Hundred Million Dollar Program for Public-Private AIDS Research and Outreach in Africa

On May 6, Bristol-Myers Squibb Company announced that it had committed $100,000,000 over five years for programs to improve HIV/AIDS research and community outreach in five countries in southern Africa: South Africa, Botswana, Namibia, Lesotho, and Swaziland. This region has some of the highest rates of HIV infection, illness, and death in the world. Most of the decisions on spending the money will be made by scientific and community boards in the countries involved.

Most of the research and treatment will target women and children with AIDS, to address the vulnerable status of women, who are often dependent on others for their economic support and medical care; the decision to focus on women and children "was made through a consultation process between Bristol-Myers Squibb and governments, National Association of People with AIDS/South Africa, medical schools, and NGOs (non-governmental organizations)," according to the company. A major priority will be improving care of hundreds of thousands of children whose parents have died from AIDS. But the community program is flexible enough to also help women develop small businesses for their economic support--and to fund HIV prevention as well as treatment and care--if the community board decides to do so.

The research component "will facilitate development of model programs for the management of HIV/AIDS appropriate for the resource-limited settings of the five participating countries," according to Bristol-Myers. "The company expects this research to generate clinically relevant data that can be used by the African medical community and policy makers to develop a range of practical, cost-effective initiatives." It is expected that approximately 20,000 patients will receive HIV treatment as part of this research; and the volunteers will continue to receive drugs for as long as it is medically useful, according to Bristol-Myers. The medical program will also train 100 African physicians and other medical professionals in HIV/AIDS treatment, and bring up to 50 U.S. physicians to teach in Africa.

This program (called Secure the Future(tm)) happened because of a conversation a few months ago between Bristol-Myers board chairman Charles A. Heimbold, Jr. and United Nations Secretary General Kofi Annan, who asked if the company could help in the African AIDS epidemic. AIDS is now the leading cause of death in Africa, and in Botswana it has already decreased the average life expectancy of the entire population by 14 years, from 61 to 47. More than 8 out of 10 AIDS deaths in the world are in sub-Saharan Africa, a larger region that includes the five countries targeted by this program.

The major partners in this effort are UNAIDS (the Joint United Nations Programme on HIV/AIDS), Baylor College of Medicine and Texas Children's Hospital (both in Houston, Texas), Morehouse School of Medicine (a historically black medical school in Atlanta, Georgia), MEDUNSA (the Medical University of Southern Africa, based in Pretoria), the National School of Public Health at MEDUNSA, Harvard AIDS Institute, and the Medical Research Council of South Africa. In addition, there are independent monitors of the program, including IAPAC (the International Association of Physicians in AIDS Care), which has been a leader in addressing the issues of access to care in developing countries.


Questions Raised

While reaction to the announcement has been largely enthusiastic or at least positive, activists have raised concerns:

While the program provides free drug for research, these studies will involve a tiny minority of those who need treatment. There are no provisions for price reductions which could make the company's drugs affordable in the five target countries or elsewhere in Africa. More than 20,000,000 people in sub Saharan Africa have HIV, according to UNAIDS and the World Health Organization; if the Bristol-Myers program provides treatment to 20,000 as hoped, then in five years it will have treated less than one person out of a thousand on the continent.

The research-based pharmaceutical industry, of which Bristol-Myers is part, is currently suing the government of South Africa over intellectual-property rights, to prevent local companies from making low-cost generic copies of important drugs--some of which were developed largely at U.S. government expense.

A questioner at the May 6 press conference noted that the $100 million for five countries for five years is less than what the company paid to Mr. Heimbold himself last year (estimated at $146 million, according to The New York Times, "Business Leaders' Giving Runs the Gamut," December 22, 1998). For additional perspective, the budget of UNAIDS (the Joint United Nations Programme on HIV/AIDS) for the entire world is $60 million.


Comment

We are encouraged by the Secure the Future program, and commend Bristol-Myers Squibb for it. The company did not have to do anything. And when it did act, it did many things right--total commitment by top management, sending officials (including a vice president in charge of the program) to Africa for fact-finding and negotiation, providing significant funding, and creating local scientific and community boards to decide how the money will be used. Public-private partnerships like this one will certainly be a necessary component of the response to AIDS, in Africa as elsewhere.

Our main concern is how well this program can address the most critical long-term needs. U.S. conventional wisdom holds that lack of infrastructure is the central problem in developing countries, but in fact, many places in Africa have good to excellent health infrastructure. We suspect that the central problem is not really lack of infrastructure, but rather lack of money to participate in the hugely expensive and inefficient Western medical system--and the consequent exclusion from patented medical technology (which in the case of HIV disease means exclusion from every drug which has been proved effective). About 90% of people with HIV live in developing countries, and almost all of them would be completely excluded from proven treatment by price alone, no matter what infrastructure they have. There is no chance that most of the world will be able to pay what the market will bear in rich countries for lifesaving drugs, any time in the foreseeable future.

So we support this program, and hope it can be a precedent for other constructive partnerships. At the same time, we will continue to raise the issue of prevailing rules, policies, and procedures which reflect the narrow interests of the rich and powerful alone, and abandon the great majority of the world's people in the face of a deadly epidemic.