One of the world's leading HIV/AIDS authorities says an African drugs agency may be created within a year. UNAIDS executive director Michel Sidibe says the organization will manufacture, regulate, store and distribute cheaper medicines. Most of the 33 million people infected with HIV worldwide live in sub-Saharan Africa. Many die because they don't have access to life-prolonging anti-retroviral treatment. But Sidibe has vowed to change this.
"This agency is vital," says the UNAIDS chief, who's originally from Mali and acknowledges a "special interest" in the welfare of Africans, 22 million of whom are HIV-positive. More than three million of the world's four million people on HIV treatment live in Africa, with another six million Africans urgently needing urgent but not yet getting it.
Most of the Africans receiving medication are on first-line treatment. This is the most effective and affordable combination drug course available. But scientists say it's normal for people to develop resistance to these medicines after using them for a prolonged period.
"[In] time, we could have rate of deaths (in Africa) increasing because the drugs aren't working. And we have to move to (get those people on) second and third-line treatment. That is very costly. It's unsustainable," Sidibe says.
It costs about $90 a year to keep someone on first-line HIV medication. But Sidibe says this amount rises to US$ 1,000 a year when more effective second-line treatment is required. That's why he emphasizes the "urgent" need for an agency to make cheaper drugs for Africa.
Agency to 'resolve a series of problems'
Sidibe has spent a lot of time in South Africa, where almost six million people are HIV-infected and 1,500 new infections occur every day. Seven hundred thousand South Africans are receiving HIV treatment. The country's president, Jacob Zuma, has pledged to boost this to 1-point-4 million people within the next two years.
But Sidibe asks, "How will we sustain that, if 50 percent of those people become resistant (to the drugs)? I am saying it's time for Africa to have a single authority to deal with pharmaceutical issues. It will help us to resolve a series of problems."
One of the problems the agency will eliminate, says Sidibe, is the growing influx of poor quality, ineffective HIV medication into Africa.
"When you have those sub-standard drugs coming in, it's coming into competition with proper drugs, so there's no incentive to produce (HIV medicine) in our continent. And it's timely now to really think about a continental vision which can help us to produce those (safe) drugs."
Sidibe says he aims to continually appeal for African "vision," especially among the continent's political leaders. "We need to not forget that our people will be on treatment for years to come…. We have 300,000 babies born every year with HIV. So those babies will be there for us (to treat) for years to come. If we don't have a mechanism to produce low-cost treatment for those people, it will be a tragedy," he says.
Sidibe's also hopeful that an African drug agency will "integrate, progressively, Africa into the global market. And it will…create an environment which is attractive for a foreigner to invest in the production of drugs in this continent."
One of the agency's aims, he says, will be to "unite" Africa in efforts to bolster the continent's response to HIV/AIDS.
"This single authority can bring people from Lesotho to Mali to Burkina Faso to work together, trying to begin a restructure, but also helping us to put in place those sub-regional observatories of the price (of HIV drugs), so we don't have someone from Swaziland paying more than someone in Burkina Faso or Benin. I think those are the strategic changes which could bring some kind of hope in this continent."
'Move fast…. Many lives in danger'
Sidibe recently met with African Union (AU) and New Partnership for African Development (NEPAD) leaders, Ethiopian prime minister Meles Zenawi, South African deputy president Kgalema Motlanthe and the nation's health minister, Aaron Motsoaledi.
"They're all keen to see how this continental vision (for an African drug agency) can be reality. Now it's important to move from the concept to…a business plan which can help the leaders and also the NEPAD to integrate that in their strategy to move forward," Sidibe says, before urging African authorities to "move fast," because many lives are at risk.
"If tomorrow we have 50 percent of our people (drug) resistant, it will be terrible – not just for this continent, but for (the) world. The movement of people (is) going on. Migration is real," he says.
Sidibe expects funds for the new agency to come from international donors, and also from "some" African countries. He's hopeful that despite a global financial crisis, leaders will do "whatever they can" to make the organization a reality "because their people are dying."
'More transparency needed'
Sidibe agrees that skeptics will have concerns about the proper, efficient management of such an agency in Africa.
"It's true that Africa needs to reform itself. It's true that we need to take a decision which could make (this agency) more accountable to our people, that transparency is needed, that we need to foster public accountability," he says.
Sidibe, though, is adamant that these concerns "should not stop us moving" and he's called for a "mindset shift" regarding health among African political leaders.
"Health is considered (by them) as a cost. (But) for me, (investment in) health is producing money. It's producing resources. It should not be seen by our leaders as just expenditure. It is an investment."
Sidibe maintains that Africa has the scientific and business knowledge, both on the continent and in the Diaspora, required to competently staff the agency. "I'm seeing a huge (number) of young African scientists outside of this continent," he says. "And they are coming from the best schools of the world. Maybe such a single authority could attract them to come back to Africa, to contribute to the transformation of this continent."
Agency to also fight TB
Asked when he expected the agency to be set up, Sidibe responded, "I think it's a political decision. What AIDS has taught us is that politics matters. Let us not be lying to each other about this. If we are really serious about it, we must have the opportunity to work on it with developed countries. You have a single authority in Europe; you have one in the US. So we can learn from those, and transfer the competencies and technologies quickly to do it in Africa. So for me, within one year it can be done."
Sidibe says "global walls" pertaining to international health crises "must fall."
"We cannot close the door anymore. We have (the) H1 N1 (swine flu virus) going everywhere. Suppose tomorrow we have an explosion of this virus in Africa. What will happen? It will be very serious. (Africa has) no research base, no real technology, no capacity tomorrow to produce (a) vaccine," he says.
Sidibe's clear that an Africa-wide drugs agency "shouldn't be seen as only about AIDS. AIDS should be the entry point. It's time to take AIDS out of isolation. AIDS should be a force to transform. We have civil society; we have movement that has been created around AIDS which helps us to mobilize 14 billion dollars a year. We should leverage those resources to produce a broader health and development outcome."
He says 500,000 people, most living in southern Africa, are dying every year from HIV and tuberculosis (TB) co-infection.
"We should stop that. And we can, by producing the drugs to fight TB. This would be a good start for this new agency," Sidibe says.
