Companies’ Plans to Donate AIDS Drugs to Africa Draw Mixed Response

By DEBRA E. BLUM

Three major pharmaceutical companies this month became the latest drug makers to pledge to donate millions of dollars worth of medicine, health services, and other support to countries in Africa and other regions hard hit by the AIDS pandemic.

The pledges — made separately by Abbott Laboratories, Boehringer Ingelheim, and Merck & Company — follow similar plans laid out recently by Pfizer and Bristol-Myers Squibb Company. And other drug makers, in the United States and abroad, are thought to have their own anti-AIDS efforts in the works.

But public-health officials and AIDS activists around the world are skeptical about the company-sponsored charity programs. While critics are pleased that more attention is being paid to the AIDS crisis in general, they say that the drug companies’ philanthropy will likely do more to burnish the reputation of the corporations than to fight the disease. They charge that the companies’ goodwill is intended, at least in part, to shield drug makers from pressure to cut the price of their medicines — an action many observers say would be the most effective way to improve access to costly drugs.

Price Cuts Sought

AIDS activists and public-health officials have been urging pharmaceutical companies not only to cut their prices, but also to allow wider use of generic copies of their drugs, which can be sold more cheaply than the brand-name versions. Drug companies have balked at the suggestions, in part because, they say, reducing the price of medicines in some countries could weaken prices everywhere, cutting into the companies’ profits and thus leaving them fewer dollars for research and development, the very process that leads to the introduction of valuable new drugs.

Despite their concerns, however, five pharmaceutical companies — including Boehringer Ingelheim and Merck — offered in May to negotiate with five United Nations agencies concerning steep cuts in the price of AIDS drugs for Africa and other poor regions. But talks on the price cuts have stalled.

Drug company officials say that their charitable programs are not intended to substitute for possible price reductions, and that their efforts are well-meaning attempts to stop the spread of AIDS and HIV, the virus that causes AIDS. In addition, they note that their efforts are adding hundreds of millions of dollars and an untold amount of expertise and organization to fighting a deadly disease in the world’s poorest areas.

Controversy over what role drug makers should play in the efforts to provide affordable drug treatments attracted heightened attention earlier this month as the international conference on AIDS was held in South Africa.

It was just days before this biennial conference, which draws thousands of researchers, activists, health workers, and journalists from around the world, that Boehringer Ingelheim, a German drug company, announced that for the next five years it would give people in certain countries free doses of its medicine to help prevent the transmission of HIV from a mother to her child at birth.

The company has not settled on what countries will receive the medication, but a spokesman says that it will be made available to developing countries that demonstrate the greatest economic need. The value of the gift has also not been determined, the spokesman says, since it will depend on how many countries accept the offer and how many patients are treated.

Merck, one of the world’s largest pharmaceutical companies, announced its new anti-AIDS program during the South Africa conference.

Under a program Merck is calling the Botswana Comprehensive HIV/AIDS Partnership, the company promised to spend at least $50-million over the next five years on contributions of medicine to Botswana, and to pay for the creation and management of the program, which is intended to improve the care and treatment of people with AIDS and HIV.

Merck plans to cooperate with the Bill & Melinda Gates Foundation, which will spend an additional $50-million, and the government of Botswana. Unilever, a British consumer-goods corporation, has also promised to help with drug distribution and provide other kinds of support for the program.

Another of the world’s biggest pharmaceutical companies, Abbott Laboratories, did not formally announce its new program at the South Africa conference, but it did unveil its anti-AIDS efforts at around the same time.

Although details of its program are sketchy — the company would not estimate how much money it expects to spend or how long the program will run — Abbott said it will focus on helping children, both those who have AIDS or HIV and those who have lost family members to the disease.

The program, called Step Forwardfor the world’s children, is already under way in Tanzania, and is scheduled to start soon in Burkina Faso, India, and Romania. Abbott expects to donate medicine, medical supplies, and services, including health-care support and engineering expertise.

A company spokeswoman says that Abbott can’t put a price tag on its program because it will be driven by the needs of people in each country — needs, she says, that will constantly be reassessed.

“Instead of going in and saying, This is how much money we have, let’s find a way to spend it, we are asking the communities what they need — that could be antibiotics, but it could also include a new well so they can have clean water,” says Ann Fahey-Widman, Abbott’s manager of public affairs.

Officials at Abbott, Boehringer Ingelheim, and Merck say that their anti-AIDS programs were not created at the expense of possible drug-price cuts, which the companies are still considering.

Greg Reaves, a spokesman for Merck, says that the Botswana project “is in the spirit of’” the May cost-cutting pledge, and that the company is still working with the United Nations agencies to come to an agreement.

$100-Million Pledge

At least two other drug companies have recently announced their own anti-AIDS effort.

In the spring, Pfizer announced plans to give to poor South Africans a drug that treats a deadly AIDS-related virus. And last year, Bristol-Myers Squibb promised to spend $100-million over five years on research, medical training, and other efforts to help women and children with the AIDS virus in southern Africa.

Bristol-Myers Squibb — which has already donated nearly $32-million through its program — has been buffeted by complaints from AIDS activists and health officials in southern Africa, mostly over what the critics say is the company’s heavy-handed approach to grant making.

Among other issues, local health officials reportedly felt snubbed because of what they saw as their limited role in the program’s creation.

Pfizer, too, has run into opposition from activists and health officials who have balked at the conditions the company has placed on how, and to whom, its medicine is to be distributed. The company, which announced its proposed donation in April, has still to work out the details of the giveaway with South African officials.

It is too early to tell exactly how the programs created by Abbott, Boehringer Ingelheim, and Merck will be received, but observers have already expressed reservations.

Doctors Without Borders, an international medical-relief charity, said in a written statement released at the AIDS conference in South Africa, that what is missing from the drug companies’ efforts are plans to cut drug costs and allow generic versions of medicines to be distributed.

In addition, the statement said, the drug companies’ philanthropic efforts “need to be put into perspective.” Past experience, the statement said, “shows that these programs are likely to come with unacceptable conditions for national health ministries and will not be sustainable over the long term.”