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Un Program Agains AIDS/HIV

June 2001 Declaration of Committment on HIV/AIDS

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Recalling the targets and goals established in the Declaration of Commitment on HIV/AIDS adopted by the General Assembly at its twenty-sixth special session in 2001 and the HIV/AIDS related goals contained in the United Nations Millennium Declaration of 2000,

Noting with deep regret that 39.4 million people worldwide are living with HIV/AIDS and that the pandemic has claimed 3.1 million lives in 2004 and has orphaned 15 million children,

Deeply concerned that the global HIV/AIDS pandemic has a disproportionate impact on women and girls and the young,

Expressing serious concern about the impact of the HIV/AIDS pandemic in exacerbating poverty and threatening economic and social development, especially in Africa,

Further seriously concerned about the threat of the HIV/AIDS pandemic to international peace and security by undermining the stability of states and regions as a function of the social and economic consequences,

Recognizing the importance of national, regional and international partnerships in responding to HIV/AIDS, including the prevention, care, support and treatment, as well as the importance of enhanced support for human and international capacity development and increased financial resources,

Applauding the steps that have been taken by the developed world and their vital role in providing resources for the fight of HIV/AIDS in the developing world,

1. Urges the Joint United Nations Programme on HIV/AIDS (UNAIDS), and all Member States, especially in the developed world to intensify their support to all governments towards achieving the goals and targets of the Millennium Declaration and the Declaration of Commitment on HIV/AIDS,

2. Requests that the developed world immediately allocate 25 billion dollars per year to UNAIDS to fight the HIV/AIDS pandemic,

3. Further requests that the developed world provide drug treatments for those infected with HIV/AIDS as part of their aid programmes to the developing world,

4. Invites the Secretary-General through the Economic and Social Council report on the implementation of this resolution within six months.

Mover: Uganda

Seconded: Bolivia

Speakers: the Netherlands, Brazil, Zimbabwe, Italy, Thailand, Peru,

 

Support Material

Two important website resources for the United Nations response to AIDS/HIV are the following. UN Program against Aids / HIV: http://www.unaids.org/en/HIV_data/default.asp 2001 Declaration http://data.unaids.org/publications/irc-pub03/aidsdeclaration_en.pdf

Some basic AIDS facts and figures that you will find there are as follows: The UNAIDS 2006 report on the global AIDS epidemic states

65 million people worldwide have been diagnosed with AIDS since the disease was first identified in 1981.

39.5 million people were living with HIV and 2.9 million would die from it in 2006, UNAIDS estimates. Over 40 per cent of new adult HIV infections worldwide in 2006 occurred among young people 15 to 24 years old

AIDS was originally called GRID, or "gay related immune deficiency" because it was perceived as a homosexual disease.

Most scientists believe AIDS and its cause, the human immunodeficiency virus, started in Africa when people ate a primate that carried a virus similar to HIV. While men having sex with men and injection drug use remain a high source for HIV transmission in Western countries, it is increasingly being passed along by heterosexual couples who have unprotected sex.

By 2010, more than 15.7 million children will have lost at least one parent due to AIDS, a UNICEF report estimates.

While most disease have a physical and biological basis at times religious or cultural reactions are equally significant. This is particularly true with AIDS/HIV. The second element you must understand to consider of AIDS/HIV is the issue of economics of the drug industry.

By 1983 French researchers had isolated a virus that would later be called HIV (human immunodeficiency virus). They and others linked this virus to the development of AIDS (acquired immune deficiency syndrome), but a test for exposure to HIV would not become widely available for several more years. HIV is unusual in that it infects the very cells of the immune system … called T-cells … that protect us from attack by viruses, bacteria and other bugs. Once a person becomes infected, the immune system mounts a counter-attack by producing massive numbers of T-cells. Yet inside the body of someone with HIV infection rages a vast war, as billions of viruses and T-cells are created and destroyed in a single day. The body cannot sustain the expenditure forever, and the virus slowly gains the upper hand. After 10 years or more of battle the immune system begins to collapse. At this point, infections that are, at worst, annoying for the average person, turn lethal as AIDS develops. Overwhelmed by wave after wave of infection, the body eventually gives in.

Modern antiretroviral drugs have worked wonders at extending the lives of those with HIV.But even the early versions of these meds are barely available in places like sub-Saharan Africa. Sub-Saharan Africa continues to bear the brunt of the epidemic, especially southern Africa, but the report says the rate of infection appears to have peaked in several countries, including Kenya and Zimbabwe. By the World Health Organization estimate for 2005, about 1.3 million AIDS sufferers there had access to antiretrovirals. A further 6.5 million did without.

Drug companies make money by investing in research and when they succeed in discovering cures or medicines they file patents which require them to identify how the medicines are produced but then give them protection for the drug for a sustained period (21 years in Canada). Canada was the first country to introduce legislation to allow for the export of generic AIDS drugs to impoverished nations — over the objections of the patent-holding big brands if necessary. The improbably titled Jean Chrétien Pledge to Africa Act was passed in the spring of 2004 and came into force a year later. (The Conservatives recently changed its name to the Access to Medicines Regime. In 2006, Health Canada approved its first generic AIDS drug for export, a combo three-in-one cocktail developed by Toronto-based Apotex, which is now trying to negotiate the rights to the main ingredients from three brand-name competitors.

