Editorial
The World Health Organization (WHO) has declared the failure to provide ARVs to people with HIV who need them to be a public health emergency.
This announcement, made by WHO Director-General Dr Lee Jong-wook on 22 September to a UN General Assembly meeting on HIV/AIDS in New York, and by Dr Paolo Teixeira, head of HIV/AIDS for the organisation, at a press conference in Nairobi, Kenya, sends a strong signal that WHO and others should and will take exceptional measures to speed treatment access.
It already appears, for example, to have been a factor in the Canadian government's sudden decision, at the request of UN envoy Stephen Lewis, to introduce a new law to allow Canadian pharmaceutical companies to override patents when producing drugs for use in developing countries (see news story, listed in this issue of HATIP).
Within WHO, this confirms the priority that is being given to the goal of getting 3 million people onto treatment by 2005 the 3 by 5 campaign,headed by Dr Charlie Gilks. WHO says there cannot be business as usual until better progress has been made.
Dr Lee has announced that WHO will provide emergency response teams to those countries with the highest burden of HIV/AIDS, based on direct appeals from governments. These teams, made up of experts in AIDS treatment from international and non-governmental organisations, will work with governments to find ways to urgently speed up the delivery of antiretroviral drugs to the people who need them.
WHO has already begun negotiating with a small number of African countries for the implementation of large-scale treatment programmes and will treat between 30 and 35 nations as priority countries for WHO support in scaling up antiretroviral therapy. By December 1, WHO aims to have a technical operations manual for programme managers ready for distribution, along with training materials for professionals, standardised, uniform Monitoring and Evaluation indicators and revised and simplified guidelines for antiretroviral use.
WHO is promoting simplified approaches to treatment delivery and has also given its strongest endorsement to date to the use of fixed-dose combination ARVs and drugs from 'generic' manufacturers. The Model List of Essential Medicines (formerly, Essential Drugs List) recommends fixed-dose combination ARVs provided they meet quality criteria and that equivalence to separately dosed medicines has been shown. However, specific fixed dose combinations still do not appear on the Model List in the way that they do for TB medicines.
The South African Health Minister has now received a treatment plan,
prepared by a national expert group headed by Dr Anthony Mbewa of the
Medical Research Council of South Africa with assistance from the William Jefferson Clinton Foundation. This will shortly go to Cabinet, with funds already committed, to make it a serious contender for Africa's largest ARV treatment programme in the next two years.
The same week also saw the 13th International Conference on AIDS and STDs in Africa (ICASA), gathering some 8,000 attenders in Nairobi, Kenya, with a substantial scientific and clinical programme as well as many opportunities for clinicians, scientists, community activists and policy makers to meet and discuss the way forwards.
Is this a turning point in the global response to the epidemic? Only time will tell. The challenge to everyone involved, to deliver what is needed in a way that truly begins to lift and does not add to people's burdens, is immense.