HHS
has two concerns in setting policy.
One:
The
Centers for Disease Control maintains that
HIV mutations in Africa will create problems for us. We have to tackle HIV there. And we need surveillance
in Africa on other emerging diseases to prevent epidemics here.
If
we set up surveillance without any effort to treat, our actions will be suspect
and unethical--it will be like the the Tuskegee project.
CDC
insists that we must participate in treatment.
On
the other hand, how can
the US government buy AIDS drugs--even at reduced prices--for Africans, and
not demand reduced prices in the US? (See Variable Pricing of Drugs by country
)
But
what if the US insists that
NGO's and African governments purchase the drugs, but arranges for collaboration with CDC,
the Army, and US medical schools for treatment, testing, surveillance, and training?
We have already set up the CIPRA
program
to fund training, research, and trials. American medical schools can
obtain these grants to run programs in Africa. CIPRA can ensure good
programs-- apparently some hospitals in Africa are not testing, or are using
procedures that are known to produce false positives .
It's important to give the right drugs--our Uganda tests show that many Africans are resistant to AZT, but not
to Combavir. Plus, in the US
the cocktail must be changed at least every 8 months. Once set
up, those programs can be used for AIDS
vaccine-testing.
Globalization means we
need more people who can recognize tropical diseases. Obviously
African countries benefit from training programs for their
people. The US has about 2500
who are skilled clinicians in tropical medicines; we have only 8 American
university medical schools with tropical programs. CIPRA will
help the US and African states.
President
Bush called for involvement of faith-based organizations, and maybe we can
promote that here--missionary hospitals and orphanages are logical targets.
Let us insist that drugs be sent
directly from pharmaceuticals to hospitals and clinics where there is CDC
collaboration or a CIPRA program. Remember the problem in the Ivory Coast when the
government forgot to reorder drugs? Patients went without for 5-6 weeks. Regularity would be a benefit.
AIDS in Africa is a calamity. Whatever we
choose will create a precedent for coping with AIDS in India, China, and other
countries. These are good options.
