World AIDS Day
Honourable Minister of Health of the Republic of Zambia, Brigadier-General Chituwo, Deputy Minister for the Southern province, Your Royal High Chief Mocuni, Mr Buendia, Secretary Thompson, Ambassador Tobias, Ambassador Holbrooke, Ambassador Brennan, Richard Feachem, Executive Secretary of the Global Fund, Colleagues,
On behalf of WHO, It is a privilege for me to be here in Livingstone today. This morning demonstrates that we are no longer willing to stand back and let the HIV epidemic take its course. We are with you to take a stand against the most devastating epidemic this continent has ever faced.
It is also highly appropriate that we should be here on World AIDS Day, as the joint WHO/UNAIDS global initiative to provide antiretroviral therapy to three million people with HIV/AIDS in developing countries by the end of 2005 is being launched around the world today. The recommendations for emergency scaling up of antiretroviral treatment for “3 by 5” were finalized here in Zambia only ten days ago at an international consensus meeting.
The “3 by 5” Initiative helps focus the efforts of all working to bring AIDS care to people in poor countries. It is inspired by the groundbreaking commitments made by US President Bush to provide US$15 billion dollars for an enhanced AIDS response. It builds on the path-finding work of NGOs and faith-based groups in providing care for people with AIDS. It complements the efforts of pharmaceutical companies to reduce the prices of AIDS treatment, and the contribution of international foundations such as the Bill and Melinda Gates Foundation. It depends on the initiative and hard work of many national and international agencies; and, critically, the courageous contributions of national governments, especially in Africa, to increasing their people’s access to ARV-based AIDS care.
Antiretroviral therapy was hailed in the 1990s as a triumph of modern science. Experts and the media proclaimed that the defeat of AIDS had begun. At last there was hope. Early death was no longer inevitable.
Sadly, that optimism was misplaced. Most people living with HIV in developed countries now have access to effective treatment that prolongs life, sometimes for a decade or more. But those living in developing countries have not reaped the same benefits. The epidemic continues to expand, destroying individuals, families and whole societies. This year three million people died of AIDS. Eight thousand deaths every day. People that could have been restored to normal life by medication that is effective, safe and affordable.
The international community has no choice but to do everything in its power to stop the AIDS pandemic. It is clearly a moral obligation, but it is also a practical matter of recognizing necessity and responding accordingly. The magnitude of this social devastation is numbing. And, the longer we fail to take effective action, the more overwhelming the task will become. Forty million people are infected with HIV. UNICEF predicts that ten million children could be orphaned by AIDS in sub Saharan Africa by 2010. Eleven million children have already lost one parent. To us, these are huge and anonymous figures. To the children, these are the faces of mothers and fathers they will never see again.
Successful prevention, including the development of an effective vaccine, is still the answer to the problem of HIV/AIDS. However, one of the most powerful means of prevention may well be the provision of effective treatment. Experience in Brazil, Haiti and elsewhere has shown that if people know they can obtain treatment they have the courage and good reasons to come forward for testing and counselling. And we know that people's awareness of their HIV status is the most powerful force in changing behaviour. More people knowing their HIV status will mean more openness and less stigma. Where children can be looked after by their mothers and fathers instead of being orphaned, their risk of becoming infected themselves is greatly reduced.
On 22 September this year, together with UNAIDS and The Global Fund to Fight AIDS, TB and Malaria, I announced that the unavailability of ARV treatment for those who need it constitutes a global health emergency. As a preliminary response, we set the target of getting three million people — that is half of the people who will need it — onto antiretroviral medication by the end of 2005. The ultimate goal is universal access. The “3 by 5” target is only the first step towards getting there, but it is perhaps the most important and difficult one, and it has already started.
In the last three months, we have worked with partners to simplify treatment. Previously we had recommended that programmes choose between thirty-five different treatment regimens. While these recommendations were an important step, countries had difficulty in using them, and we did not see significant increases in the numbers of people receiving treatment.
Based on experience in several countries we are now able to recommend just four different regimens, each containing three drugs, which can be used in even the poorest settings. Community health workers are already providing treatment in Haiti and parts of Africa. These simplified treatment regimens will make it possible for many more people to get treatment in their community.
The exciting development of single pills containing all three drugs will make treatment even simpler. Today, I am pleased to announce that WHO has pre-qualified three preparations of this single pill three-drug combination.
To help increase access to these simplified regimens, we are setting up a global AIDS Medicine and Diagnostics Service. This service will ensure that poor countries have access to quality medicines and diagnostic tools that they need at the best prices available. We anticipate that twenty countries will begin to use the AIDS Medicine and Diagnostics Service within the next six months.
The work of providing antiretroviral treatment is inseparable from the broader issues of health financing and staffing and other disease prevention and control activities. Great care must be taken to ensure that no-one is excluded from treatment because of the cost of medicines. Patients who have to find the money for treatment either do not come forward in the first place or cannot remain on treatment. The cost of first-line treatment is around three hundred dollars per person per year at present. We expect it to fall to less than half of that by the end of 2005. That is about a dollar a day at present, falling to fifty cents a day or less.
The annual cost of medication for three million people in December 2005 should be well under one billion dollars. Compare this with the contribution that people can make to economic and social life when they are well instead of dead or dying, and it is clear that cost is not a genuine obstacle. Teachers back in schools. Farmers working their land. Mothers caring for their children. These drugs not only save lives, they help to rebuild societies. The cost of ignoring treatment needs is far higher than that of meeting them.
This is an initiative that is broad enough to include everyone, and specific enough to consolidate the efforts of all of us into the single major objective of “3 by 5”. Like the Health-For-All movement, everyone can contribute to it and we urge them to.
In the space of a few months, “3 by 5” has changed from a general idea into a specific and detailed plan. In the next two years it will change again, from a plan into events and realities that can save three million lives. Preventing and treating AIDS may be the toughest health assignment the world has ever faced, but it is also the most urgent. The lives of millions of people are at stake. This strategy demands massive and unconventional efforts to make sure they stay alive.
I call on all our present and potential partners to lose no time in adding your strength to this effort. Now that we know what is needed, our task is to make it happen.