Show them the money 

Bill Clinton may have brokered the cheapest price yet for HIV/Aids drugs, but it's small comfort if world governments fail to follow suit 

Sarah Boseley
Thursday October 30, 2003
The Guardian 

The following correction was printed in the Guardian's Corrections and Clarifications column, Friday October 31 2003
Britain has pledged £138m to the UN Global Fund to combat HIV/Aids, not $80m as the following article, and the fund's website, said. 

The cost of HIV/Aids drugs has just gone through the floor. Bill Clinton, acting with the sort of independent audacity that comes easily to a former US president, did a deal last week with generic drug manufacturers - the companies the multinational pharmaceutical giants so close to his successor, George Bush, call pirates. 
Generic drug manufacturers make cheap copies of drugs whose invention has cost a fortune, but whose ingredients cost mere pence. Clinton supped at what for Bush would be the devil's table, and brokered a price of 36 cents a day. That's nearly half the cheapest available price for a combination of the three antiretroviral drugs that have worked miracles for people with HIV in the UK and the US. 
Only days earlier, pharmaceutical giant GlaxoSmithKline announced it was slashing prices of its HIV/Aids drugs to poor countries. Its price for a two-drug combination pill (a third drug is also required) is 65 cents a day. This cut should be music to the ears of those living in parts of the developing world where the incidence of HIV is horrendously high. 
Drugs are getting cheaper because the task of delivering treatment to whole continents, as opposed to small projects, is beginning. The Clinton Foundation's HIV/Aids Initiative has got cheaper prices because it is bulk buying. For over a year, the foundation has been helping countries, including four in Africa, prepare to treat HIV-infected populations. "Right now we have about 2,000 people on treatment," says the initiative's chairman, Ira Magaziner. "Within about six months we expect to have 30-40,000 people on treatment." 
And it could be more. The Clinton Foundation has helped South Africa embrace the concept of Aids treatment. South African president Thabo Mbeki, who resisted pressure to acknowledge his country's enormous health problem, has accepted the foundation's assistance. According to Magaziner, the treatment plan for South Africa will be aggressive and positive: "I think it will be a gold standard." 
The foundation needs low drugs prices - its money is required elsewhere. In Mozambique, it plans to double the number of nurses, increase their salaries by 30% and build up to 80 health outposts. Malnutrition is also an urgent issue. 
The bill for five years in Mozambique will be $355m. Irish and Canadian governments, the World Bank and the UN Global Fund to Fight Aids, Tuberculosis and Malaria will each contribute. 
Meanwhile GlaxoSmithKline says it is cutting its prices because selling more drugs to poor countries equals greater economies of scale. It may also have in mind the intentions of President Bush, who promised $15bn for Aids over five years, of which $10bn is supposed to be new money. In fact, when the money is finally voted through the excruciating appropriations process in Congress this year, it could be just $2.4bn. And Bush's people have actively resisted a vote on more than $2bn. 
There will, eventually, be extra money, and there is a plan to increase the scale of treatment in 14 countries. It is hard to imagine generic drugs will be part of it - even though they are approved by the World Health Organisation - so GlaxoSmithKline is in with a good chance. 
Two big Aids initiatives and still a massive global problem. Enter the new director general of the WHO: Lee Jong-Wook has made HIV/Aids treatment for 3 million by 2005 an overwhelming priority for the organisation. With plans to send strategic teams to find out where the gaps are, the WHO wants to offer governments its expertise. But above all it needs to urge donor governments and charitable organisations to do even more than they have in mind at the moment. 
At current rates, less than 1 million people will be treated by the end of 2005. With the extra efforts from Bush, Clinton and the UN Global Fund, that will become 950,000 by 2005 - 2 million short of the WHO goal. 
Some will say it is over-ambitious to increase treatment rates in the developing world from 300,000 to 3 million in two years, but there is desperation and frustration in the air. By now everyone knows this is a global disaster, but progress is slow. The wrangles over money continue. The Macroeconomic Commission on Health set up by Lee's predecessor, Gro Harlem Brundtland, said $10bn a year is needed to turn the epidemic. The Global Fund set up by Kofi Annan struggles to get donor countries to open their wallets. Bush has offered just $200m (of the $2bn nobody has yet agreed to) to the fund, which gives money directly to individual, validated, government schemes. 
Like Bush, the British government prefers to carry on with its bilateral projects rather than put big money into the global organisation set up to target Aids. For 2004, the Global Fund has roughly $860m, of which just under $600m is from Europe. This in spite of bold undertakings from Jacques Chirac and Romano Prodi to raise $1bn in the hope the US would respond with increased generosity. 
The need becomes more urgent by the day, as more people fall ill, making their countries less productive and endangering the upbringing of millions of children. The drugs needed are cheaper than some thought possible. Small-scale treatment efforts are beginning. For the world to have a real chance of arresting the HIV/Aids epidemic, governments like ours need to show the colour of their money.