WHO official warns of crisis in supply of low cost AIDS drugs

Geneva John Zarocostas

By 2010, poor developing countries will continue to suffer from a
shortfall in supplies of low cost antiretroviral drugs (ARVs) for
patients with HIV/AIDS unless rational measures are taken quickly, a
top World Health Organization official has warned.

"We're going to reach a crisis in terms of supply very very
soon . . . of [antiretrovirals] throughout the developing world
because the scale-up is happening very very quickly," Dr Jim Yong
Kim, WHO's outgoing director for HIV/AIDS, told the BMJ.

The issue now for the public health world, he said, in the aftermath
of the recent summit of the G8 (the world's most industrialised
countries) in Scotland, was that a potential eight to 10 million
people will need treatment. In July, the leaders of the G8 agreed at
the Gleneagles summit "to provide as close as possible to universal
treatment for AIDS by 2010."

Dr Kim doubts whether this can be achieved with the current
regime: "We think it's impossible for the holders of intellectual
property to supply that need at the price that we're looking for."
Dr Kim steps down from his post with WHO in December to return to
his academic post at Harvard Medical School. He said that the
research based pharmaceutical industry had made enormous
contributions to the struggle against HIV/AIDS, and, as a result,
500 000 people were now receiving reduced cost drugs. But he also
voiced serious reservations whether the industry could continue to
deliver low cost antiretrovirals.

"We really wonder whether they will be able to reach all the eight
to 10 million people. They're taking a loss on each regimen they
sell, they tell us. So something has to be done," he said.

Harvey Bale, the director general of the International Federation of
Pharmaceutical Manufacturers and Associations, countered that, "It's
simply premature to make a forecast for 2010." He said that the
federation has been pressuring WHO for eight months to agree to set
up a joint team to improve the forecasting of demand.

If companies were given good lead times in demand forecasting on
what the needs were for (low cost) antiretrovirals, Dr Bale told the
BMJ, then companies can respond.

Dr Kim believes the way ahead is to find a way of protecting first
world markets, so that the research based industry continues to have
an incentive to develop new HIV/AIDS drugs, and at the same time
create a humanitarian corridor so that low cost producers such as
China can sell low cost drugs to Africa.

Dr Kim, back from a trip to China to look at its capacity to
manufacture both first and second line antiretrovirals, said
authorities and manufacturers had told him that, "With fairly
reasonable corroboration they are now able to produce all the first
line and second line drugs except for the fusion inhibitors. They
feel the target price for both first and second line drugs is around
the current lowest cost, which would be around $150 [£86; €127] per
person per year."

For first line drugs, Dr Kim said, the Chinese indicated that
they "could go below $100 per year fairly quickly if they have the
volume." If the corridor can be created within a year and a half,
the Chinese said they would "be able to scale up to meet the entire
global demand," Dr Kim said.

Dr Bale said that the price offered by companies within his
federation to Africa and some of the other poorest nations were at
no profit, at cost, or below cost. "They're not making any money on
these sales," he said but added that original research
companies "can still cut their losses" if they had more volume.

BMJ 2005;331:1104 (12 November), doi:10.1136/bmj.331.7525.1104-b
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