Fighting AIDS in Sub-Saharan Africa: Is a public-private partnership a viable paradigm?

Medical Science Monitor

Volumn 9, Issue 9, 2003, Pages

  Clark, Peter A ^a   O'Brien, Kevin ^a  

^a SAINT JOSEPH S UNIVERSITY   (United States)

Author keywords

Antiretrovirals; HIV AIDS; Infectious diseases; Pandemic; Public private partnerships; Sub Saharan Africa; Treament and prevention

Indexed keywords

ANTIRETROVIRUS AGENT; DIDANOSINE; LOPINAVIR PLUS RITONAVIR; RITONAVIR; STAVUDINE;

ACQUIRED IMMUNE DEFICIENCY SYNDROME; AFRICA; BOTSWANA; COMMUNITY CARE; CONDOM; COPING BEHAVIOR; DEVELOPING COUNTRY; DRUG INDUSTRY; ECONOMIC EVALUATION; GOVERNMENT; HEALTH CARE ACCESS; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH ECONOMICS; HEALTH EDUCATION; HEALTH PROGRAM; HEALTH PROMOTION; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; INFECTION PREVENTION; LABORATORY TEST; PATIENT COUNSELING; PATIENT EDUCATION; PATIENT REFERRAL; PREVENTIVE MEDICINE; PUBLIC PRIVATE PARTNERSHIP; RESPONSIBILITY; REVIEW; SOCIOECONOMICS;

ACQUIRED IMMUNODEFICIENCY SYNDROME; AFRICA SOUTH OF THE SAHARA; ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE; BIOETHICAL ISSUES; HUMANS; INTERINSTITUTIONAL RELATIONS; INTERNATIONAL COOPERATION; PRIVATE SECTOR;

EID: 18144452939     PISSN: 12341010     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (67)

