From talk to action in fighting AIDS in the developing countries: 8th Retrovirus Conference opening session

In the final address of the opening session, economist Jeffrey Sachs addressed the “utter, complete, one hundred percent failure of international policy to address this crisis in the poorer countries of the world.”

The essence of the crisis in Africa, he maintained, results not from “exceptionalism,” but from poverty, noting that AIDS has occurred against a background of health problems for which solutions exist, but which have not been addressed because of insufficient resources. The international response to AIDS in Africa, he asserts, has been “a few tens of millions of dollars and a lot of hand-wringing, but no real assistance,” since the total annual contribution of about $70 million amounts to $3 per HIV-infected individual per year in Sub-Saharan Africa.

Noting that World Bank programs have addressed issues ranging from grief support to replacement of lost workers, but not treatment, Sachs criticized donor agencies for failing to acknowledge the responsibility of rich countries to make treatments available in poor countries. While he finds activism targeted at large pharmaceutical manufacturers to be often appropriate, he noted that drug companies have agreed to provide substantial discounts to developing countries. In his view, these agreements are undermined by lack of rich country support, because many affected African countries cannot afford to pay even the minimum production costs of effective antiretroviral regimens.

Sachs outlined a plan to provide treatment for several million Africans with AIDS over the next few years, at a cost to rich countries of about $2 billion per year. Comparing this figure to the $8 trillion dollars in capital gains the US has experienced in the past decade, and noting that tax cuts of trillions of dollars are being considered in the US, he characterized $2 billion as “rounding error” to the macroeconomist – the equivalent of a levy of $2 per person per year in rich countries.

The first element of Sach’s plan, therefore, is support by rich countries, with acknowledgement by the United States that, if treatment interventions can be shown to be effective, then rich countries should be prepared to fund them. Second, pharmaceutical companies would, with US government commitment to the program, provide antiretroviral drugs at their manufacturing cost. In return, the rich country markets for the drugs would be preserved, “and we should be strong supporters of that.”

Thirdly, the scientific and research establishment would test propositions that antiretroviral therapy could in fact be applied effectively in poor countries, and determine what kind of protocols can work. For example, this operational research might address adherence, and whether CD4 count and viral load monitoring are in fact necessary for effective treatment. In this scenario, the World Bank would fund scientific proposals to test such medical and epidemiologic hypotheses.

In closing, Sachs emphasized that, “We now know that at least we can try to do somethingÉ. What we need to do urgently is, finally, to move.”

Sachs JD. Keynote Lecture: From Talk to Action in Fighting AIDS in Developing Countries. 8th Conference on Retroviruses and Opportunistic Infections; February 4-8, 2001; Chicago, Illinois. Abstract L3.