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USA/Africa: Health Policy Updates

AfricaFocus Bulletin
Mar 3, 2008 (080303 )
(Reposted from sources cited below)

Editor's Note

The House Foreign Affairs Committee last week approved a commitment of $50 billion over 5 years for spending on global AIDS and related diseases, $20 billion more than the President's original proposal. The bill, which also includes other provisions such as funds for training of health care workers, and is expected to pass the full Congress. But health activists note that additional pressure on U.S. presidential candidates is needed to ensure other measures, such as ensuring access to essential medicines.

This AfricaFocus Bulletin includes a summary of the provisions of the compromise Global HIV/AIDS Bill passed by the House Committee, an editorial from The New York Times on the same subject, and an article on intellectual property rights policy and global health by Jamie Love. Love, who has been one of the leading experts and activists on the subject, stresses that there are hopes for new policy from U.S. presidential candidates, but none has yet supported legislation to ensure that trade agreements do not block access to essential medicines. .

For earlier AfricaFocus Bulletins on related issues, see and

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Summary of Compromise on Global HIV/AIDS Bill

Staff, House Committee on Foreign Affairs

February 27, 2008

  • The compromise text includes more than 95% of the language contained in the Democratic draft of the 5-year reauthorization legislation. This new legislation has the support of Foreign Affairs Acting Chairman Howard Berman, Ranking Republican Member Ileana Ros-Lehtinen, and the White House.
  • The legislation contains groundbreaking provisions which move the Global HIV/AIDS program beyond the "emergency" phase of implementation to "sustainability", dramatically boost HIV/AIDS programming related to women and girls, strengthen health systems in countries hard-hit by the HIV virus, authorize HIV/AIDS programs to include linkages to food and nutrition, education and health care programs, and increase U.S. contributions to the Global Fund.
  • The new bill funds the Global HIV/AIDS, Tuberculosis and Malaria initiative at $50 billion over 5 years, the amount provided for in the Democratic draft. The President previously had called for $30 billion over 5 years.
  • The compromise legislation overturns the controversial and ineffective 1/3 abstinence-only requirement that applies to global HIV/AIDS prevention funding. Instead, the Administration will be directed to promote a "balanced" prevention program in target countries, including all elements of the Abstinence, Faithfulness, and Condoms (ABC) approach towards HIV prevention. The Administration will also be required to report to Congress if behavioral change programs, such as abstinence and fidelity, do not receive 50% of the funds devoted to the prevention of sexual transmission of HIV in countries in which there is a generalized HIV epidemic (currently, 33% of all HIV prevention funds in all countries - a much larger pot of funds - must be spent on abstinence). The 50% figure triggers a report, and is not an earmark governing the expenditure of funds.
  • The new bill authorizes, for the first time, the expenditure of Global HIV/AIDS funding to provide HIV/AIDS testing and counseling services in family planning programs supported by the U.S. government. This will ensure that many more women of reproductive age receive vital information related to their HIV status and HIV/AIDS education. While the compromise bill does not authorize the use of Global HIV/AIDS funding to provide contraceptive services (other than condoms and other related bulk commodities as in current law) in the context of HIV/AIDS programming, it does not prohibit such activities.
  • The compromise text returns to existing law related to the so-called "prostitution pledge.
  • The bipartisan bill contains new benchmarks for U.S. contributions to the Global Fund, but does not contain a funding penalty if the benchmarks are unmet.

The Global AIDS Fight: Editorial

The New York Times, February 29, 2008

Congress and the White House are preparing to ramp up spending on programs to combat AIDS and related diseases around the world while removing some of the ideological blinders that have long undermined the effort to slow the spread of the AIDS virus. It will be a welcome strengthening of a foreign aid program that was already one of the shining accomplishments of the Bush administration.

