Frequently Asked Questions

On this page we’ve tried to answer some of the tricky questions you might have, or might be asked, about the campaign. We’ll add to it throughout the year, so do check back. Don’t forget to check out our campaign briefing, which outlines many of the issues aorund AIDS, and why we’re campaigning on access to treatment.

If you have a tricky question we’ve not anticipated, you can submit them below and we’ll try to suggest an answer as soon as possible!

Contents

• Is treatment for all unrealistic?
• Haven’t we won this campaign already
• Shouldn’t we spending the money on something else, like prevention or strengthening healthcare systems?
• ARVs are toxic, dangerous, and don´t work
• Doesn’t poor infrastructure make delivering ARVs and monitoring people taking them impossible?
• Should we provide treatment when, in poor areas, people don´t take the drugs properly, endangering themselves and risking drug-resistant varieties of the virus appearing?
• Isn’t the patent system (which allows drugs companies to charge higher prices) necessary to provide companies with an incentive to research and develop new medicines?
• Submit a tricky question

Is treatment for all unrealistic?

No! There’s a lot to do, but it can be achieved. When our campaign began in 2003 only 2% of those in need of treatment in Sub-Saharan Africa could access it. In August 2006 coverage had risen to 23%.

The last few years have proved that treatment can be delivered effectively, even in the poorest parts of the world. A lack of political will is the only real barrier that stands in the way of meeting this target.

Ambitious campaigning resulted in the G8 commitment to universal access by 2010. With more of the same, we can make sure this promise is kept.

Haven’t we won this campaign already?

Unfortunately not. While the commitment to universal access by 2010 was a fantastic victory, history is littered with broken promises. We need to keep the pressure up to make sure it happens.

That’s why we’re asking for action on trade rules. Generic drugs have been vital in bringing down the price of treatment, but trade rules are blocking access to generic versions of newer drugs — which will be increasingly needed.

Secondly the money is available for AIDS now is far less than UNAIDS has estimated is needed to tackle the epidemic.

Without action to increase the availability of affordable generics we won’t be able to meet let alone sustain the commitment to universal access. And without action to make significant and sustainable funding available, the promise will also be broken. Student campaigning played a vital role in getting this far, and it’s absolutely crucial we don’t look away now.

Shouldn’t we spending the money on something else, like prevention or strengthening healthcare systems?

Prevention programmes and good healthcare infrastructure are vital, and we are campaigning for extra money precisely so that we don’t end up taking money from necessary existing efforts. That’s also why we’re campaigning on the trade rules that keep the price of drugs high. Removing the barriers that stand in the way of increased production and export of generic drugs will the bring the cost of treatment down and allow us to meet the target of universal access to treatment in the short term, and sustain it over the long term.

A comprehensive approach is necessary to tackle the epidemic, but treatment is a vital component of any effective programme. Treatment has a positive knock-on impact on prevention, enables people to continue working and supporting their families and reduces long-term health costs. In the long term, treating AIDS actually saves money.

“Rolling out effective HIV/AIDS treatment is the single activity that can most effectively energise and accelerate the uptake and impact of prevention” World Health Organisation

While providing access to treatment will cost money in the short term, it is not an excuse to refuse something which could save people’s lives. The money needed is very little in comparison to what we as a nation spend on wars, cosmetics or ice-cream. We cannot use the cost of drugs as an excuse for inaction; instead we must take action to make treatment affordable for all.

ARVs are toxic, dangerous, and don´t work

“Dramatic reductions in morbidity and mortality have been well documented” UNAIDS

In Brazil, the use of ARVs cut AIDS deaths by 51% from 1996-1999. The drugs can restore a person from death´s door to being able to go to work and live a normal life.

ARVs are now considered `essential´ medicines by the World Health Organisation, and are safe if monitored. They are given automatically to people with AIDS in the West, and should be elsewhere.

Doesn’t poor infrastructure make delivering ARVs and monitoring people taking them impossible?

MSF are currently running small-scale trial programmes delivering ARVs free to people in countries as poor as Malawi and Cameroon. They have shown it is possible, with a bit of initiative and imaginative thinking, to deliver ARV treatment even in areas with little or no infrastructure.

A report on “3 by 5”, the global initiative to get 3 million people on treatment by 2005, concluded that the initiative had demonstrated it is possible to deliver treatment in resource-poor and rural settings, and that AIDS can be tackled effectively in the developing world.

Simplifying treatment regimens, for example, by producing combined therapies (which combine different components of ARV treatment together, reducing the number of pills and doses patients need to take) make it easier to deliver treatment in poor and rural areas. Unfortunately many of the drugs most suitable for use in resource-poor settings, as well as important testing equipment, are priced out of reach.

