The Philadelphia Inquirer
Diplomats, public health officials and advocates for people with AIDS will convene at the United Nations tomorrow for an unprecedented special session on HIV and AIDS.
Drug companies will be present, but they insist that they will play little more than a supporting role.
That's a big change from this winter, when GlaxoSmithKline P.L.C., Merck & Co. and Pfizer Inc. were thrust onto center stage in the global debate over how to deal with the pandemic that has infected 37 million people with the virus that causes AIDS, two-thirds of them in Africa.
In March, after months of bitter accusations from AIDS activists that the drug companies were putting profits before lives, the firms agreed to slash prices on AIDS drugs in Africa.
Drugs that sell for $10,000 a year or more in the United States were promised to Africa at prices as low as $500 a year, though that figure is still out of reach for many African nations.
Almost immediately, the spotlight turned back to African governments and global health agencies. Momentum began to build for what is expected to be the prime achievement of this week's U.N. special session: the creation of a global fund to combat AIDS.
The United Nations is seeking donations to the fund from governments, charities and corporations.
"Everybody seems to realize now that this overwhelming focus on the price of drugs was just part of the story," said Jeffrey Sturchio, a spokesman for Merck, the first company to drop its price for AIDS drugs in Africa.
"It is a more realistic debate and less emotional debate now," said Howard Pien, president of international pharmaceuticals at GlaxoSmithKline, which is the world's largest manufacturer of AIDS medications and has its U.S. headquarters in Center City.
"There is a growing recognition that HIV/AIDS in the developing world is an issue of enormous complexity," said Pien. "The debate has become more somber."
The pharmaceutical industry is downshifting mightily to deliver the message that it is merely one player among many in the AIDS crisis. Meanwhile, AIDS activists are trying to keep the heat on.
While there is consensus for creation of a global fund to benefit AIDS patients in Africa, AIDS activists say they still expect a fight with drug manufacturers over some of the mechanics of the fund.
The fund, which is still well short of the $7 billion to $10 billion the United Nations has estimated it would take to bring the disease under control, is expected to be in operation by the end of this year.
Paul Davis, a spokesman for the Health Gap Coalition, an activist group aligned with ACT-UP Philadelphia, predicted that the companies would work behind the scenes to object to the bulk purchase of drugs by a single buyer, such as the proposed fund, and the use of cheap generic copies of patented medicines.
But industry representatives say they are comfortable with bulk drug purchases, having already experienced the process through vaccination programs managed by UNICEF and other organizations in the developing world.
Pien, however, said most of the fund's money should be spent on prevention measures, not drugs.
He also said his company wants to make sure most much of the fund's money goes directly to health care, not bureaucratic overhead.
But he said no one should expect massive distribution of complex anti-retroviral drugs to happen immediately, because of the lack of health-care systems in Africa and concern that availability of the drugs could create widespread resistance to them if they are not administered carefully.
"I would say it is closer to 10 years than one or two," Pien said.
Industry officials say they support the use of generic drugs, but not those that, in the industry's view, would violate World Trade Organization rules on intellectual property.
Disagreement over just how the rules should apply to medicines in the developing world prompted a meeting in Geneva of World Trade Organization officials last week.
The United States took a stronger position in support of drug patents than some European countries, although the group reached no resolution. The organization will meet again in July, before a September special session of the WTO's standing committee on intellectual property meets to decide the issue.
Activists also object to the possibility that drug companies will be represented on advisory bodies to the fund.
"It's a blatant conflict of interest," Davis said.
But the industry already has an invited seat at the table. Hank McKinnell, Pfizer's chairman and the current chairman of the industry's Washington lobby organization, will be among the 50 official delegates to the conference this week.
The U.N. conference opens a little more than one year after five drug companies signed onto a U.N.-sponsored initiative to deliver lifesaving drugs to AIDS patients in Africa.
That program, however, became bogged down in lengthy country-by-country negotiations between the drug companies and governments.
Frustration with the delays led activists to target the industry again last winter.
Kate Krauss, a spokeswoman for ACT-UP Philadelphia, said that experience made activists concerned that Western drug manufacturers should not be the only source of AIDS drugs and that developing nations should have access to generic copies in order to save lives.
Pien, whose company this month broadened its pricing reductions to other medications for other diseases, insists that Western drugmakers are sincere.
"I'm hopeful," he said, "that the extraordinary responses demonstrated by the industry will be looked at as evidence of our support."