The House Foreign Affairs Committee this week approved a bipartisan compromise, crafted in negotiations between House leaders and the White House, that would authorize a hefty $50 billion over the next five years to support campaigns against AIDS, tuberculosis and malaria. This represents a huge increase over the $19 billion appropriated in the first five years of the program and a significant increase over the new funding requested by President Bush. The president had originally proposed $30 billion over five years, primarily to fight AIDS, whereas the new bill would authorize perhaps $37 billion to $41 billion to the AIDS struggle.

The administration's program started small five years ago to meet a perceived emergency as the AIDS epidemic spread out of control. It has already provided drug treatment to almost 1.5 million men, women and children and supportive care to millions of others. The focus for the next five years will be on making some of the initial gains sustainable.

In one farsighted move, money will be used to train some 144,000 new health care workers over the next five years to care for people infected with H.I.V., the virus that causes AIDS. That is at best a start on easing the severe shortage of health care workers in the developing world, which some estimates peg in the millions. Other donor nations will need to contribute to the training effort as well.

The most troublesome ideological constraint on the program - a requirement that one-third of the funds used for prevention services be spent on abstinence education - has been greatly eased. The bill calls for a balanced prevention program that would promote abstinence until marriage and fidelity thereafter, as well as condoms. It requires countries to report if abstinence and fidelity funding falls below a certain percentage, but it sets no firm percentage that has to be met.

The House is expected to pass the bill in the near future, and the Senate is considering its own version. Although some Republicans are grumbling over the amount of money proposed, it is important that Congress appropriate the full $50 billion if possible. Even that sum would almost certainly not provide universal access to treatment for all people infected with H.I.V., a goal that the major industrialized nations claim to be pursuing.

Access to medicine in developing countries -- hoping for change

The Huffington Post

February 29, 2008

By Jamie Love

For his first seven years, Bill Clinton pursued an aggressive policy of imposing tough intellectual property rules for developng countries, most importantly in the area of new medicines, which were seen as an important U.S. export. In 1994, I began a long effort to address the flaws in this policy, working first with (Huffpo blogger) Rob Weissman, Ralph Nader, and soon a few global public health groups, like Health Action International and MSF, and local public health groups in Thailand and South Africa. In 1998, through 1999, a global campaign advocating the use of compulsory licenses on medicines was launched. By June of 1999, a small but very motivated and informed group of U.S. AIDS activists began a campaign to disrupt the Gore campaign for President, to protest Gore's direct involvement in bullying South Africa over proposed changes in its patent laws.

With very few exceptions, the U.S. news media had ignored this issue, until it became an unexpected but real problem for Al Gore. For the first time, the U.S. public had some information about why the U.S. is resented around the world, on this topic. The United States Trade Representative and the U.S. Department of State, directed by President Clinton and Vice President Gore, were forcing developing countries to impose tough and costly monopolies on medicines, and directly reducing access to medicines needed to prevent death and suffering. As an aside, it was through this issue that I met Arianna Huffington. Although she was then known mostly as a right wing allay of Newt Gingrich, she began writing about the dispute over drug patents in Africa, and more generally about the nature of corporate power, and her columns on this topic helped change U.S. trade policy.

Both Gore and Clinton responded to the pressure from AIDS activists (people like Paul Davis, Asia Russell, Mark Milano, Eric Sawyer, Bob Lederer and many other brave and selfless persons whose names I am ungratefully neglecting) and groups like ours, and by 1999, U.S. trade policy was significantly modified, most dramatically in a well received speech delivered by Bill Clinton on December 1, 1999, on world AIDS day, at a chaotic WTO meeting in Seattle. Gore flipped too, and made peace with the AIDS activists, who then supported his run against George W. Bush.

The changes in Trade policy announced by Bill Clinton in December 1, 1999 began a moderation of a very bad trade policy, but only partly. For example, in January 2001, in his last ten days in office, Bill Clinton authorized a WTO case against Brazil, in order to stop Brazil from issuing compulsory licenses on patents for the AIDS drug efavirenz, an action dubbed "the Merck case" by USTR.

