Wall Steet
Journal article
23 October 2003, pages B1 and B5
Clinton Program Would
Help Poor Nations Get AIDS Drugs
By MARK SCHOOFS
Staff Reporter of THE
WALL STREET JOURNAL
Former President Bill Clinton plans to announce Thursday a
landmark program that attacks two of the toughest obstacles to treating AIDS in
the developing world: high drug prices and low-quality health
infrastructures.The Clinton Foundation HIV/AIDS Initiative has clinched a deal
with four generic-drug companies, including one in South Africa, to slash the
price of antiretroviral AIDS medicine.Engineered by longtime Clinton adviser Ira
Magaziner, the agreement will
cut the price of a commonly used triple-drug regimen by
almost a third, to about 38 cents a day per patient from an already cut-rate
generic price of about 55 cents. The lowest available price for the same regimen using
patented versions of the drugs in developing nations is $1.54. For a key drug,
nevirapine, the price will be cut by almost half.
The agreement also
establishes a way of working that is rare in the secretive pharmaceutical
industry. The companies involved -- Ranbaxy Laboratories Ltd., Cipla Ltd. and
Matrix Laboratories Ltd., all of India, and the South African company
Aspen Pharmacare Holdings Ltd. -- opened their books and manufacturing processes to a group
of Clinton business advisers. Then the advisers and the companies hunted for
ways to cut costs, starting with raw-material suppliers in China and ending with
the products' packaging. Mr. Clinton's team plans to use this approach to try to
lower the price of diagnostic tests, which are still very
expensive.
Under the supervision of Mr. Magaziner, the Clinton Foundation
HIV/AIDS Initiative also helped several Caribbean states and three African
countries prepare detailed government-approved plans for rolling out the drugs
nationwide, instead of just in selected regions. The plans aim to improve the
entire health-care system by preparing budgets for hiring and training nurses
and doctors, building and upgrading laboratories and clinics, developing
patient-information systems, and improving drug warehousing and delivery. Only a
handful of other sub-Saharan countries, such as Botswana and Senegal, have
created similarly ambitious, government-approved plans.
In the past,
South Africa, which has more HIV-infected people than any other country,
resisted public pressure to roll out full AIDS treatment in public hospitals and
clinics. But the South African government recently named Mr. Clinton's AIDS
Initiative as its main advisory group on HIV treatment, and the Clinton team has
helped draft a detailed operational plan for treating AIDS patients that the
cabinet is expected to approve shortly.
To pay for the drugs, and for the
necessary improvements in the countries' tattered health systems, Mr. Clinton
has secured partial funding by personally lobbying leaders of rich nations, such
as Ireland and Canada. Ireland has committed �50 million ($58.3 million) over
five years, mainly to Mozambique. Canada hasn't yet finalized its donation, but
it will be in the "tens of millions," according to a senior government official
there.
The money will go directly to the governments of the countries
that Mr. Clinton's team is assisting. "All I do is procure," Mr. Clinton said in
an interview, "I don't receive." Mr. Clinton has also raised more than $1
million from private sources."Usually I just call the prime minister or the
president," Mr. Clinton said, "and tell them what we're doing and ask them to
have somebody look at it. And I always tell them that even though we're friends
they don't have to do this for me -- don't do it unless they think it's a good
thing. But I think it's the best thing going in the world in AIDS
care."
To develop the programs, Mr. Magaziner has been working with a
team of medical experts from such institutions as Harvard and Columbia
universities, as well as business executives and consultants. All but one -- a
Kenyan who can't afford to work free of charge -- volunteer their time or get
support from their organizations.
It's unclear whether enough money can
be raised to support millions of patients on lifelong AIDS therapy, and Mr.
Clinton concedes his efforts don't always work out. In any case, he isn't
expected to raise all of the money. Rwanda, Mozambique and Tanzania have each
secured partial funding from other sources, such as the World Bank and the
Global Fund to Fight AIDS, Tuberculosis and Malaria.
Mr. Clinton
vehemently denies any partisan motivation, but his efforts threaten to steal
some thunder from President Bush. Months after Mr. Clinton began working on his
initiative, Mr. Bush called for $15 billion over five years to fight AIDS in
poor nations. That proposal still hasn't cleared the congressional
budget-authorization process.
Getting other governments to prepare and
approve ambitious treatment plans was critical to securing the drugs deal,
because the plans promised the drug makers large numbers of patients over time
-- up to 1.5 million by 2008. Essentially, the Clinton Foundation is becoming a
market maker. "This is the first time a group has come forward with predictable
volumes," said Yusuf Hamied, chairman of Cipla.
Mr. Magaziner then
approached drug companies and asked them to follow what he calls a total quality
management approach: open up their cost structures to lock in prices that would
give the companies a small profit but make the drug available at the lowest
possible cost. He says he first approached the patent-holding pharmaceutical
companies "because President Clinton believes in intellectual property." So far,
though, none of the Western companies are involved.
Bristol-Myers Squibb
Co. says it never received a Clinton proposal, and Merck & Co. says it is in
early-stage discussions.
There is a chance that the Western companies
will try to block the deal by charging patent infringement. But they have
damaged their images when they have tried to do that with AIDS drugs in the
past. In South Africa, which has the strongest
patent protection in Africa, GlaxoSmithKline PLC and Boehringer Ingelheim GmbH
have licensed some of their AIDS drugs to Aspen, one of the Clinton partner
companies.
You may Write to Mark Schoofs at
[EMAIL PROTECTED]
The
Mulindwas Communication Group
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