WHO’s HIV/AIDS strategy under the spotlight
Dr Jim Yong Kim, Director of HIV/AIDS Department, talks to the Bulletin about “3 by 5” – the global strategy which aims to provide three million people in developing countries with antiretroviral treatment by 2005
Bulletin:
What is the US$ 5.5 billion for?
JK:
“It is for the many aspects of treatment and prevention scale-up — training health workers, paying for ART, providing medicines for opportunistic infections and all the different aspects of a comprehensive treatment program that must be in place.”
Bulletin:
WHO is working with countries to help them develop health systems capable of delivering HIV/AIDS treatment. How will countries persuade their private health sectors to implement the pillars of “3 by 5”?
JK:
“The private sector is already a major provider of HIV treatment in many countries. Our experience has been that the private sector is also looking for guidance on how to treat HIV patients
because there are many choices. But governments need to play a stronger regulatory role and WHO is working to provide them with a framework by which they can establish procedures, rules and regulations to guide the treatment activities of not only the private sector but also of nongovernmental and faith-based organizations. Strengthening health systems means strengthening the policy and regulatory capacity of governments in relation to the whole range of health care providers.”
Bulletin:
WHO has committed to getting three million people on ART by2005 and to keeping them on treatment for the rest of their lives. Is this target achievable?
JK:
“The target is achievable but it depends on how much political will, money and resolve the world is willing to invest. Many people tell me that it’s not achievable, but since very few have really tried to scale-up ART treatment, how could they possibly know with such certainty that it is impossible? I’m not interested in defeatist conclusions at the outset. We should be discussing the obstacles to achieving this target and working to develop ways of overcoming them, instead of citing reasons why it can’t be done.”
Bulletin:
WHO has been accused of double standards because it has recommended drugs for developing countries that have not been approved by national drug regulatory authorities for use in developed countries such as the EU, Japan and the US. What is the justification for this?
JK:
“The reason they are not approved in those specific countries is that selling generic medicines would breach national patents in those rich countries. Recent developments at the World Trade Organization have allowed poor countries — in the event of a pandemic like HIV/AIDS — to import generic drugs made under compulsory licensing, if they are unable to manufacture the medicines themselves. Several countries are doing this now. But how do those countries which may not have
good drug regulatory authorities evaluate the quality of these imported generic drugs? The EU, Canada, Australia and the US have highly respected drug regulatory authorities but it is difficult for them to test these generic drugs for a number of reasons including the enforcement of patents.
“So we have a situation where the drugs are available, poor countries want them and they want them with quality assurance but they themselves may not have the regulatory capacity to give that kind of assurance. WHO, therefore, has developed its pre-qualification system which utilizes drug regulators from countries like Switzerland, Canada, Australia, France and 16 other countries to assess the quality of the drugs. This allows the UN system and poor countries to import them with confidence.”