George W. Bush's election was initially not a disaster on the access to medicines issue. Bob Zoellick, then the head of USTR, initially retained the Clinton changes in trade policy, and to make a very long story short, in November 2001, agreed to the Doha Declaration on TRIPS and Public Health, which called for implementing patent laws in manner to promote "access to medicine for all." Unfortunately, drug company CEOs then began meeting directly with Karl Rove, and a much reigned in USTR began a long pro-big-pharma drift that now features regular bullying of developing countries on the drug patent issue.

Looking back, on his worst days, George W. Bush has had a better trade policy on medicine patents than Bill Clinton did on his worst days. But looking forward, it is quite important that the next president make some big changes, and allow countries like India, Brazil, Thailand and others to issue compulsory licenses on drug patents. More important, we need to create a new global trade policy based upon public health needs, looking to treaties on research and development, rather than the ever tougher intellectual property rules. Resolutions that would support these changes included Senate Resolution 241, and House Resolution 525.

We now have three leading candidates for President, and none of them have agreed to co-sponsor Senate Resolution 241. But we have "hope" for good things.

Hillary has clearly been influenced by a combination of her own sensitivities to the health issue, and the increasingly deep commitment of Bill Clinton, as an ex-president, to address concerns about access to medicine in developing countries. Like many liberal Congressional Democrats, Bill Clinton has often embraced a policy of AIDS exceptionalism on these issues, which focuses on the needs to AIDS patients, but does not necessarily extend this concern to other health problems, such as the need for developing countries to have access to new treatments for cancer or heart diseases. But many activists believe that Hillary will be very good on this issue if she becomes president. My own 16 year old son actually talked directly to Hillary about this topic, during a February 7 visit she made at an Arlington High School. Senator Clinton took a moment to personally express her support for poor patients having access to new medicines, and she endorsed the use of compulsory licensing of patents to make this possible.

AIDS activists have had some luck in getting Obama to offer some encouraging words on this topic, as it relates at least to AIDS, and his very bright Senate staff has given meetings on the topic, and seem sympathetic.

For both Hillary and Obama, I should emphasize that huge efforts have so far have failed to get either candidate to co-sponsor Senate Resolution 241. This is not entirely encouraging. But we have hope.

John McCain has shown a lot of independence from big pharma on domestic issues, like parallel trade in medicines (importing cheaper brand name drugs from Canada or Europe to benefit U.S. consumers). But he has yet to directly address the trade issue in a constructive way, and the best that can be said is that his unhelpful statements reflect a lack of understanding. But, we hope that if he becomes president, he will do the right thing.

This is a very important issue. Thailand is today being pressured by the U.S. Department of State and the USTR to abandon compulsory licenses it had earlier issued on patents on drugs for AIDS, heart disease and cancer. Brazil is being pressured to not issue a compulsory license for the Gilead drug tenofovir. Chile has been pressured over it's efforts to import generic versions of an expensive leukemia drug. The USTR is pressuring dozens of Latin American countries to abandon a pro-public health position in a far ranging negotiation on public health, innovation and intellectual property at the World Health Organization. The U.S. government is trying to stop the World Health Organization from offering useful technical assistance on patent issues to poor countries, and opposes many measures that would promote greater access to safe generic medicines.

These issues don't directly concern U.S. voters, but they are extremely important. We are creating new global norms that will last several decades, and impact billions of persons throughout the world. For people who don't follow this issue very closely, this is what is at stake. People who live in developing countries typically have average incomes of anywhere from 1 to 20 percent of the US. And, within developing countries, unskilled workers are far below the average. With monopolies, drug companies typically choose prices that are only affordable for the richest 1 to 20 percent of the populations. With generic competition prices fall a lot (More than 95 percent for many important drugs), and access is much better.

In the global battle over access to medicines, what side are these candidates on? And what changes will they made if elected?

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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