Commentaryjune24-2006

was equally efficacious as PI-basedHAART regimens.
US in 1996, hospital admissions and AIDSdeaths immediately declined and AIDSwards were closed down. We now knowthat for these drugs to be effective, 95 percent adherence is required and a range ofdrug toxicities are recognised. These drugsare not curative because of a reservoir ofinactive cells, which are latently infectedwith the virus. Resistance to anti-retroviraldrugs occurs over time, resulting in treat- Access to Healthcare for All ment failure and necessitating change in What Can We Learn from the AIDS Movement? People’s Initiatives in
Development of ART
Community activism in Brazil and Thailand compelled nationalgovernments to provide treatment to the HIV positive population, a decision facilitated by pharma companies, defining research policy, ensuring that trialsaddressed concerns of the gay community, including many from India, cutting prices 40-fold. If quality and expensive care can be provided for one disease, then the same promoting access to drugs for affected people.
should be achievable for common diseases which require less policy required representatives of affectedgroups. Research guidelines required that ANAND ZACHARIAH
Development of Anti-Retroviral
Treatment and HAART
volved in trial planning, execution anddissemination. Concepts such as compas- sionate use, expanded access, accelerated the world in low and middle in-come countries received free anti- access and parallel track came into use in of how understanding of the basic biology of the virus has enabled drug development activism. Peoples’ groups negotiated di- WHO’s “3 by 5 initiative”. This programme research priorities and with Food and Drug zymes in the virus life cycle, reverse tran- licensing. Scientific writings today do not access to anti-retroviral treatment for all largely due to people’s movements across political issue, that governments, inter- about 2000, the cost of drug treatment was started early, could eradicate the virus in ment. The governments and people of Brazil public health issues, such as water, food, a few years, with the slogan, “hit early, housing and sanitation. It is obvious that hit hard”. In 1997, trials of a combination were crucial in changing this status quo.
of two NRTIs with one protease inhibitors Brazilian Experience
pression of viral replication. This three able for one disease, then surely the same Brazil’s freedom struggle from dictator- constitution in 1988 and the first election politically and to ensure access for all to Figure: The Effects of Generic Competition
Sample AIDS Triple Combination: Lowest World Prices Per Patient Per Year
(Stavudine (d4T) + Lamivudine (3TC) + Nevirapine) Thailand. The Royal Thai government, inresponse to the rapidly evolving HIV programmes which reduced the incidenceof the disease in the 1990s. After the early published reports of the effectivenessof AZT in preventing mother to child campaign was started in 1996 which cutmother to child transmission to 5 per cent.
trial setting. In 1999, Thailand published of AZT in the last trimester of pregnancy.
Soon after, the Thai government startedimplementing operational trials with Source: Perez-Casas et al 2001.
receiving AIDS care at a cost of US $ 426 health rights for the affected people and million of which 80 per cent was spent on Thailand’s universities along with Thai treatment. This cost has not increased over groups involved in the political struggle the six years of its functioning. The effi- ration), have been conducting research trials Reform Movement”, a loose affiliation of infections, 50 per cent reduction in AIDS mortality and 70 per cent reduction in in- expertise and models of relevant practice.
demanded a health system that was respon- actively involved in the early response to as a basic right under the new constitution.
announced. This has been gradually scaled The constitutional provision for healthcare up from treatment available to 3,000 people as a basic right for each citizen, was used in 2002, to treatment provision for 50,000 and were involved in the formation of the department to fight legal cases for better “National Unitary Health System” based that have appeared critical to this support were: (a) the international recognition of retrovirals and provides about 18 per cent of the country’s requirement. In 1971, the tion. Just as they had struggled together tise, infrastructure and relevant models of right to manufacture patented drugs. When the law had to be revised to recognise the international patent regimes, Brazil intro- of which was anti-retroviral treatment, was generic drug manufacture, if the patented put into place. AZT became available from drug was not manufactured in Brazil within 1991 and HAART therapy in the late 1990s.
three years of patent issue. Brazil later Anti-retroviral treatment was provided not issued compulsory licences for Nelfinavir Durban Conference
healthcare system. Training of health per- prices of these drugs. Thereby they forced price reductions. Today, Brazil is cited to agencies met in Durban at the international AIDS conference in 2000, in the context of it is estimated that 1,54,000 people were Indian AIDS Programme
be created to provide universal access to HIV treatment to 3 million people by 2005.
provide ART, free of cost to people living lence states of Tamil Nadu, Andhra Pradesh, Nagaland and the state of Delhi. Since then tiative”, which envisaged use of common several other state governments have also and simplified guidelines, reliable supply of medication, better diagnostics, training resources. Twenty-five larger hospitals are because I can pay for life itself.” The speech crystallised sentiments in favour of providing treatment to countries who could being conducted for personnel involved in not then access care, and the need to cut this programme. Currently it is estimated Durban conference, that if prevention was to succeed it must be integrated with care, tries to set up local ART programmes.
and treatment must become available to all As a result of this strategy, by June 2005, thinking at that time, that treatment should – increasing from 4,00,000 to 1 million.
Conclusion
be available only to people and countries who could afford it, that the poor and the 50 per cent of persons who are in need of prevention. International funding must be receiving treatment (a threefold increase), 1,55,000 in Asia, 20,000 in central Europe areas the demand outstrips supply. Thirty- Role of Indian Pharmaceutical
Industry
although the programme falls short of its target, it has shown that such large-scale Soon after this, Brazil offered to export treatment initiative is achievable, effec- nology for local drug manufacture. In re-sponse to this, five major pharmaceuticalindustries offered to reduce prices to sub- Development Convention 2007
Saharan African countries. In March 2001, the Indian firm Cipla offered to sell threeanti-retroviral drugs at US $ 350 per Madras Institute of Development Studies invites papers for the sixth Development patient per year. The companies responded Convention to be held on 22-24 February 2007. The theme is ‘Transformation, by further price cuts (see the figure). This Transition or Stagnation? Understanding Change in a Globalising Economy’.
Papers should address this larger question by analyzing changes in one of the following arenas: (i) Sectoral changes (Agriculture, Industry, Trade, etc.); (ii) Structural changes (caste, religion, gender, etc.); (iii) Institutional changes and civil society responses. Interested scholars are invited to submit a one page India who have used patent laws strategi- abstract not later than 31 July 2006 and completed papers by October 3, 2006. A detailed concept note is available on MIDS website: www.mids.ac.in
[email protected]
United Nations Global Fund
[email protected]
and 3 by 5 Initiative
point. In response to it, Kofi Annan pro- Madras Institute of Development Studies
vided a vision for taking these ideas for- to provide treatment. It really is. Seven to national initiatives and the impact these nine billion dollars is not a great amount portant. Pharmaceutical companies arenot immune to the pressure of people’s Reference
agencies. Concerted action can reduce costsof drug treatment.
Perez-Casas, C, C Macé, D Berman and J Double (2001): Accessing ARVs: Untangling the Webof Price Reductions for Developing Countries, in 2002, “the question is not whether treat- ment is affordable. It is a question of will

Source: http://www.jsk.gov.in/articles/access_to_healthcare_anand_zachariah.pdf