Wall Street Journal - July 12, 2004
Gautam Naik, Staff Reporter of The Wall Street Journal

In December, the Geneva agency launched an ambitious program known as "three-by-five" to supply antiviral drugs to three million AIDS patients by the end of 2005. In the plan's first six months, the medicines reached 440,000 people -- a shortfall of 60,000, based on the agency's own target, the WHO said in a progress report it released Saturday at an international AIDS conference in Bangkok, Thailand.

The WHO, an arm of the United Nations, conceded that the initial result was "disappointing" and that "progress is not rapid enough." However, the organization said it expects to see a brisk increase in the number of people receiving treatment during the plan's remaining 18 months.

The outcome of the WHO project has major implications for how the world fights the HIV scourge in coming years. The agency believes its plan can offer a "universal framework" to eventually treat the 38 million HIV-infected patients around the world.

Jim Yong Kim, a senior WHO official leading the agency's charge against AIDS, said AIDS-related funds expected to be paid out by the U.S. government as well as the Global Fund to fight AIDS, Tuberculosis and Malaria will put the agency's goal within reach.

"If we don't do something extraordinary in the next 18 months, we deserve to be slapped and told to go home," Dr. Kim said.

Saturday in Bangkok, Dr. Kim and his partners in the oft-criticized three-by-five program defended their position at a news conference. Facing a group of reporters who asked if WHO figures were "snake oil" and "Enron"-like, Dr. Kim said he remained optimistic about his goal and trying to improve the program's coverage and accounting. "I've heard a lot of prognosticators say [the program's goal] will not be possible," he said. "I couldn't care less about prognosticators." At his side, Stephen Lewis, a U.N. special ambassador on HIV/AIDS, defended the program as "a potential...breakthrough tool."

Under its three-by-five plan, the agency advises governments of developing countries about which drugs to buy and how to distribute them. By the end of next year, it also plans to train 100,000 health-care workers, help set up diagnostic services and refocus 10,000 clinics for treating the AIDS virus in developing countries.

In its progress report, the WHO acknowledged that many key objectives in the first six months hadn't been met. For example, the WHO had hoped to deploy or realign 200 of its staff to WHO country offices as part of the AIDS plan, but the figure achieved was fewer than 60, a shortfall reflecting the shortage of funds, it said. The plan also called for at least 35 countries to commit to treatment targets in accordance with the WHO plan, but only a dozen have done so.

The price of AIDS medications is another hurdle. The WHO had expected the average price per person per year for a first-line drug regimen to fall to between $100 and $300 by the end of June. According to WHO, the average price today is $484.

Separately, over the weekend, another U.N. agency, the International Labor Organization, released results from one of the largest studies conducted on the impact of AIDS on the working world. The ILO estimates that as many as 36.5 million people world-wide who are engaged in some type of productive activity -- most are 15 to 49 years of age -- are HIV-positive. By 2005, more than two million labor-force participants will be unable to work, 78% of them living in Africa, it predicts.

Their inability to participate fully in the labor force as a result of illness or an early death "is a direct threat to goals for poverty eradication and sustainable development," the report concludes.

According to projections in the report, 11 countries -- all are African -- stand to lose more than 10% of their labor force as a result of AIDS, while Zimbabwe will lose more than 20% of its labor force. The economic impact of the disease already has been felt. In South Africa, labor-force losses cost the economy more than $7 billion annually from 1992 to 2002, according to the ILO.

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