Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
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Wall Street Journal - April 23, 2002
Rachel Zimmerman, Staff Reporter of The Wall Street Journal
By including 10 new AIDS drugs, called antiretrovirals, on its model list of essential medicines, the WHO strengthened the argument that treatment of HIV/AIDS should get equal priority in developing nations with prevention. Its guidelines presume that poor countries can adequately administer complex AIDS-drug regimens that are required to slow the progression of the disease and protect against resistance.
The Geneva-based U.N. agency's endorsement also supports national health departments trying to overcome political obstacles that have blocked access to AIDS medicines, as in South Africa. The updated essential-medicines list, which was first established in 1977, should make these drugs easier for governments to procure and for doctors to use, even in resource-poor settings.
"The list represents the World Health Organization's most rigorous and scientific evidence and should dispel any questions about safety, efficacy and public health relevance," said Dr. Jonathan Quick, director of the WHO's essential-medicines program.
The WHO's endorsement of AIDS drugs is timed to coincide with the first round of grants, to be issued this week, to poor countries by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The fund was launched last year by U.N. Secretary General Kofi Annan. Although the WHO's announcement comes with no money to back programs, officials hope that the health organization's new guidelines will be used by countries that win money from the Global Fund, which may grant $700 million to $800 million this year.
People familiar with the Global Fund say a political and philosophical battle is raging internally about how much should be spent and which applicants should be chosen. One faction believes proposals should be evaluated under very strict guidelines, and grants should be awarded only to proposals likely to succeed. Others advocate that all available money should be doled out to as many applicants as possible no matter the quality of the proposals. "The question is, do you just throw the money at countries or do you have high standards?" one person knowledgeable about the negotiations said.
The humanitarian aid organization Doctors Without Borders says it's worried that the Global Fund's grants will focus more on prevention rather than wide-ranging drug treatment. "Twenty years of no access to drugs is a crime against humanity," says Brigitte Syamalevwe, program director of a group called Life AIDS International, based in Zambia, speaking on a conference call organized by Doctors Without Borders.
Last month, the WHO for the first time issued a list of "quality medicines" that included both generic and brand name AIDS drugs. Now, the WHO's guidelines include three recommended first-line drug-combination regimens that cost generally between $1 and $10 a day. The agency estimates that currently six million people need access to these regimens.
In the U.S., the introduction of such drug cocktails in 1996 led to a 70% decline in deaths attributed to HIV/AIDS, according to UNAIDS.
Write to Rachel Zimmerman at rachel.zimmerman@wsj.com
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