By 2030 an estimated 50 million people will need HIV/AIDS treatment compared to only 9 million who need the treatment today. This is the projection of the UK All-Party Parliamentary Group on AIDS (APPG) contained in - The Treatment Timebomb - a report released on 15th July 2009 in London. The report contains the findings of an inquiry of the APPG into the long-term access to HIV medicines in the developing world.
It is a sober and compelling report that anyone concerned with or involved in HIV/AIDS treatment or prevention, and indeed, anyone who might be affected by HIV/AIDS must read. This means it is a report that everyone who has the opportunity must read.
Current HIV/AIDS Treatment Needs and Gaps
According to the report, today only about 4 million people are receiving anti-retroviral therapy (ARVs) out of approximately 9 million who need treatment. The numbers of those in need is rising and will continue to rise for many years. When you break down the numbers, as UNAIDS does in its 2008 Report on the Global AIDS Epidemic, the situation if frightening. While about a third of adults who need treatment are currently receiving it barely, 10% of children indeed have access.
This means that notwithstanding the major efforts that have gone in improving access to HIV/AIDS treatment we are still very far from the mark, a situation made worse by the fact that we are dealing with a fast moving target in terms of treatment needs. One key recommendation that the APPG report makes in the first section is therefore that “HIV needs to be understood as both an emergency for those without treatment and as a chronic condition for those with it.”
The Timebomb
But if we are far from the mark today what is likely to happen in 2030 when the number of people in need is estimated to be about 50 million and when the current favourable treatment conditions, such as significant financial resources and very low prices for the first-line treatments due to generic competition, change? As time progresses, the medicines that people living with HIV will need will change and they will be more expensive because of a number of factors that the report cites. These include the fact that we will:
- See high prices for tolerable first line treatments;
- Need better medicines to prevent mother-to-child transmission;
- See high prices for second line and subsequent treatments; and
- See increased costs related to meeting the price of related medicines (for opportunistic infections) and diagnostics.
These factors are fairly obvious and anticipated so why the idea of a Timebomb?
The idea of a Timebomb is predicated upon APPG’s argument that the drivers of past price reductions for HIV treatments are unlikely to be at play in 2030. The case is made in sections 3 and 4 of the report. In particular, the APPG makes the case that things will be different because the current low prices for first line ARVs were made possible by generic competition which was possible because of the favourable patent laws in India and a few other countries in the 1980s up to the start of this Century. The legal situation has already changed because of the requirements of the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) and other trade rules, such as those contained in bilateral free trade agreements (FTAs). The practical impact has started to be felt but is likely to become clearer in the next few years. All major projections indicate that hard times lie ahead.
The report has been seen as a wakeup call because as Dr. Peter Piot, the former head of UNAIDS, says in the foreword “we cannot deliver on Universal Access in the long-term by just doing more of the same.”
Joining the Bomb Squad
If we are sitting on a Timebomb then how do we defuse it and who should defuse it? The report calls on a wide range of stakeholders, from governments to international organisations and regional organisations, donors, the pharmaceutical industry (both generic and brand) through to non-governmental organisations (NGOs), charities and civil society to act.
But literally each individual can join the bomb squad to help defuse the ticking timebomb. You can make a contribution as a member of the bomb squad by doing something about the ideas and recommendations of the report around incentives that compliment or offer alternatives to patents as a way to support research and development (R&D). The report cites a number of push and pull mechanisms that are currently under consideration in a number of contexts, including direct funding, prize funds, advanced market commitments and patent pools. To tackle the HIV treatments R&D challenge patent pools, particularly the UNITAID patent pool receives the highest endorsement in the report. I would also vote for it. For other R&D needs, such as those related to TB and other co-infections, constructive debate and ideas around prize funds and other ideas will be crucial.
