Thursday, May 11, 2000 GLOBAL CHALLENGES AFRICA I: Drugmakers Will Cut HIV Drug Prices in Developing Nations       Five of the world's largest pharmaceutical companies have agreed to slash HIV drug prices by as much as 85% to 90% for those in developing nations, the Wall Street Journal reports. In a joint statement of intent to be released today by the United Nations, Bristol-Myers Squibb Co., Glaxo Wellcome PLC, Merck & Co., Boehringer Ingelheim GmbH and Roche Holding AG pledge to offer the anti-HIV drugs to the world's poorest countries "for as little as pennies above manufacturing costs ... or about one-fifth of the already-discounted prices now charged in some African nations." UNAIDS Executive Director Peter Piot, who has been negotiating the agreement since April, said, "It's the first time the companies are collectively willing to discuss a truly significant decline in prices. It is something many of us have hoped for." The drugmakers' decision to cut prices came after an "impassioned plea" last December by U.N. Secretary General Kofi Annan. The drugmakers also feared that unless they took action soon, Africans would turn "en masse" to generic versions produced illegally by patent violators, who, "fattened by profits, might extend their sales to developed nations." The exact prices the pharmaceutical companies plan to charge has yet to be determined, but Glaxo has already indicated that it may offer its Combivir, a mixture of AZT and 3TC, for about $2 per day or less -- about one-third of the current daily cost in Uganda and one-fifth of the U.S. price. Not Enough       Despite the dramatic cuts in prices, most infected Africans still will not be able to afford the treatments, the Wall Street Journal reports. Under the agreement, new prices for an HIV cocktail could average around $150 or $200 per month, "far below" the current price of $800 but still too costly for most in Africa, where the per-capita monthly income is less than $50 and employer- or government-provided health care is rare. The United Nations and the drugmakers hope, however, that their announcement and the drugs' lower price will spur employers, African governments and donor institutions to provide subsidies to help pay for treatment. In their joint statement, the companies also call for new prevention efforts, better health care infrastructure and more political commitment to the fight against AIDS in African nations, as well as increased international support. Currently, Africa has "nowhere near enough" health care workers who are trained to administer complex anti-HIV regimens, and many governments "have been slow to acknowledge the extent of the epidemic." Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, called the price pledge "an excellent idea" that was "long overdue." But, he argued, "If the offer isn't well thought-out and combined with funding to educate people about how to use the drugs or build health services to provide and monitor their use, the drugs' availability in Africa could be disastrous. These are potentially dangerous medicines." The World Bank already has tentatively agreed to provide funds to educate African health providers and to help buy the drugs. World Bank President James Wolfensohn said, "With the prices so high, there was little incentive for the governments to build the health infrastructure to provide care. The companies' offer may now stimulate that effort and inspire wealthy nations to help fund it" (Waldholz, Wall Street Journal, 5/11). Kaiser Daily HIV/AIDS Report