Carol C. Adelman | International Herald Tribune | May 23, 2006
http://www.iht.com/articles/2006/05/23/opinion/edadelman.php
The World Health Organization and its member countries are holding
their annual meeting, known as the World Health Assembly, in Geneva
this week. With hopes dashed for meeting its ambitious AIDS
prevention and treatment goals, criticisms of its failed Roll Back
Malaria Program, and chronic illnesses such as heart disease, cancer
and diabetes threatening even the poorest of countries, the
organization's limits are being tested.
The greatest tribute to Lee Jong-wook, the WHO director general who
died Monday, would be a new commitment to implementing policies that
work.
Even before WHO and the United Nations AIDS agency announced
their "3 by 5" initiative to treat three million HIV-infected people
with life-saving drugs by the end of 2005, the effort was destined
to fail. The centrally planned program was not even approved by
member states until six months after the announcement.
Instead of learning from existing AIDS programs in the private
sector, engaging with other countries' ongoing treatment programs in
India, South Africa, Botswana and Brazil, and setting realistic
treatment goals, WHO played to the crowds. It proclaimed that
unrealistically large numbers of people would be treated quickly.
Sadly, WHO promised much and delivered little. Of the 1.3 million
who have been treated for AIDS since Jan. 1, 2004, more than half
were funded directly by the pharmaceutical industry's Accelerated
Access Initiative and much of the rest came from European
governments and U.S. donations to the Global Fund and through
President George W. Bush's initiative. Once these numbers revealed
the WHO shortfall, the agency downplayed its previously trumpeted
goal. WHO must reach out beyond its normal circles of consultants
and government health ministries in order to work with local
doctors, clinics, hospitals and businesses in fighting AIDS and
other diseases.
WHO allowed advocacy to trump science. Routine HIV tests should be a
cornerstone of science-based medicine and a global AIDS program, yet
WHO decided they were too expensive.
WHO has focused on patents and alleged high prices of AIDS drugs as
primary barriers to treatment in poor countries. It recommended
using copies of AIDS drugs produced in the developing world - with
unknown safety and efficacy - as the key therapies for its "3 by 5"
program. In 2004, the global health agency then had to disqualify 18
of these antiretroviral formulations due to lack of proven
bioequivalence.
In reality, drug prices have not been a major barrier to treatment.
The majority of patented AIDS drugs are either less expensive or the
same price as copied drugs, because drug companies either donate
them or provide them at highly subsidized prices to developing
countries.
The real barriers to AIDS treatment receive little attention from
WHO. Substandard and counterfeit medicines may be contributing to
dangerous drug- resistant strains of HIV, yet registration of proven
drugs continues to be complicated and lengthy.
Developing countries also place exorbitant taxes and tariffs on many
essential medicines. The U.S. Mission to the United Nations in
Geneva, citing UN statistics, points out that "almost $33 billion in
pharmaceuticals and $23 billion in medical equipment are still
traded subject to duty, predominantly by developing countries."
Accordingly, the United States, Switzerland and Singapore introduced
a proposal to eliminate these tariffs and substantially lower the
price of medicines for poor people.
To its credit, WHO did admit publicly that its "3 by 5" strategy had
failed. But the failed campaign did not prevent WHO from quickly
announcing a new "10 by 10" AIDS treatment program - with the goal
of treating 10 million people by 2010. The effort calls for $28
billion a year for treatment starting in 2008, even though there are
no modifications to WHO's strategy. Should the G-8 countries really
be expected to continue footing the bill for proven failure?
Sound medical and public health policies, not publicity and
exaggerated numbers, should be WHO's priority. Governments,
nongovernmental organizations, industry leaders and global bodies
should check their ideological guns at the door and work in good
faith to break down the real obstacles to AIDS treatment. Developing
countries need to provide the leadership for improved health care
infrastructure as well.
It is time for WHO to rethink its strategies and modus operandi. It
must reach out to new health care players in developing countries,
reorient itself to science- based medicine, and reclaim a leadership
role to meet the looming public health challenges. The world's
global health authority must stop chasing numbers in order to
achieve the desired bureaucratic outcome and instead focus on
testing and evaluation, responsible treatment, and monitoring of
AIDS patients.
Health professionals and policy makers around the world will be
watching the World Health Assembly for lessons learned from failed
campaigns, and hoping that member states demand accountability. WHO
should be judged by its performance, not by its rhetoric. Good
intentions are not good enough.
