HOW HE SEES IT The big lie about AIDS

By JAMES K. GLASSMAN
SCRIPPS HOWARD NEWS SERVICE
Few actions by President Bush have infuriated opponents more than his initiative to help Africans and other poor people dying of AIDS. How dare this "compassionate conservative" usurp an issue that's rightfully theirs?
A year ago, Bush committed $15 billion for Africa and the Caribbean, and the United States this year will spend "approximately twice" as much internationally as "all other donor governments combined," says Randall Tobias, who heads the president's Emergency Plan for AIDS Relief.
Secretary of State Colin Powell told Haitians last week that AIDS is "the greatest weapon of mass destruction on the earth today," and the CIA calls the global pandemic a severe security threat.
The Bush AIDS commitment sticks in the craw of radical activist groups and antagonists like Sen. Ted Kennedy, D-Mass., and former President Bill Clinton, whose own administration's efforts fell short. As the election approaches, such foes have mounted a campaign to embarrass Bush; instead, their cynicism imperils millions of Africans who deserve safe, high-quality treatment.
How it unfolds
The story of Bush's foes goes like this:
UGlobal health agencies want to rush cheap generic drugs -- served in "fixed-dose combinations" (FDCs) of two daily pills, rather than the current six. The FDCs, "pre-qualified" by the World Health Organization, comprise anti-retrovirals (ARVs) that impede the progress of HIV into AIDS.
UThe Bush administration stands "alone in opposing these safe, inexpensive WHO-certified generic medicines," says Human Rights Watch. Why? Because Bush "is more interested in protecting the interests of the pharmaceutical industry than it is in expanding ... treatment," says Doctors Without Borders.
UIn October, Clinton's foundation engineered a deal with companies in India to make generic FDCs for only $140 per person per year, striking fear in the hearts of the big pharmaceutical firms that developed the original ARVs. Bush is blocking the plan.
This story, promoted by a gullible media, is wrong in all its particulars:
The main FDC, Triomune, made by India's Cipla, combines what CBS's "60 Minutes" calls "knockoffs" of three patented ARVs invented by Western drug companies. Although the three individual drugs have been approved for use by the U.S. Food and Drug Administration, the FDC has not -- because "pharmacologists well know that when drugs are combined, they can act differently from when taken separately," as Jeremiah Norris and Carol Adelman of the Hudson Institute wrote April 3 in The Lancet.
Results could be disastrous. Inadequate FDCs, says Terrence Blaschke of Stanford Medical School, "can accelerate the emergence of drug-resistant HIV," requiring an entirely new generation of expensive ARVs. Such resistant strains have already developed for tuberculosis and malaria.
Implications
At a conference in Botswana last month, African representatives insisted, one delegate put it, that the new FDCs "be held to the same standard [as other drugs] because bad products have broad implications."
As for U.S. drug companies: Africa is a tiny market, not a profit center. Merck, Pfizer and others spend tens of millions of dollars on humanitarian efforts in Uganda, Botswana and elsewhere in Africa, and all the research firms agreed at last year's WTO conference to compulsory licensing of AIDS medicines for use in poor countries.
In fact, on the whole, Western ARVs are cheaper than the knockoffs made in India and Thailand. A December price list showed that across 12 categories, the average price of a patented ARV was $441 a year; for a generic, $911.
Finally, the vast Clinton plan -- run by Ira Magaziner, the notorious chief of the ex-president's failed national-health scheme -- is, at this stage, a pipe dream. "It was unclear yesterday," the New York Times reported April 6, "whether the ambitious plan would be realized." Conditions are onerous (African nations have to pay cash and place huge, long-term irrevocable orders at a fixed price) and the $140 figure is unrealistic. For example, an Italian faith-based group just bought Triomune for Africans at $324.
In short, the entire tale of Big Pharma's teaming up with Bush to deny drugs to Africans is a lie. The U.S. aim, says Tobias' deputy, is "not to avoid buying generics but to assure the quality, safety and efficacy of them."
XJames K. Glassman is a fellow at the American Enterprise Institute.