Clinton calls for two-year cut in US prices for AIDS drugs
This article was originally published in Scrip
Former US President Bill Clinton on 1 December called on manufacturers of antiretrovirals (ARVs) and other drugs to treat HIV/AIDS to drop the prices of their medicines in the US for at least two years to assist states and other programmes that provide the treatments during the tough economic times.
States and HIV/AIDS clinics in the US are making "life-or-death decisions based on too few dollars for too many demands," Mr Clinton said during a World AIDS Day event at George Washington University, which marked 30 years since the HIV virus was identified.
So, he pleaded with drug makers, "help us figure out how to do this for two years".
He recommended that lawmakers not try to "jam this through or get around the big pharmaceutical companies".
"I think we should ask them for their support of this proposal or a variant of it just to get through the next two years," urged Mr Clinton, who was speaking via satellite from Florida during the event, which was hosted by the ONE Campaign and (RED), two HIV/AIDS fundraising organizations co-founded by U2 lead singer Bono, who also attended the event in Washington.
"Everybody knows what we are up against here," Mr Clinton said.
If lawmakers and state programmes make the proposal to manufacturers, "they might even allow us to get their medicine at a very bargain-basement price and then get reimbursed later, let's say, sometime within the next five years when the economy picks up again," he said. "There's a lot of ways you can do this, but I think it is very, very important."
The former US president said he thinks his plan will work because "after two years, the economy will be stronger and, number two, the health care reimbursement system will be different".
But in the meantime, he said, "I think we might consider a two-year emergency period".
Even if pharmaceutical makers would cut their prices for HIV/AIDS drugs for one year "it would make a huge difference" for states facing "terrible dilemmas," Mr Clinton said.
At the same event in Washington, President Barack Obama said he was directing $50 million in increased funding for US domestic HIV/AIDS, $15 million of which will go to the Ryan White programme for HIV medical clinics across the country.
"We want to keep those doors open so they can keep saving lives," President Obama said.
The White House said those funds will allow services to 7,500 more patients across the US.
The other $35 million in increased funding will go to state AIDS drug assistance, allowing for an additional 3,000 more patients to have access to treatments.
But, Mr Obama said, "The federal government can't do this alone".
"I'm also calling on state governments, and pharmaceutical companies and private foundations to do their part to help Americans get access to all the life-saving treatments," the president said.
Mr Clinton welcomed the new funding, given that so many HIV/AIDS treatment programmes in the US have been pared back just as the "epidemic is coming back in America, especially among gay men, primarily African-Americans".
"I'm very worried the death rate is going to go up in America simply because of the budgetary constraints on the states," he said.
While programmes like the President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, the Bill and Melinda Gates Foundation, Unitaid and the Clinton Health Access Initiative have worked to bring the prices of ARVs down to about $120 for adults and $60 for children in places like Africa, Latin America and Southeast Asia, the costs to Americans for the medicines remains high at about $10,000 per year, Mr Clinton said, although he noted those US prices used to be much higher.
Mr Clinton said his foundation and other programmes were able to get prices reduced in developing nations by convincing pharmaceutical makers to change what he called their "flawed" business model.
"They were operating on the assumption that they would have low volumes and uncertain payment, so they needed a high profit margin," he said, calling that model similar to the way a small town jewelry store in the US might operate.
"So we asked them to change to a grocery store model – very high volume, very low per treatment profit margin and absolutely certain upon payment," Mr Clinton explained. "In return, we worked to improve the productivity of manufacturing and the supply chain, and then we worked in the countries that asked us to come in and help on improving their forecasting and delivery mechanisms so that they cut their own costs."
As a result, he said, large companies in wealthy countries came forward and lowered their unit costs.
"You've got to make the money go further, but you don't have to make the suppliers lose money," Mr Clinton said. "All of the suppliers are making more money now than when they were charging much more for AIDS medicines. Even though about 4 million people are getting their medicine off these contracts, the truth is, everybody can get medicine within 10% to 15% of our costs now, because it would be immoral just to charge this price for these contracts and charge everybody else more. So it collapsed the entire price structure in the developing world."
But, he emphasized, "This would not have been possible if it had not been for the Global Fund, PEPFAR and bilateral donations and then Unitaid. If we hadn't had all of this money flowing into the system it would not have been possible."
"The number of people who live today as a result of PEPFAR is staggering," former President George W Bush said, speaking via satellite from Tanzania.
As the US and the rest of the world face budgetary struggles, "it seems to me the best thing to do is set priorities and to focus on that which is effective," Mr Bush said. "There is nothing more effective than PEPFAR," he declared, urging the US to continue its support of the programme, which was launched initially by his administration.
"There is no greater priority than living by the admonition that to whom much is given, much is required. We are a blessed nation in the United States of America, and I believe we are required to support effective programmes that save lives," Mr Bush said.
But while PEPFAR, the Global Fund, Unitaid and others have done "phenomenal work," Mr Clinton said more transparency is needed in how funds are spent.
"Embarrassingly," he said, often less than half of the dollars appropriated actually make it to the people those funds were intended to help.
"One thing that is screaming for a bipartisan resolution is to increase the percentage of American aid dollars actually going to the people for the purpose for which it was intended," Mr Clinton said.
"There's a lot more money there than people know," he said.