During 2003, we should find out whether our governments are prepared to rally around the Global Fund to fight AIDS, TB and Malaria and stump up the funding that is essential if it is to fulfil its mandate. Or will their ambivalence towards the idea of providing treatment and care, in settings with limited resources, continue to hold them back?
The response of the international community to the drought-and-AIDS famine that threatens 14 million people in Southern Africa, and a further 15 million whose lives are at risk in Ethiopia and Eritrea, will equally show whether ‘globalisation’ means global solidarity or everyone looking out for themselves.
Military conflict, either at an international level or a civil war, can also divert attention and at worst wreck prospects for responding to the epidemic (which is one of the risks facing Cote d'Ivoire). But in countries emerging from conflict – hopefully, with the Democratic Republic of the Congo and Angola now set to follow the examples of Rwanda and Mozambique – there should be plenty of scope for improvement.
Above all, it should become far clearer, whether WHO’s proposal that 3 million people in less developed and middle income countries be started on antiretroviral treatment by 2005 is realistic or not.
For the WHO target to be achieved, it is clear that several things have to happen.
Conditions for wider access
Firstly, there has to be political will on the part of governments. For example, South Africa must show that it truly believes its citizens have the same right of access to healthcare as those of Brazil and Thailand. There are reports that Uganda’s finance ministry has told the health ministry that any money received from the Global Fund will be balanced by cuts to their core budget. “Structural Adjustment Programmes” from the World Bank and IMF, setting limits on government spending, are given as the reason. If true, those policies must change. If not true, the finance ministry must explain why other areas of spending are receiving priority over the health needs of Uganda’s people. Whatever happened to the Abuja declaration that 15% of African governments’ spending would be on health?
Secondly, the trend towards preferential drug prices for people living in developing countries must continue to gain support, in the wealthy north as well as in the south. Multinational drug companies that adopt such policies will need support and understanding from their shareholders, especially the institutions such as pension funds and insurance companies. Generic producers – in the private and the public sector – will need to show that they can meet international quality standards and deliver real improvements in health care for substantial numbers of people.
Thirdly, the drug regimens and the way they are delivered will require further simplification, identifying those practices which contribute to healthcare provision and clearing away those which do not. Fixed dose combinations – three or more drugs in one pill - have the potential to block bad practice, where doctors prescribe or patients share scarce drugs in ways which ultimately make them useless.
The progress that has been made by the Afford CD4 Group and others towards radical cost cutting and technical improvement of diagnostic and monitoring tests needs to be sustained and accelerated. Their effective networking and focus on addressing practical issues is an admirable model for others to follow.
Will the newly-launched International HIV Treatment Access Coalition be able to lift the global response to a higher level, and achieve greater local impact in the worst-affected countries? In 2003, we should begin to find out.