Inter Press Service - September 20, 2000
Greta Hopkins

The Commission, the executive arm of the European Union (EU), Wednesday adopted a communication entitled "Accelerated Action Targeted at Major Communicable Diseases Within the Context of Poverty Reduction" as part of the EU's new development policy strategy.

Almost all of the 5 million yearly deaths caused by HIV/AIDS, malaria, and tuberculosis occur in sub-Saharan Africa. Thirty-four million people are now infected with the human immunodeficiency virus that causes AIDS, so the death toll is set to rise dramatically. Some estimates suggest that that by 2010, 30 million people a year could be dying from AIDS. The disease has already orphaned 13.2 million children. Thousands of skilled workers are dying in the worst affected countries of Africa.

The macro-developmental impact of HIV/AIDS is clear, and studies show that up to 40 percent of gross national product can be lost because of HIV/AIDS in some badly affected African countries. Kenya's gross domestic product is already 10 percent less than it would have been without AIDS, and continues to decline by one percent a year.

"Last April the Commission adopted a new Development Policy for the European Union with two major objectives - poverty reduction and greater coherence and synergy between development and other EU policies," explained the EU Commissioner in charge of development, Poul Nielson.

"This Communication is an important element of this fresh approach to our development work. Whilst continuing our support for national health systems, the Commission will seek to improve the impact of existing strategies and technologies to protect the poor from infection with these diseases, improve the affordability of diagnosis and care for people who are sick, and increase investments in research to find long term solutions to disease, such as vaccines to prevent malaria and AIDS," the EU development chief said.

The Commission's document concludes that the EU should play an important role in taking additional and innovative initiatives to respond to the urgency of the situation. The Commission says that it has a range of instruments and policies that can and should be used to support an accelerated response to confront these diseases.

The Communication adopted Wednesday suggests "three core areas for increased and accelerated action".

It says reaching optimal impact of existing interventions, services and commodities targeted at the major communicable diseases affecting the poorest populations, is an important part of the strategy. The saddest fact about these big killers, the Communication says, is that they are often preventable/and or readily treatable using existing low-cost, effective interventions. Such help often does not reach the most vulnerable people, especially in developing countries struggling to provide essential health care with less than five dollars per capita per year.

Another core area of the EU's accelerated action is increasing affordability of key pharmaceuticals through a comprehensive and synergistic global approach. Developing countries face many barriers to affordable medicines, including international and national pricing policies, tariffs and taxation and implementation of intellectual property rights agreements, the Communication says.

Alternative systems to improve access include differential pricing, voluntary licensing agreements, parallel trading, technology transfer and increase in local capacity for production, use of generic and patented products and review of tariff and taxation options at country level, it adds.

The Communication also addresses the need to increase investment in research and development of global goods targeted at three major communicable diseases. Only those countries which can pay for medicines, determine research and development priorities in the pharmaceutical industry. As a result, 10 percent of global health research efforts target diseases which make up 90 percent of the global disease burden, it notes.

Incentives are also needed to encourage the European pharmaceutical industry to invest in diseases that hit developing countries, and the research capacities of developing countries must be strengthened.

An International Round Table will be held on Sep. 28 in Brussels under the auspices of the French Presidency of the EU Council of Ministers in an effort to devise a co-ordinated approach to tackle this problem effectively.

The Round Table is being co-sponsored by the World Health Organisation (WHO) and the United Nations' Joint Programme on HIV/AIDS. About 130 people will be present including representatives of developing country governments, other international organisations such as the World Trade Organisation, civil society organisations, research agencies, and the private sector.

After this consultation effort, the Commission will draft an action programme. The strength of the Commission's effort according to Andrew Castles from the WHO is that it combines measures to improve access to medicines with international research and development and affordability.

"The Commission is the first major donor agency to come up with such a broad based proposal. They have recognised the need to take work on TB, malaria and AIDS further and faster if any effect is to be felt. We would encourage other donors to look at ways of tackling this problem, and for donors to work together," he said.

Castles said that the WHO is keen on encouraging donors to look at different ways of getting health services to people. In the past there has been a tendency to focus on the public sector, but there are other important methods such as contracting and franchising (i.e. farming out health care service to the private sector).

The international health charity Medecins Sans Fronti res (MSF) has been campaigning for access to essential medicines for the past year. Seco Gerard, the EU liaison officer, explained that MSF does not want medicines to be treated just like any other commodity.

There are three main strands to this campaign. First, medicines which have been abandoned for the lack of profitability should be put back on the market.

Second, more research and development is needed for new medicines, which meet the needs of the poorest and most vulnerable. "There are forgotten diseases other than the three big killers, such as sleeping sickness and cla-azar for which we urgently need drugs," said Gerard.

Third, we need to set up a differentiated pricing policy to enable expensive AIDS drugs to be distributed in developing countries. Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) said on Sep. 4 that AIDS is one of the key issues shaping the world today and should rank as high on the list of human concerns as globalisation, peace and the environment. Dr Piot was speaking at a symposium in London organised by the Royal Institute of International Affairs "AIDS is no longer simply a public health issue: it cuts across agencies, disciplines, and national boundaries," he said.

"There is no part of society in the hardest hit areas that is not in some way touched by the epidemic. We are talking not only about health, but also about education, agriculture, the economy. AIDS threatens to roll back decades of hard-won development. Indeed, it has become a full-fledged development crisis."
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