Dr. Carol C. Adelman is the director of the Center for Science in
Public Policy at the Hudson Institute in Washington.
WASHINGTON The World Health Organization and its member countries
are holding their annual meeting, known as the World Health
Assembly, in Geneva this week. With hopes dashed for meeting its
ambitious AIDS prevention and treatment goals, criticisms of its
failed Roll Back Malaria Program, and chronic illnesses such as
heart disease, cancer and diabetes threatening even the poorest of
countries, the organization's limits are being tested.
The greatest tribute to Lee Jong-wook, the WHO director general who
died Monday, would be a new commitment to implementing policies that
work.
Even before WHO and the United Nations AIDS agency announced
their "3 by 5" initiative to treat three million HIV-infected people
with life-saving drugs by the end of 2005, the effort was destined
to fail. The centrally planned program was not even approved by
member states until six months after the announcement.
Instead of learning from existing AIDS programs in the private
sector, engaging with other countries' ongoing treatment programs in
India, South Africa, Botswana and Brazil, and setting realistic
treatment goals, WHO played to the crowds. It proclaimed that
unrealistically large numbers of people would be treated quickly.
Sadly, WHO promised much and delivered little. Of the 1.3 million
who have been treated for AIDS since Jan. 1, 2004, more than half
were funded directly by the pharmaceutical industry's Accelerated
Access Initiative and much of the rest came from European
governments and U.S. donations to the Global Fund and through
President George W. Bush's initiative. Once these numbers revealed
the WHO shortfall, the agency downplayed its previously trumpeted
goal. WHO must reach out beyond its normal circles of consultants
and government health ministries in order to work with local
doctors, clinics, hospitals and businesses in fighting AIDS and
other diseases.
WHO allowed advocacy to trump science. Routine HIV tests should be a
cornerstone of science-based medicine and a global AIDS program, yet
WHO decided they were too expensive.
WHO has focused on patents and alleged high prices of AIDS drugs as
primary barriers to treatment in poor countries. It recommended
using copies of AIDS drugs produced in the developing world - with
unknown safety and efficacy - as the key therapies for its "3 by 5"
program. In 2004, the global health agency then had to disqualify 18
of these antiretroviral formulations due to lack of proven
bioequivalence.
In reality, drug prices have not been a major barrier to treatment.
The majority of patented AIDS drugs are either less expensive or the
same price as copied drugs, because drug companies either donate
them or provide them at highly subsidized prices to developing
countries.
The real barriers to AIDS treatment receive little attention from
WHO. Substandard and counterfeit medicines may be contributing to
dangerous drug- resistant strains of HIV, yet registration of proven
drugs continues to be complicated and lengthy.
Developing countries also place exorbitant taxes and tariffs on many
essential medicines. The U.S. Mission to the United Nations in
Geneva, citing UN statistics, points out that "almost $33 billion in
pharmaceuticals and $23 billion in medical equipment are still
traded subject to duty, predominantly by developing countries."
Accordingly, the United States, Switzerland and Singapore introduced
a proposal to eliminate these tariffs and substantially lower the
price of medicines for poor people.
To its credit, WHO did admit publicly that its "3 by 5" strategy had
failed. But the failed campaign did not prevent WHO from quickly
announcing a new "10 by 10" AIDS treatment program - with the goal
of treating 10 million people by 2010. The effort calls for $28
billion a year for treatment starting in 2008, even though there are
no modifications to WHO's strategy. Should the G-8 countries really
be expected to continue footing the bill for proven failure?
Sound medical and public health policies, not publicity and
exaggerated numbers, should be WHO's priority. Governments,
nongovernmental organizations, industry leaders and global bodies
should check their ideological guns at the door and work in good
faith to break down the real obstacles to AIDS treatment. Developing
countries need to provide the leadership for improved health care
infrastructure as well.
It is time for WHO to rethink its strategies and modus operandi. It
must reach out to new health care players in developing countries,
reorient itself to science- based medicine, and reclaim a leadership
role to meet the looming public health challenges. The world's
global health authority must stop chasing numbers in order to
achieve the desired bureaucratic outcome and instead focus on
testing and evaluation, responsible treatment, and monitoring of
AIDS patients.
Health professionals and policy makers around the world will be
watching the World Health Assembly for lessons learned from failed
campaigns, and hoping that member states demand accountability. WHO
should be judged by its performance, not by its rhetoric. Good
intentions are not good enough.
Dr. Carol C. Adelman is the director of the Center for Science in
Public Policy at the Hudson Institute in Washington.
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