It is possible to deliver treatment effectively in developing countries. The barriers that remain are political. Decision-makers have no excuse for failing to tackle AIDS.

Should we provide treatment when, in poor areas, people don´t take the drugs properly, endangering themselves and risking drug-resistant varieties of the virus appearing?

“Compliance is very, very high”. Mohga Kamal-Smith, Oxfam

In Brazil, 70% of patients take their medicines properly 80% of the time, the same as in the USA. Médecins Sans Frontières´ trial programmes in Uganda and Senegal have been `very encouraging´, with rates of those taking medicines properly matching those in the EU and US. Combined therapies increase adherence rates further.

In the normal course of the disease, patients everywhere tend to become resistant to a treatment within 4-7 years, and need to move onto a different treatment program. Many of these second generation drugs are still under patent and are far more expensive than `first line´ treatments. Current and future patients will require treatment for many years, and will need to move onto newer drugs at some stage in their treatment. If we are to meet the promise of universal access we need to look to the longterm and tackle the rules that keep newer drugs priced out of reach.

Isn’t the patent system (which allows drugs companies to charge higher prices) necessary to provide companies with an incentive to research and develop new medicines?

A patent grants the inventor of a product (e.g. a pharmaceutical company who has developed a new AIDS medicine) a property right. This gives the company a monopoly - meaning no-one else is allowed to sell the drug - for the period of the patent. Under WTO rules patents are granted for 20 years. This means there is no competition in the market, so the drug company can effectively charge what the like, as they are the only provider of the drug.

One justification for patents is that this period when the company has exclusive rights to sell the product is necessary for them to recoup their research and development (R&D) costs. If other people were able to copy their product immediately, there would be no incentive for them to engage in the expensive and time-consuming research necessary to produce a new drug.

Under the current system only a small proportion of profits are spent on R&D.

The pharmaceutical industry is one of the world’s most profitable industries. The figures on the right are an estimate of the spending of US pharmaceutical companies in 2004. A relatively small proportion of their income was spent on R&D - especially when compared to the amount they spent on marketing or on lobbying decision makers..

Only a small proportion of R&D money is spent on developing innovative products

In addition, the patent system skews priorities, so that much of the R&D money is spent on developing drugs which duplicate the effects of existing drugs, and offer little, if any, new theraputic value. In 2002, ‘me-too’ drugs accounted for a staggering 92 per cent of medicines approved by the US Food and Drug Administration (FDA).

The patent system does not encourage R&D where it is most needed

“We have no model which would [meet] the need for new drugs in a sustainable way…You can’t expect for-profit organisation to do this on a large scale. If you want to establish a system where companies systematically invest in this kind of area, you need a different system.” Novartis CEO, Daniel Vasella

Furthermore, the patent system only works as an incentive for research and development in areas where there is something to gain economically. This means it does not provide a great incentive to research diseases that mainly affect the developing world as there is not much money that can be made from treating diseases that affect only poor people. For example, while there are 2.3 million children worldwide living with HIV/AIDS, very little resource has been given to developing treatment that is suitable for children. This is despite the fact that if left untreated, half of all infected babies die before the age of two. A majority of children living with HIV/AIDS are in developing countries - not considered an attractive market for pharmaceutical companies who research and develop new treatments.

Before TRIPS, drugs companies claimed that they conducted little research into neglected areas such as tropical diseases, because of a lack of patent protection in developing countries.They argued that increasing patent protection through the TRIPS agreement would increase their investment in these areas. Despite the fact that the enhanced patent protection they lobbied so hardfor now exists, research and development for ‘neglected diseases’ remains shockingly low.

According to the Global Forum for Health Research only 10% of global R&D money is spent on research into the problems that afflict 90% the world’s population.

There are other ways to encourage R&D, AND make the products of R&D more widely available

And the flaws and inequalities in the patent system are not problems without a solution. Patents are not the only way to encourage research and development - there are many alterative systems - the Consumer Project on Technology has suggested the idea of country contributions to a global R&D fund, (with the contributions based on GDP). This could encourage real innovation through ideas such as non-profit collaboration, or prizes for innovative ideas. Innovation would be rewarded directly, and competition would then be encouraged, bringing prices down to something close to the cost of manufacture.

A means to an end, not an end in itself

We need to remember that the patent system is a means to an end, not an end in itself. It is supposed to be a means of enouraging innovation for the benefit of humankind. If it does not do this as effectively as possible, changes must be made.

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