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
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
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.