Inter Press Service - July 14, 2000
Marwaan Macan-Markar

For developing countries, this means ensuring that voluntary counselling and testing services are in place, said the Geneva- based health body. Also required are consistent access to such services, as well as hospitals and outpatient care.

"The task, thus, is a huge one and is one that does not simply imply infrastructure development, but also the political will and necessity to recognise AIDS as an emergency," observed Gregory Hartl, spokesman for the WHO.

The WHO's response to this call for readiness - initially made by the International AIDS Vaccine Initiative (IAVI) at the 13th International AIDS Conference that ended in Durban, South Africa on Friday - has been endorsed by another organisation, too, the AIDS Vaccine Advocacy Coalition (AVAC).

Political leaders in developing countries need to improve their healthcare infrastructure and give top priority to ensure control of the killer disease, wrote Chris Collins, head of AVAC, in an article for IAVI's web-page.

"Political will in developing countries is a critical factor," he noted. "Without that commitment, purchase funds and loan programmes will have only limited appeal."

In addition, remarked Collins, other players, too, will have to make "critical decisions" to ensure that "a credible plan to purchase and deliver an AIDS vaccine" is in place to guarantee prompt worldwide distribution of the future vaccine.

Currently, there is little incentive for the vaccine industry to invest in developing vaccines appropriate for people of the Third World or to build manufacturing plants that can produce them fast enough to meet the anticipated demand, he revealed.

"The reasons for limited access to AIDS drugs in developing countries are many and complex, and the raging debate on this issue foreshadows similar controversy on access to AIDS vaccines," he added. "History provides ample reasons for concern that when an AIDS vaccine is finally available, it will sooner protect people in rich countries than those in poor areas of the world where the epidemic is spiralling out of control."

IAVI's plan, spelled out in the report "AIDS Vaccines for the World: Preparing Now to Assure Access," touches on five areas that need to be addressed by both the governments of the developing and developed world, by the vaccine industry and financial institutions, and by health experts and non-governmental organisations (NGOs).

According to the IAVI, effective pricing and global financing mechanisms "must be developed to assure that vaccines are promptly available for use where they are needed."

To achieve that, it states, key political leaders and institutions should work in tandem with the private sector to secure the establishment of "a tiered pricing structure for AIDS vaccines that enhances access by enabling poorer countries to pay what they can afford and at the same time (to) permit companies to obtain a satisfactory return on investment."

Furthermore, it wants mechanisms to be developed to ascertain reliable estimates of demand for specific vaccines, thus ensuring the creation of vaccine production centres to enable "accelerated worldwide access."

It also calls for appropriate delivery systems, policies and procedures to be developed to help adolescents, sexually active adults and other high risk sections of, specifically, a Third World country's population.

Thus, "developed and developing countries, health experts, multilateral institutions, non-governmental organisations and other appropriate parties should collaborate to design and establish vaccine delivery systems in developing countries."

According to Dr. Seth Berkley, president of IAVI, a research organisation working in collaboration with the United Nations department for AIDS (UNAIDS), the vaccine industry will have to "learn new ways of doing business." Consequently, he added, the world would have to recognise the company's right to a reasonable return on its investment, since the world has never attempted the simultaneous introduction of vaccines in rich and poor countries at the same time.

"The world has no moral choice other than to plan for the swiftest, most effective introduction of a preventive vaccine," he argued.

And already, community leaders have responded well to the IAVI's plan. "Africans know that a vaccine is one of the important and realistic hopes for controlling HIV/AIDS," said Dr. Moustafa Gueye, director of the African Council for AIDS Services.

Yet, he felt African governments have not demonstrated sufficient commitment to address this issue. "The will to do so still does not exist within most of our leaders, not even a clear commitment to improve and support a scaling up of necessary health infrastructures that would allow for, amongst other things, local vaccine trials and eventual distribution."

What Berkley's organisation wants to avoid through the sweeping changes it has recommended is the pattern that prevails globally regards vaccine distribution -- where it often takes 15 years or more for a new vaccine introduced to the developed world to reach the developing world.

This, in fact, is the case with the vaccine to stall the spread of hepatitis B, a disease that still kills more than a million people annually. Although recommended for distribution in the early 1980s, it still remains beyond reach to those in the poorest countries.

For countries in sub-Saharan Africa, home to about 70 percent of the 34.3 million people estimated to be infected with HIV - (human immunodeficiency virus), the virus strain that causes AIDS (acquired immune deficiency syndrome) - that would be disastrous, said Berkley.

"Waiting a generation or more to introduce an AIDS vaccine, as we have done in the past for other diseases, would mean that literally tens of millions of people would needlessly become infected with HIV," he stressed. And in countries that lack health care, he added, such a wait would be "tantamount to a death sentence." (END/IPS/HE/mmm/da/00)
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