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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



Cheap drugs 'not enough to fight Aids in Africa'


By David White in London
Financial Times; Sep 05, 2003

A hard-won battle for access to cheap generic drugs leaves poor African countries ill-prepared to implement nationwide programmes to treat Aids sufferers, experts working on health projects on the continent warn.

World Trade Organisation members reached a breakthrough deal last weekend to ensure that countries without the capacity to manufacture drugs themselves can continue to import cheap copies of patented medicines.

The deal has boosted expectations in Africa for wide access to antiretroviral (ARV) therapy. It makes drugs available at much lower prices and with extra funding from the US and other donors to combat the disease, reckoned to have caused 2.4m deaths in Africa last year.

But experts warned that many countries lacked sufficient health networks or trained personnel to ensure treatment was properly administered and followed up.


They feared that distribution of ARVs without adequate compliance procedures could have damaging consequences, possibly building up resistance to the drugs. Some argued that drug prices were less of an issue than investment in basic health service provision.

Yusuf Mwawa, Malawi's health minister, attending a World Health Organisation regional meeting in Johannesburg this week, warned against "jumping the gun" on ARV distribution.

"Drugs alone are not the panacea," he commented. "We welcome the generics initiative, but that should not be the only thing we put into the package."

However, officials from Nigeria, Africa's most populous country, said there was a pressing case for extending treatment without delay.

"At first probably they won't be able to manage it," said one official. "But then management controls can be put in place."

Lee Jong-wook, WHO director-general, argued at the meeting for the urgent need to introduce treatment, proposing a strategy for providing 3m Aids sufferers with ARV medicines by 2005.

Sub-Saharan Africa accounts for two thirds of the estimated 42m people infected with HIV worldwide. Until now only Botswana has had a comprehensive ARV programme. However, South Africa last month agreed to set up a national ARV treatment plan. South African companies are, meanwhile, gearing up to produce generic ARV drugs for export to other African countries.


But Pedro Alonso, scientific director of a collaborative health research centre at Manhiça in Mozambique, raised serious doubts about how the cheaper drugs could be used in a country where half the population had no access to basic health facilities.

"Who is going to monitor their efficacy? Who is going to manage their side-effects?" he asked.