The ACT UP Historical Archive: Barcelona AIDS Conference Reports ~ How will the WHO deliver on Medicines Access?

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An exclusive interview with Dr Gro Harlem Brundtland, director of the World Health Organisation

"It is difficult for a single UN agency like WHO, with a budget the size of two country hospitals in England, to create global change," says Dr Gro Harlem Brundtland, former prime minister of Norway and now director general of the World Health Organisation. "We work with partners and alliances. We create guidelines for treatment of patients with AIDS. We try and move health knowledge."

Brundtland said that WHO's attempts to get pharmaceutical companies to drop drug prices, and the compilation of an essential drugs list, had proved primary impetus to assist civil society and the South African government, as examples, win major concessions from drug companies that led to lower prices a year ago.

"We gave anger ammunition. I addressed the executive of WHO two and a half years ago and said that patients in poor countries should not be left behind. When I said that, it caused a shock wave. The general sentiment at that time was prevention, prevention, prevention. I saw that we could not ask people to test without treatment. It was kind of revolutionary.

"At that time AIDS drugs cost US$1,500 per person per month, and we worked hard to push prices down. Within six months we got prices down to 7%, and then we began discussions about a Global Fund for prevention and therapy.

"We need a sequence of simple diagnostics working to develop new medicines and lower prices. If we can simplify diagnostics, we can get broader treatment access. It is not enough for us to say people should: we have to show how, and we are doing that. We are showing them how to scale up. This helps countries that are big purchases to get the lowest prices."

The goal of getting three million people under antiretroviral treatment in developing countries by 2005 is feasible, Brundtland says. "It can be done, but not without a broad partnership with civil based society groups. We are better off because of WHO, because of activists, because of feminists, governments.

"We also have to scale up prevention for AIDS, malaria and tuberculosis, we have to reach more people and save them. "We have to do it with people in every community, every village. Infectious disease is the work of poverty.

(Barcelona) At the XIVth International AIDS Conference, AIDS activists responded to the WHO's most recent analysis of their Accelerating Access Initiative and its announcement of support for scaling up treatment access to get HIV treatment to 3 million people in the developing world by 2005. The announcement was most recently made during a meeting of the Global Access Alliance, a new public private alliance formed by the WHO about treatment access in developing countries.

"Three million by 2005 is unrealistic-but not because it can't be done. On the contrary, it can be done. But WHO's failure to offer bold leadership on treatment access means this plan has long odds," said Sharonann Lynch of Health GAP. "Without a major shift in its efforts on HIV treatment, this will be just another number, another broken promise."

Activists denounced a history of WHO's refusals to prioritize HIV treatment access programs that focus on open competition among generic and proprietary bidders, facilitating procurement of lowest cost medicines, technical assistance, and other aspects proven to assist countries in establishing sustainable access to affordable HIV medicines.

Activists pointed out that under the WHO-run Accelerating Access Initiative, treating 3 million people would take at least 100 years, as Accelerating Access has only provided treatment to about 30,000 people in two years.

"WHO must be held accountable for its failings," said Allison Dinsmore of ACT UP Philadelphia. "Accelerating Access has failed miserably. The WHO knows what works on the ground-so where is the plan that will lead to life extending treatment access for millions who are dying?"

"Poor countries need substantial technical assistance in order to get funding, to implement, and to monitor treatment access programs," said Asia Russell of Health GAP. "That is the WHO's job. But the WHO is refusing even to use its voice at the table of the WTO to insist on a workable solution to the problem of how to export generics to countries without drug manufacturing capacity."

"The WHO is acting like Big Pharma-better at making grand statements than delivering results-or even the substantial roadmap to achieve those results," said Gaelle Krikorian from ACT UP Paris.

"We don't need more partnerships," continued Krikorian, referring to the WHO's new Global Access Alliance. "What we need is for the WHO to stop pursuing failed alliances and start doing what works: prioritizing generic drug access, prioritizing treatment focused technical assistance, and showing real commitment on scaling up treatment now.

The activists demanded a concrete plan from the WTO by October regarding how they will achieve the goal of treatment for 3 million in the developing world by 2005, as well as a commitment to providing free technical assistance to countries seeking support and guidance in creating sustainable drug access programs-including assembling applications to the Global Fund to fight AIDS, TB and Malaria.