1. Maugh Thomas: 'AIDS' Global Spread Staggers Researchers, 'Los Angeles Times, 3 July 2002: A-1, A7, A-27. The full report, of the UNAIDS study can be found at http://www.unaids.org (accessed July 5, 2002)
2. UNAIDS, Press Release: 'UNAIDS Releases New Data Highlighting the Devastating Impact of AIDS in Africa, June 25 2002. http://www.unaids.org/whatsnew/press/eng/pressarc02/G8_250602.html (accessed July 4, 2002).
3. UNAIDS, Press Release: 'New UNAIDS Report Warns AIDS Epidemic Still in Early Phase and Not Leveling Off in Worst Affected Countries', July 2, 2002. http:#www.unaids.org/whatsnew/pressarc02/prreport020702.html (accessed July 2, 2002)
4. Altman Lawrence: 'U.N. Forecasts Big Increase in AIDS Death Toll', New York Times, 2002; 3: A-1, A-6
5. Sengupta, Somini, 'U. N. Session Begins to Tally the Perils of Being Young', New York Times. 2002: 9: A-14
6. Stolberg, Sheryl Gay: 'With Convert's Zeal, Congress Awakens to AIDS', New York Times, 2002; 12: A-1, A-20
7. Altman, Lawrence, 'By 2010, AIDS May Leave 20 Million African Orphans', New York Times, 2002; 11: A-10. In total, by 2001, 13. 4 million children in Africa, Asia, and Latin America had been orphaned by AIDS. By 2010, in addition to the 20 million children likely to be orphaned to AIDS in Africa, an additional 5 million children elsewhere in the world will lose a parent to AIDS. Ibid
8. UNAIDS press release, July 2, 2002
9. Maugh, A-1
10. Altman, 'U. N. Forecasts Big Increase in AIDS Death Toll', A-1
11. Van Niekerk, Anton, 'Moral and Social Complexities of AIDS in Africa', Journal of Medicine and Philosophy 27. 2 (2001), 144
12. Fuller SJ Jon: 'Theological and Ethical Considerations in Developing Antiretroviral Therapy Programs for Developing Countries', a paper presented at the Workshop on Access to AntiRetroviral Therapy in Developing Countries, sponsored by Caritas International and International Cooperation for Development and Solidarity, August 2001; 27-29, Wuerzburg, Germany, at http://www.uni-wuerzburg.de/missio/institut/health/arv/home.htm (accessed July 7, 2002)
13. Altman: 'UN Forecasts Big Increase in AIDS Death Toll,' A-1, A-6
14. UNAIDS press release, July 2, 2002
15. AVERT, 'AIDS Orphans In Africa', http://www.avert.org/aidsorphans.htm, (April 28, 2002.)
16. I b i d.
17. UNAIDS press release, June 25, 2002
18. UNAIDS press release, June 25, 2002; Schemo, Diana. 'Education Suffers In Africa As AIDS Ravages Teachers,' New York Times. 2002; 8: A-12
19. UNAIDS press release, 2002; 24
20. AVERT, 'AIDS Orphans in Africa'
21. UNAIDS press release, July 2, 2002
22. AVERT, 'AIDS Orphans in Africa', 'In the area of care for orphans and for people living with HIV and AIDS, costs depend very much on what kind of care is being provided. It is estimated that, with at least US $1.5 billion a year, countries in sub-Saharan Africa could buy symptom and pain relief (palliative care) for at least half of AIDS patients in need of it; treatment and prophylaxis for opportunistic infections for a somewhat smaller proportion; and care for AIDS orphans'. AVERT. 'HIV & AIDS in Africa', http://www.avert.org/aafrica.htm (accessed July 19, 2002). p. 6.
23. Avert, 'AIDS Orphans in Africa'. It should also be noted that the health care infrastructure in many African countries has been devastated in recent decades by the World Bank and the International Monetary Fund, which dictated 'structural readjustment programs' (SAP's) to redirect monies from local social investment to debt repayment.
24. Maugh, A-26
25. ACHAP, 'Background information', (April 2002): 1-6
26. Editorial, 'AIDS Reduces Botswanan Life Expectancy', The Daily News, 2002; 19: A-7
27. In a research study by Thomas Quinn, et al. in Uganda in 2000, findings showed that male circumcision was protective against HIV-1 infection, with no infections occurring among 50 circumcized HIV-1 negative male subjects, as compared with 40 infections among 137 HIV-1 negative uncircumcized male subjects. For additional data see. Quinn, Thomas, Wawer, Maria, Sewankambo, Nelson, et al, 'Viral Load And Heterosexual Transmission Of Human Immunodeficiency Virus Type 1'. The New England Journal of Medicine 342 (13) (March 30, 2000): 921-929
28. In a research study by Thomas Quinn, et al. in Uganda in 2000, findings showed that male circumcision was protective against HIV-1 infection, with no infections occurring among 50 circumcized HIV-1 negative male subjects, as compared with 40 infections among 137 HIV-1 negative uncircumcized male subjects. For additional data see. Quinn, Thomas, Wawer, Maria, Sewankambo, Nelson, et al, 'Viral Load And Heterosexual Transmission Of Human Immunodeficiency Virus Type 1'. The New England Journal of Medicine 342 (13) (March 30, 2000): 921-929
29. Cowley, Geoffrey, 'Bill's Biggest Bet Yet', Newsweek (February 4, 2002): 45-52
30. UNAIDS press release, July 2, 2002
31. UNAIDS press release, July 2, 2002
32. UNAIDS press release, July 2, 2002
33. Stolberg, 'With Convert's Zeal', A-20. According to Kofi Annan, the United States' responsibility for global AIDS relief is one quarter of the $10 billion, of $2.5 billion, payable immediately.
34. For a helpful overview of the traditional and contemporary views of corporate social responsibility, see Resnik, David B, 'Developing Drugs for the Developing World: an Economic, Legal, Moral, and Political Dilemma', Developing World Bioethics 1. 1 (2001): 17-18, and John R. Boatright, Ethics and the Conduct of Business (Englewood Cliffs, NJ: Prentice-Hall, 1993), 381-407
35. For a helpful overview of the traditional and contemporary views of corporate social responsibility, see Resnik, David B, 'Developing Drugs for the Developing World: an Economic, Legal, Moral, and Political Dilemma', Developing World Bioethics 1. 1 (2001): 17-18, and John R. Boatright, Ethics and the Conduct of Business (Englewood Cliffs, NJ: Prentice-Hall, 1993), 381-407
36. Boatright, 385-86, 396
37. Boatright, 386
