media
(allAfrica.com).

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