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July 19, 2002
Rio + 10 Series: UNAIDS' Accelerating Access Initiative May Decelerate Access
    by William Baue

ACT UP Paris criticizes Accelerating Access, a joint United Nations/pharmaceutical industry initiative, for limiting price reduction on AIDS medicine in developing nations.

United Nations Secretary-General Kofi Annan has coined an acronym, WEHAB (Water and sanitation, Energy, Health, Agriculture, and Biodiversity) to describe the five key areas he feels concrete results can be achieved through the World Summit on Sustainable Development. While summit organizers seem to be giving equal weight to each of the areas, the Secretary-General has said in the past that world health is one of his top concerns, especially HIV/AIDS.

"[T]he fight against AIDS has become my personal priority," said Secretary-General Annan in April 2001 in Amsterdam. "The epidemic is the greatest public health challenge of our times and we must harness the expertise of all sectors of society. The pharmaceutical industry is playing a crucial role."

The Secretary-General made the statement after meeting with international pharmaceutical companies as part of the Accelerating Access Initiative (AAI). The initiative involves a dialogue between the UN and the pharmaceutical industry with the intention of making HIV/AIDS medicines and diagnostic equipment more available and affordable in developing countries. AAI was launched in May 2000 by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

AAI consists of five pharmaceutical companies: Boehringer Ingelheim, Bristol-Myers Squibb (BMY), GlaxoSmithKline (GLX), Hoffman-LaRoche (RHHBF.PK), and Merck (MRK). At the April 2001 Amsterdam meeting, the pharmaceutical companies agreed to continue to accelerate the price reduction of HIV/AIDS medicine, particularly for the least developed countries in Africa. The meeting was not attended by Merck, but was attended by two other companies not participating in AAI, Abbott Laboratories (ABT) and Pfizer (PFE).

Seven months after the Amsterdam meeting, AAI issued a progress report regarding the status of the desired price reductions. The November 2001 Progress Report conceded that there had been limited success.

"It is estimated that today some 27,000 people in countries supported through Accelerating Access are on ARV [antiretroviral] therapy. Although these numbers represent only a fraction of those in need of antiretroviral therapy, they herald the beginning of an enormous effort to scale up access to treatment," the report states. "WHO [the World Health Organization] estimates that, overall, only some 230,000 people have access to antiretroviral therapy in low- and middle-income countries (half of them in Brazil alone), while some 6 million are in need."

On May 15, 2002, just days after the two-year anniversary of the launch of AAI, the Paris chapter of the AIDS Coalition to Release Power (ACT UP Paris) released a statement condemning AAI as a puppet of the pharmaceutical industry.

"Accelerating Access serves, above all, pharmaceutical companies who profit from a partnership with international institutions while using the program to maintain their monopolies and to limit any reductions in price," the statement reads. "According to the most optimistic of estimates, after two years Accelerating Access has only resulted in getting an additional 0.1% of people with AIDS on treatment." The statement goes on to say that WHO estimates that 10 million people require immediate antiretroviral therapy.

ACT UP Paris especially criticized AAI for not including generic drug manufacturers in the initiative.

Last week, Oxfam International released a report demonstrating that generic competition is necessary to lower AIDS medicine prices. The report tracked prices of brand name drugs in Uganda, an AAI country, from May 2000 to April 2002.

"We had been promised price cuts since May 2000 and didn't see them until we started to import generics [from India] in October," said Dr. Cissy Kityo, deputy director of the Joint Clinical Research Council in Uganda. Prices fell by as much as 97% over the two years of Oxfam's study.

Oxfam points out the irony that World Trade Organization (WTO) rules will prevent Uganda from importing generics from India in 2005. ACT UP Paris claims that AAI discourages generic imports because the price-reducing effect does not serve the interests of the AAI-member pharmaceutical companies.

"Accelerating Access is a striking example of a dishonest compromise between international institutions and the pharmaceutical industry at the expense of people and public health," ACT UP Paris' statement reads.


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