Newsday - December 1, 2003
Laurie Garrett, Staff Writer

Called the "3 By 5 Initiative," the plan is nothing less than historic. Though the WHO has carried out massive global efforts in its five decades of operation - notably the 1970s eradication of smallpox - the provision of medicine to millions of people to treat a chronic disease has never been attempted.

The plan envisions getting anti-HIV drugs to half the 6 million infected people in poor countries who experts believe have developed illnesses requiring immediate treatment, at an overall cost of $5.5 billion.

As officials released details of the plan in Geneva, Dr. Lee Jong-wook, WHO director-general, was en route to visit six nations in southern Africa with an 80-member delegation led by U.S. Secretary of Health and Human Services Tommy Thompson. Also on the trip to observe the AIDS epidemic are the chief executives of several large corporations and drug companies and two U.S. congressmen - Reps. Don Nickles (R-Okla.) and Dave Weldon (R-Fla.), two of the most outspoken critics of U.S. spending on HIV prevention campaigns and condom distribution.

The initiative and the high-profile U.S. delegation to Africa reflect a growing level of international anxiety over the out-of-control pandemic, which now afflicts 40 million people and has killed an estimated 25 million, according to the United Nations AIDS Programme, or UNAIDS.

"Essentially, it is clear that it is unacceptable for 8,000 people to die every day from a preventable and treatable disease," Charles Gilks, WHO's 3 By 5 Initiative director, said at the Geneva news conference. A focus on treatment, he said, will not only achieve the humanitarian goal of giving poor people fair access to medicines but also will help slow the spread of HIV by identifying the infected and getting them into the medical system.

WHO officials said their role in the initiative - with its complicated web of donations from wealthy nations, spending by poor countries and actual medical implementation - would be advisory, acting as a clearinghouse for information about drug prices, side effects and training.

Under current drug discount pricing, the initiative would cost about $400 per person per year, but WHO economics expert Jonathan Quick said the agency expects competition and demand to drive down prices, perhaps to as low as $150 per person per year.

The plan would offer just four treatment packages, drawn from the more than 34 cocktails of anti-HIV drugs on the market. But it would not include protease inhibitors, the most potent but expensive anti-HIV class of drugs. Gilks said, however, that "this is not substandard care. ... The substandard issue to me is that people do not get access to these drugs ... and people are dying!"

About 20 countries have signed on to the initiative, the WHO says, which means that within a year the world will need billions of pills. Quick insisted manufacturers will be ready to roll by 2005.

The United States has not adopted the WHO initiative. The Bush administration has requested - but not yet received - $15 billion from Congress over five years to be spent on as-yet-undescribed HIV prevention and treatment campaigns in 14 hard-hit nations. So far, only a small portion of U.S. AIDS monies have gone to the Global Fund, with the United States preferring to go it alone with programs that are directed by the U.S. Agency for International Development and the State Department.

Because more than a third of all donated HIV dollars in developing countries so far has come from the United States, Bush administration support for the initiative is essential to its success. Sources told Newsday it was last-minute concern that Washington might take a radically different direction that prompted WHO's Lee to scrap plans to unveil the initiative in Nairobi today and head to Lusaka, Zambia, with Thompson instead.

The UNAIDS document predicts an ever-widening gap between the amount of money poor nations need and the amount that is donated as the initiative revs up. For 2003, that gap was $2 billion. The report states that "a three-year delay in achieving full implementation would reduce the total number of new infections averted by 2010 by 50 percent."

In economic terms, the UNAIDS document predicts that failure to meet the initiative's goals - and even bolder treatment and prevention plans by 2010 - will be devastating. The document forecasts economic losses of a half-trillion dollars in the already impoverished afflicted countries, loss of half their work forces and lost government revenues as high as $100 billion a year by 2010.

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