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Plan to Battle AIDS Worldwide Is Falling Short
March 28, 2004
By DONALD G. McNEIL Jr.
Three years after the United Nations declared a worldwide
offensive against AIDS and 14 months after President Bush
promised $15 billion for AIDS treatment in poor countries,
shortages of money and battles over patents have kept
antiretroviral drugs from reaching more than 90 percent of
the poor people who need them.
Progress in distributing the drugs, which have sharply cut
the death rate in the United States and other Western
countries, has been excruciatingly slow despite steep drops
in their prices.
As a result, only about 300,000 people in the world's
poorest nations are getting the drugs, of six million who
need them, according to the World Health Organization.
Experts, advocacy groups and health officials agree that
the delays, compounded by inadequate medical facilities and
training in very poor countries, are likely to persist
unless spending is stepped up sharply.
Early this month, Stephen Lewis, the special United Nations
envoy for AIDS in Africa, conceded that the W.H.O.'s
ambitious plan to have three million people in treatment by
2005 - announced on Dec. 1, World AIDS Day - was already
collapsing from a lack of money. Donations to the Global
Fund to Fight AIDS, Tuberculosis and Malaria are now about
$1.6 billion a year, barely 20 percent of what Secretary
General Kofi Annan said was needed when he created the fund
in 2001.
Saying that global contributions come to a tiny fraction of
what is being spent on military operations and building
civilian institutions in Iraq and Afghanistan, Mr. Lewis
added that if the W.H.O. program failed, "there are no
excuses left, no rationalizations to hide behind, no murky
slanders to justify indifference - there will only be the
mass graves of the betrayed."
While Mr. Bush promised in his 2003 State of the Union
address to spend $15 billion over five years on AIDS in
Africa and the Caribbean, his budget requests have fallen
far short of that goal. For the most recent donation to the
Global Fund, he requested only $200 million, although
Congress authorized $550 million.
Nor have Europe and Asia been as generous as the fund had
hoped.
Dr. Richard G. A. Feachem, a Briton who is the fund's
executive director, put a brave face on the situation,
describing current donations as "a steep upward flight path
to our cruising altitude, which we anticipate to be $8
billion." To get there in the fund's first two years would
be "inconceivable," he added. He is lobbying Congress for
$1.2 billion for 2005.
At the same time, few people in poor countries have been
able to get lower-priced generic antiretroviral drugs.
While the generic drugs have been approved by the W.H.O.,
endorsed by the World Bank and used in several African
countries, the Bush administration has so far paid only for
medicines that are still under patent and cost much more.
For example, Daniel Berman, co-director of the Doctors
Without Borders campaign for low-cost drugs, said that in
Zimbabwe his organization planned to treat 1,000 patients
with drugs from two approved Indian generic makers, Cipla
Ltd. and Ranbaxy Laboratories Ltd.
Both companies combine three antiretrovirals so that a
day's dose is just two pills and the cost is $244 to $292
per patient per year. Meanwhile, Mr. Berman said, the
Centers for Disease Control in Atlanta plans to pay for the
treatment of 1,000 Zimbabweans, buying the same three drugs
separately from GlaxoSmithKline, Bristol-Myers Squibb and
Boehringer-Ingelheim. The best prices available in Africa
from those companies, he said, add up to $562 a year, and a
daily dose is six pills.
Advocates of cheap drugs say the Bush administration has
yielded to pressure from the pharmaceutical lobby to find
ways to reject the generics.
On Friday, Senators Edward M. Kennedy, Democrat of
Massachusetts, and John McCain, Republican of Arizona,
wrote a joint letter to the White House urging it to accept
W.H.O.-approved generics.
In a separate letter, Representative Henry A. Waxman,
Democrat of California, accused the administration of
trying to set standards for Indian generics higher than
those for American ones.
A spokesman for Randall L. Tobias, the administration's
AIDS coordinator, said any suggestion that he was snubbing
generics was "utter nonsense."
"We will buy whatever drug is safe and effective at the
lowest possible price," said the spokesman, Dr. Mark R.
Dybul. "We don't care if it's made by Cipla or Ranbaxy, in
South Africa or Brazil or Nigeria."
Mr. Tobias has scheduled a meeting in Botswana for Monday
to ascertain whether the W.H.O.'s approval process is
rigorous enough.
Dr. Lembit Rago, who leads the W.H.O. assessments, said he
used "absolutely the same principles" as the Food and Drug
Administration, and borrowed his inspectors from regulatory
agencies in Canada, France, Germany, Sweden and
Switzerland. As soon as his office approved the Indian
pills, he said, "a very cold wind began to blow from the
U.S."
"It is no secret that Pharma is lobbying against us in a
big way," he said.
A spokesman for the Pharmaceutical Research and
Manufacturers Association of America, the industry's
American lobbying group, said his association was "not
involved in any way in this." But he called the Indian
drugs "new combinations that have not been appropriately
treated."
Dr. Dybul said Mr. Tobias wanted to see all the data the
Indian companies gave the W.H.O.
A W.H.O. spokeswoman said the agency signed confidentiality
agreements, but she said the Bush administration could ask
the Indian companies for the data.
Against that backdrop, prices for both branded and generic
medicines have plunged in the last two years. Last October,
a foundation organized by former President Bill Clinton
announced an agreement with Indian and South African
generic makers to sell the drugs for $140 per patient per
year if large orders were guaranteed, payment was in cash
and the drug maker did not have to pay the legal and
lobbying costs of getting each drug licensed in each
country.
In January, Mr. Clinton announced that he had brokered
another price-cut deal with five companies making AIDS
tests. One of the companies, Becton, Dickinson & Company,
dropped the cost of its CD-4 count, which measures immune
cells, to as little as $3, from a high of $10.
On Dec. 9, with little fanfare, an important step took
place in South Africa. Two pharmaceutical giants, Glaxo and
Boehringer-Ingelheim, agreed to grant licenses to produce
AIDS drugs to four generic companies from India and South
Africa.
The companies will be allowed to sell the drugs anywhere in
sub-Saharan Africa. In return, Glaxo and Boehringer will
get royalties of 5 percent of sales. Under the threat of
heavy fines, the companies had backed down from their
original plan: a license for one small generic maker
supplying only South Africa's public hospitals and
royalties of 15 percent to 30 percent.
The Canadian government has proposed a law encouraging its
drug makers to make cheap copies of drugs to treat AIDS and
malaria for export to poor countries. The bill is bogged
down in Parliament.
Treatment plans have varied wildly in different countries.
South Africa, with the world's largest number of AIDS
patients, was slow to roll out nationwide treatment because
of years of opposition by President Thabo Mbeki. India,
which has the second largest number, has been slow to
negotiate low prices with its own generic companies. Brazil
makes its own generic drugs. Romania buys only brand-name
drugs, but its epidemic is confined to about 10,000 people.
Nigeria, Africa's most populous country, has had trouble
running even so much as a pilot program for 15,000 of an
estimated 3.5 million infected people. Many of the
country's 25 treatment centers, which were selling the
drugs at a subsidized price of $85 a year, ran dry in
September and did not get new supplies until February.
Malaysia is the only country to exercise a "compulsory
license" right under trade treaties to ignore a patent and
import generics, said James P. Love, director of the
Consumer Project on Technology, a group that is pushing for
cheaper drugs. Uganda, Mozambique and Zambia may soon do
the same, he said, but China backed away from doing so for
fear of American trade retaliation. "They're using older
drugs that are already off patent in China," he said.
http://www.nytimes.com/2004/03/28/international/28AIDS.html?ex=1081592074&ei=1&en=a8ffc8cebbbe1cbb
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