Both Apotex and Doctors Without Borders, who are partners in this endeavour, say the Canadian law is more cumbersome than it needs to be. But the real problem here does not seem to be the legislation so much as that Apotex is not able to offer up the name of an African country willing to buy its product, despite the obvious need. The simple fact is no African nation has formally requested that Canada, or any of the other jurisdictions that have subsequently passed similar legislation, including the European Union, supply it with generic AIDS medications. And that request is needed to trigger the compulsory licensing process.

Why hasn't one? That's a good question. The problem does not seem to be the cost of the drugs so much as deep-rooted African anxieties about trade rules and development grants, as well as perhaps a longer-term fight by aid groups to get the broad rules on pharmaceutical patents changed on humanitarian grounds. Canada’s law followed closely on the heels of a World Trade Organization ruling in August 2003, which opened the door to generic drug makers to export to developing countries, almost regardless of patents. The Canadian law was announced only a month after the WTO ruling, at the specific urging of Canadian Stephen Lewis, the UN's special representative on HIV/AIDS. Like the WTO, the Canadian legislation attempted to walk the line between the generic manufacturers, the big brands who held the patents (after expensive R&D in most cases) and the large non-governmental organizations, NGOs like Doctors Without Borders and UNICEF, who were in the business of buying up cheap medications and distributing them. Doctors Without Borders, for example, currently provides antiretroviral therapy to about 57,000 patients in over 30 countries. And its interest in being a broader supplier, especially on behalf of African nations that might be afraid of trade retaliation if they angered big drug makers directly, is at least partly responsibly for the current dilemma.

The initial WTO ground rules, which Canada followed, included: Brand-name patent holders must first be invited to negotiate voluntary licensing agreements with generic manufacturers before they could be compelled to hand over their patents for humanitarian use. If there was to be compulsory licensing, this had to be on a one-shot contract with an identifiable country as purchaser (royalties were to be based on a specific country's ability to pay, among other criteria). As a result, the deal couldn't be made through an NGO. These requirements are part of the catch-22 holding up the current Apotex deal.

The doctors group wants Apotex to try to negotiate a voluntary deal with the brand-name companies basically to end-run the legislation and deliver these much-needed drugs to well-intentioned NGOs, like Doctors Without Borders. This is allowed, Kiddell-Monroe says: "If the will is there, a brand-name company can give a voluntary license on any terms." The catch, though, is that this type of negotiation can go on forever. If Apotex and Doctors Without Borders want to trigger the Canadian law and seek compulsory licensing, then there is a mere 30-day limit to negotiations before Ottawa is asked to intervene and make a decision. But to trigger the access law, there has to be a specific buyer, and it has to be an under-developed country. Those are the rules and that's the embarrassing part for a country like Canada. India has a huge generic drug industry and it currently accounts for the lion's share of the antiretroviral drugs in Africa and much of the Third World. In fact one of its companies, Aurobindo Pharma, just received U.S. regulatory approval for its three-in-one pill, which uses the same three first-line drugs (zidovudine, lamivudine and nevirapine ) as Apotox.

Competition among India's generic industry is the reason, Kiddell-Monroe points out, why prices for antiretroviral drugs in Africa have dropped from something like $10,000 US a year per patient in the late 1990s to something like $150 per patient today. NGOs can just fax in their orders and have them delivered. India's low-cost generic drug industry is also why Canada's noble gesture can be seen as largely academic — at least for the time being. (It's hard to imagine Toronto-based manufacturing companies being able to compete with India on price. Maybe that's why Apotex is the only one that's come forward publicly.)

India's advantage in this field is that it didn't come under the WTO purview until 2005, and even then much of its pharmaceutical patents have been grandfathered. But India's AIDS-drug industry is largely confined to first-generation medications. When these meds start to become ineffective in Africa and the Third World, which is likely given the history of this virus, that is when the more sophisticated, next-generation drugs will be needed. And that's when countries like Canada, with their well-intentioned laws and their mix of generic manufacturing and front-line research companies, will come under greater pressure to do more.

The current impasse here is "absolutely not Canada's fault," says Kiddell-Monroe. The bottom line for her is that the WTO, and Canada, should simply have allowed compulsory licensing of AIDS and other essential public health drugs whenever there was a clear and present humanitarian need in the developing world. Many countries make grand pronouncements of their desire to change the situation with respect to the export of drugs or financing the battle against aids. The government of Canada for example has recently teamed together with Bill Gates of Microsoft fame to invest 70 Million into finding a vaccine to fight aids. Many other countries have put up similar amounts.

Norway is lobbying for a solidarity agreement where many countries would provide a levy on air travel. The Government is hoping that more countries will introduce air travel levies for development purposes. Before Norway introduces a new solidarity levy on air travel, more countries have to come off the fence. If more countries introduce air travel levies, so that there is more money in the pot, Norway will advocate using some of the revenues for climate-related development assistance. To date, about 20 countries have indicated that they plan to introduce levies on air travel. This year, Norway is channeling approximately NOK 140 million of the revenues from its CO 2 tax on domestic air travel into UNITAID’s international purchase scheme for AIDS, tuberculosis and malaria medicines. The scheme facilitates large-scale joint purchases of medicines at reduced prices.

And the world continues to turn