AIDS and Malaria in sub-Saharan Africa
From the Wall Street Journal
WHO Is Likely to Miss Its AIDS-Program Goal
By GAUTAM NAIK
June 30, 2005; Page D4
LONDON — The World Health Organization acknowledged that it is unlikely to meet its goal of providing life-saving drugs to three million AIDS patients in poorer countries by year end, a sign of how difficult it is to stem the death toll of the disease.
In a report released yesterday, the United Nations health agency said about one million people in poorer countries receive antiviral drugs, compared with a target of 1.6 million. Half of the patients on treatment are in sub-Saharan Africa, the region hardest hit by HIV, the virus that causes AIDS.
“It is disappointing because we’re not saving as many lives as we can,” said Jim Yong Kim, director of the WHO department of HIV/AIDS, in an interview. He declined to provide a new estimate of patients expected to be on antiviral therapy by year’s end.
The original goal, known as “3 by 5″ and announced at the end of 2003, had aimed to provide antiviral drugs to three million AIDS patients in low- and middle-income countries by the end of 2005. The global push is led by the WHO and the Joint United Nations Program on HIV/AIDS, also known as UNAIDS. Endorsed by all 192 member states of the WHO, the plan is seen as a vital step toward the bigger ambition of providing antivirals to every HIV patient.
Today, about 6.5 million people urgently require the medicines but don’t have them. More than 40 million people world-wide are infected with the virus. A wider availability of AIDS drugs is also crucial to the long-term goal of reducing the rate of new infections, as patients are more likely to get voluntarily tested if they have access to treatment.
The WHO’s effort has fallen short of its expectations partly because it initially focused on backing AIDS programs run by small nongovernmental organizations with limited scope in providing antiviral medicines. The agency says it also underestimated the logistics of getting the drugs from manufacturers to patients. “Many poorer countries couldn’t manage” the complexities of procurement and supply, said Dr. Kim.
Despite falling short of its target, the WHO plan has had one key beneficial effect: It has persuaded many previously reluctant countries to pledge greater resources to fight AIDS, the WHO said. In sub-Saharan Africa, 500,000 patients get antiviral therapy, nearly double the number six months ago, the WHO added. In Asia, 155,000 people receive the drugs, triple the number from a year ago.
From the New York Times
Health Groups Expect to Miss AIDS Target
By Lawrence K. Altman and Donald G. McNeil Jr.
Published: June 30, 2005
The World Health Organization and the United Nations AIDS program said yesterday that they would not reach their heavily promoted “3 by 5″ goal of treating three million H.I.V.-infected poor people by the end of 2005.
Officials of several health agencies fighting AIDS blamed problems in the drug supply chain and shortages of health workers.
At the same time, they expressed hope that the number of people dying of the disease annually could stop growing by next year.
About one million people in poor countries are receiving antiretroviral drugs, said Dr. Jim Yong Kim, director of the World Health Organization’s AIDS department, meaning the program is not on track to reach the goal announced in late 2003. The agency set three million as its goal because it seemed to be a reasonable target that could inspire donors and poor countries to act quickly.
Donors have committed $27 billion over the next three years but have delivered only $9 billion, the health agencies said.
About 6.5 million of the 40 million people infected are so sick that they are within two years of death and need treatment immediately, officials said yesterday in a telephone news conference from Geneva, where the World Health Organization is based. For the first time, they included an estimate for desperately ill children - 660,000, a tenth of the total.
The number of people desperately in need of drugs has grown by about half a million since the treatment goal was announced.
Progress has bogged down for several reasons, health officials said. Many countries have small model treatment programs, often run by outside charities, but not full-scale national plans.
Problems with drug delivery have been greater than expected, including issues as simple as countries not guaranteeing locked warehouses and trucks for the drugs, which are valuable and toxic if misused. Poor countries have too few doctors, nurses and pharmacists.
But there are reasons for hope, Dr. Kim said. Asia and Africa have tripled the number of people being treated, and Mozambique has decided to train high school graduates as AIDS clinic workers, he said.
From the New York Times
Bush to Seek More Aid for War on Malaria in Sub-Saharan AfricaTop of Form 1
By Richard W. Stevenson
Published: June 30, 2005
WASHINGTON, June 29 - President Bush plans to call on Thursday for a substantial increase in spending to fight malaria in Africa, people who have been briefed on the plan said Wednesday.
Mr. Bush’s plan will ultimately channel increased assistance to 15 nations in sub-Saharan Africa, the region hardest hit by malaria, people inside and outside of the government said. Malaria is one of the deadliest diseases in the developing world and one of the most preventable, causing at least a million deaths a year worldwide.
The program would initially be limited to three nations, with six more being added in each of the second and third years. The spending would be in the tens of millions of dollars a year to start with, rising to hundreds of millions of dollars once the program is fully put into place, a government official who had been briefed on the program said.
Ultimately, the new program, with a budget still being completed on Wednesday, would at least double the $230 million the United States spends on fighting malaria now, the official said, speaking on condition of anonymity because Mr. Bush has yet to make the announcement.
The announcement, six days before the leaders of the seven big industrial democracies and Russia gather in Scotland for a summit meeting that is to focus on fighting global poverty and disease, will give Mr. Bush a new initiative to head off criticism from advocacy groups and some European governments that the United States is not being generous enough in helping Africa.
Most current spending by the United States to fight malaria is channeled through an international organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria. But people who had heard the outlines of the administration’s new program said it appeared it would be run directly by the United States and would supplement the Global Fund. The American plan, they said, may also draw on work being done by the Bill and Melinda Gates Foundation, which is sponsoring an antimalaria program in Gambia.
In advance of the summit meeting next week, the White House has already signed off on a plan to wipe out the debts of many poor nations, and has won some international praise for its program to fight AIDS in the developing world. But Mr. Bush has resisted calls from Prime Minister Tony Blair of Britain for further increases in direct financial assistance to African nations, saying he has already increased American aid to Africa substantially.
The malaria initiative, to be presented in a speech on Africa that Mr. Bush is to deliver Thursday morning in Washington, provides the president a chance to show another side of American foreign policy when the war in Iraq has hurt the image of the United States in many other nations.
In sub-Saharan Africa, 3,000 people die each day from malaria, most of them children, the fund said. Among the countries hit hardest by the disease, which is transmitted by mosquitoes, are Nigeria, Congo, Tanzania and Ethiopia.
Mr. Bush’s new plan will call for a variety of approaches to fight malaria, including providing insecticide-treated sleeping nets, encouraging greater use of insecticides indoors and financing more widespread use of a new generation of antimalaria drugs called artemisinin, drawn from the extract of an Asian plant.
Nongovernmental groups that have been pressuring the administration to do more to help Africa welcomed word that Mr. Bush would step up spending on fighting malaria, but said the White House still had an obligation to make battling extreme poverty a higher priority.