Medical and scientific progress enjoyed by the few is inaccessible to the many
VIENNA, Austria -- At the Third International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses in Vienna, October 11 - 13, world leaders, physicians, economists, governmental health organizations, and pharmaceutical manufacturers will discuss the economic, ethical, and human rights issues underlying healthcare resource allocation. Some of the highlights of this meeting include:
Consequences of a fragmented response to a global crisis
In his keynote speech opening the Vienna conference, former US Secretary of
Health and Human Services Louis Sullivan argued that a "better balance of
financial and human resources made available for prevention and primary care,
versus resources for acute care (including tertiary and quaternary care) must be
achieved." Sullivan told the 250-plus conference delegates that "critical
adjuncts [to the fight against AIDS must] include health education of
populations, economic development, and the establishment of a sound public
health system to assure that the marvelous advances from our biomedical research
enterprise can be effectively implemented worldwide."
Are medical ethical standards used in the West appropriate in developing
countries?
Emma Pickworth, LL.B., M. Jur., University of Central Lancashire, U.K.,
suggested that while scientific validity must be assured, there are situations
in which it is ethically acceptable for standards of informed consent,
compensation and confidentiality to be lower in developing countries. "This is
due to the crisis inherent in the situation and the expense incurred in applying
high ethical standards," she says, and requires new guidance to achieve a
compromise between universal and situational ethics.
Is access to essential drugs a basic human right?
The effects of international trade regulation, including the controversial TRIPS
Agreement raise serious concerns about the affordability and accessibility of
essential therapies, according to Ellen Hoen of Health Action
International-Europe. While patents are used to restrict access to innovation
to create economic incentives for research and development, she says these
"restrictions to access must be reasonable and not create a situation where
large numbers of a population are denied effective therapies. Global trade
regulation where possible should be used to ensure that health prevails over
commercial interest." But Harvey E. Bale, Jr., Ph.D., of the International
Federation of Pharmaceutical Manufacturers Associations in Geneva, claims that
neither development of nor access to medicines are served by interfering with
intellectual property rights, suggesting instead a "cooperation model" that
includes a secure global intellectual property standard.
Is access to HIV/AIDS treatment just access to inexpensive drugs?
Improving access to HIV/AIDS therapies in many poor countries is a problem of
health care delivery, not pharmaceutical pricing, according to Jeffrey L.
Sturchio, Ph.D., Merck & Co., Inc. Citing that intellectual property protection
is non-existent in sub-Saharan Africa, Sturchio claims the argument about
compulsory licensing is irrelevant and misleading. Instead, Sturchio says,
solving the problem of access in the developing world will take political
commitment from the governments involved, and the productive partnership of all
stakeholders, to provide the healthcare infrastructure, training and education
of healthcare professionals needed to obtain the desired impact.
Self-interest and the human development club
As the chasm between the world's haves and have nots continues to grow,
development aid contributed by industrialized, market-economy countries is at a
record low. Jose Zuniga of the International Association of Physicians in AIDS
Care argues that development aid -- predicated on reliable economic analyses,
regulated to avoid waste and abuse, and offered in realistic terms that take
into account already fragile national economies -- is more necessary than ever to
create the conditions necessary to close the widening gaps in levels of income,
future market opportunities, and human development by attracting private
capital and promoting lasting economic growth. Zuniga claims that the economic
consequences of failing to support development assistance mechanisms is a
decelerated pace in achieving the eradication of conditions that contribute to
human deprivation and disease, slower than necessary economic growth in
developing countries, and potential repercussions for industrialized countries.
Is there a better way for the pharmaceutical industry to fight AIDS
The pharmaceutical industry's most note-worthy success in fighting AIDS has
been in generating a prolific flow of new antiretroviral treatments focused on
an ability and willingness to pay for therapeutic advances for a relatively
small target population in the West, said Peter F. Young, AlphaVax Inc. Less
successful have been the industry's efforts to respond to some of the daunting
policy changes in the fight against AIDS, like treatment access in the
developing world. Industry investment can be encouraged by continuing to reward
success in therapeutic innovation in the West while establishing new models for
integrated public sector/private sector interaction to address the still
untreated majority of the world's HIV population, according to Young.
Improving HIV/AIDS care access in developing countries
Approximately 90 percent of people living with HIV/AIDS worldwide live in
developing countries where access to medical care and resources is extremely
limited. Joseph Saba, MD, of UNAIDS and representatives from four countries
participating in the UNAIDS HIV Drug Access Initiatives -- Chile, Cote d'Ivoire,
Uganda, and Viet Nam ? reported progress on this controversial drug access
model. In Uganda, where the initiative has completed its first year, more than
700 people with HIV/AIDS are benefiting from access to antiretroviral drugs
through the initiative. Richard Marlink, MD, Harvard School of Public Health,
described the work of the Enhancing Care Initiative in Brazil, Senegal, Thailand
and South Africa using multidisciplinary AIDS care teams to improve HIV/AIDS
care in resource poor settings. Mark Ahn, Ph.D., Bristol-Meyers Squibb,
described the growing importance of public-private sector partnerships in
solving public health issues, including his company's Secure the FutureTM
response to the devastation being caused by the HIV/AIDS epidemic in
five southern African countries.
What will we do when we have an AIDS vaccine?
José Esparza, Ph.D., Joint United Nations Programme on HIV/AIDS, warned that if
the current vaccine for the subtype B and E virus shows efficacy, it may be
effective for the Americas, Europe and Asia, but might not be appropriate for
India or Africa, where different HIV subtypes are prevalent. He encouraged a
major effort to increase activities to promote the development of HIV vaccines
for Africa, "otherwise the continent with the greatest need for a vaccine may be
the last to have it."
Human rights and HIV in New Delhi, India
Being HIV positive in New Delhi is akin to leprosy 20 years ago, according to C.
Thangsing MD, of New Delhi. He said that people are denied medical services on
a routine basis, and even patients admitted to hospital have no guarantee they
will receive any attention. What is required, he maintained, is that the
government take the issue of HIV/AIDS seriously and install fool proof systems
which lead to service becoming the norm and not the exception.
Rapid diagnosis of HIV
Diagnosis of HIV in developing countries is often difficult due to lack of
sophisticated equipment and technical and economic resources, and the lack of
immediate feedback is harmful because patients may not return for the results,
or continue to spread the disease while they are unaware of the disease status,
said C.J. Palmer, Ph.D., Nova Southeastern University. Palmer's group evaluated
a new rapid point-of-care test, DetermineTM, in Honduras, Trinidad,
Jamaica and the Dominican Republic. They found 100 percent agreement between
the results of these rapid test strips and previous in-country test results.
Because results are known in 15 minutes, the DetermineTM test facilitates
timely patient management.
Fore more information, to pre-register, to arrange pre-conference interviews, or to receive abstracts, please contact: Kirk Monroe at 202-789-8101, kmcpr@aol.com.
The Third International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Diseases is sponsored by the International Association of Physicians in AIDS care, in association with The World Bank, World Health Organization, Austrian AIDS Society, Joint United Nations Programme on HIV/AIDS, and the Pan American Health Organization.