38. For a concise review of the advantages and disadvantages of these approaches, see Schuklenk, U. and Ashcroft, R, 'Affordable Access To Essential Medication In Developing Countries: Conflicts Between Ethical And Economic Imperatives', Journal of Medicine and Philosophy 27 (April 2002): 179-195
39. United Nations Universal Declaration of Human Rights (1948), Article 1: http://www.un.org/Overview/rights.html (accessed July 7, 2002)
40. According to Article 25. section 1, of the Universal Declaration of Human Rights, 'Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control'.
41. For a religious perspective on the principles of human dignity and human rights, see the final report of the Workshop on Access to Anti-Retroviral Therapy in Developing Countries, sponsored by Caritas International (CI) and International Cooperation for Development and Solidarity (CIDSE), August 27-29, 2001, Wuerzburg, Germany, at http://www.uni-wuerzburg.de/missio/institut/health/arv/home.htm (accessed July 7, 2002)
42. See Fuller
43. See Fuller. For another compelling discussion of the need for an integrated approach to the AIDS epidemic in Africa, including the need for basic health care infrastructure and cooperation between the public and private sector, see the summary report of a conference, 'Ethical Dimensions of Issues of Access to Medicines and Care', April 7-9, 2002, Notre Dame Center for Ethics and Religious Values. http://www.nd.edu/~ethics/events/0205_past_events_aids_conference.htm (accessed July 9, 2002)
44. Schuklenk and Ashcroft, 187
45. Van Niekerk, 149
46. Ibid, 150
47. Resnik 24
48. Japsen, Bruce, 'Abbott Sets More Africa AIDS Drug Price Cuts', Chicago Tribune, 27 April 2002: business section. 1; Petersen, M, 'Abbott to Sell Low-Cost AIDS Drugs in Africa: New York Times, 28 March 2001: C-9
49. Japsen, Bruce, 'Abbott Sets More Africa AIDS Drug Price Cuts', Chicago Tribune, 27 April 2002: business section. 1; Petersen, M, 'Abbott to Sell Low-Cost AIDS Drugs in Africa: New York Times, 28 March 2001: C-9
50. 'Caribbeans to Buy AIDS Drugs at Discounts', New York Times, 7 July 2002: A-3. The Caribbean is second only to sub-Saharan Africa in the rate of HIV-infection. Ibid
51. Japsen, 1
52. Maugh, A-27
53. Japsen, 1
54. Resnik, 13
55. I b i d.
56. Schuklenk and Ashcroft, 190-91
57. Abbott Laboratories Annual Report, (2001): 4
58. Resnik, 26
59. Ibid, 14. By industry estimates, it costs about US$500 million for R&D on a single drug sold in the U. S. Ibid, 16. Investment in the research and development of new drugs is risky, as only 30% of new drugs make a profit. Ibid. 97. On the other hand, the profits of those successful drugs more than make up for R&D costs of drugs that failed or were not approved for sale.
60. Abbott Laboratories. Fact Book, (2002): 2
61. Pharmaceutical companies can also be challenged on the amount the spend on marketing new drugs: US $14 billion in 2000. Resnik, 14. Another important issue is whether drug companies are spending enough money to develop drugs that treat life-threatening diseases in developing countries, where there is great demand for necessary medications but little return on their investment, given the inability of most people in those countries to pay exorbitant prices. Pharmaceutical companies are more eager to invest earnings in developing lifestyle drugs for consumers in wealthier nations. For example, drugs to prevent baldness, increase virility, and alleviate minor physical discomfort may not be life-saving, but can yield companies a substantial return. These drugs are more likely to be developed than drugs used to treat tropical diseases. See Donald McNeil, Jr. 'Drug Makers and Third World: Study in Neglect', New York Times, 21 May 2000; 1: 1
62. The resolution also urged Abbott to expand access to drugs used to treat tuberculosis and malaria.
63. A corporation as large as Abbott has millions of voting shares. Institutional investors, like mutual and pension funds, will often vote shares in blocks. Individual investors get proxy statements sent to them in the mail. These statements allow their shares to voted at the annual meeting without their attendance. Only the most interested shareholder takes the time to read the proxy statement, which includes a copy of the shareholders' resolutions, if any. In the proxy statement, the directors of the corporation suggest to the investor how their shares should be voted. In the present case, Abbott recommended that shareholders reject the Jesuits' resolution.
64. Three people spoke in favor of the resolution: Doris Gormley, the Jesuits' advocate at the meeting: Rev. Jon Fuller MD, a Jesuit priest and physician who works with HIV/AIDS patients in Boston; and Mr. Artemus Gaye, a Methodist seminarian raised and partly educated in sub-Saharan Africa.
65. In May 2002, Abbott informed the filers of the resolution that Abbott had or will soon undertake the following steps to address the AIDS pandemic in developing countries; (1) Abbott will reduce the prices of its ARV's, Kaletra and Norvir, in line with the prices of other ARV manufacturers; (2) through its program called 'Abbott Access', Abbott is shipping its products to 41 nations, 37 of which are in Africa; (3) through its program called 'Step Forward', Abbott is providing employee expertise, product donations, and grant funds to care for orphans and vulnerable children impacted by AIDS in Bukina Faso, Tanzania, Romania, and India. This program includes efforts to improve local health care infrastructure and education programs; (4) Abbott promised to abide by international agreements under which a participating country may produce generic versions of one of their drugs to meet emergency needs.
66. In the second year, the resolution must receive at least 6% of the votes to be refiled. In the third year, the threshold increases to 10%.
67. In the Russian Federation, the HIV infection rate has been nearly doubling every year. In China, 1.5 million people are currently infected, a number projected to climb to 10 million by 2010. Maugh, A26