The global AIDS community meeting in Vienna last week ended with renewed determination to fight the epidemic but underlined an urgent need for increased funding to sustain scientific advances and universal access. Some warned against an intellectual property rights enforcement push threatening global access in particular through bilateral and regional trade agreements.

The 18th International AIDS conference took place from 18-23 July and drew 19,300 participants from 193 countries, according to a press release [pdf].

The conference aimed at keeping the HIV issue an international priority in the context of a global economic downturn and at promoting universal access to treatment (IPW, Public Health, 19 July 2010).

“International governments say we face a crisis of resources, but that is simply not true. The challenge is not finding money, but changing priorities,” Julio Montaner, AIDS 2010 chair and president of the International AIDS Society, said in the release. “When there is a Wall Street emergency or an energy crisis, billions upon billions of dollars are quickly mobilised.”

Scientific evidence that shows benefits earlier expanded treatments benefits are being disregarded by international donors, according to Médecins Sans Frontières (MSF, or Doctors without Borders), with a “general trend toward backtracking on HIV funding.” For instance, research carried out in Lesotho, in southern Africa, showed evidence that earlier treatment “reduced the mortality and hospitalisation among HIV patients by more than 60 percent,” it said. However, international donors tend to advise countries to restrict treatment to people in advanced stages of HIV disease.

Bill Gates, co-chair of the Bill and Melinda Gates Foundation, speaking at the conference on 19 July, said there was reduced investment in global health, according to his keynote speech.

Advocating efficiency, he said, “We have to be honest with ourselves: we do not have the money to treat our way out of this epidemic.” He added that “we need to make sure we are getting the most benefit from each dollar on funding and every ounce of effort.”

But MSF warned against what they defined as “dominating messages heard throughout the conference calling for more financial efficiencies in a time of economic recession,” that could shift the focus from patient needs.

Drug prices are increasing, said MSF, such as the cost of improved World Health Organization-recommended first-line regimen. There is also an increased need for second-line drugs, which are “coming down slowly,” the group said, and patent protection is limiting generic competition for newer drugs. Drug companies were not challenged at all on prices during the conference, MSF said, with the “head of a major foundation” stating that drug costs were “low enough” and “efficiencies needed to be found elsewhere,” Tido von Schoen-Angerer of MSF said in a release.

Countries Need Trade Flexibilities, NGOs Say

The relationship between intellectual property rights, pricing and access was discussed in several events at the conference.

At a side session entitled, “Access to Essential ARVs and Intellectual Property Rights: A continued Battle in Developing Countries,” Mark Heywood, of Section 17 in South Africa, said that countries must take advantage of the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, according to a report by one of the organisers.

Supatra Nakapew, of the Thai NGO Coalition on AIDS, said that new threats were coming from the EU-Thailand free trade negotiations with TRIPS-plus rules, and the country is still listed in a United States “watch list” because of a compulsory licence on AIDS, heart disease and cancer drugs.

The event was organised by China Access to Medicines Research Group, the Third World Network, the South Centre, Lawyers Collective, and Brazilian Interdisciplinary Association on AIDS

Hu Yuanqiong, legal consultant for China Access to Medicines Research Group, said that China has capacity for generic pharmaceutical production, and that in 2007, 6,913 generic drug companies were established in the country. However, patents prevented local production of second-line formulations of antiretrovirals. The way forward is to make use of patent flexibilities and share information among broad networks like China, India, Brazil, South Africa, and others, Yuanqiong said, according to the organiser’s report.

Anand Grover of India, the UN special rapporteur on the right to health, said TRIPS flexibilities are threatened by TRIPS-plus measures appearing in the EU-India free trade agreement, according to the report.

The Third World Network also released a press statement about what they described as the EU actions threatening universal access in developing countries.

“The EU is negotiating or planning to negotiate free trade agreements with over 90 developing countries and is pushing these countries to accept TRIPS-plus provisions,” Sanya Reid Smith of TWN said in the release. “Some TRIPS-plus provisions that the EU has been pushing are data exclusivity, patent term extension and higher enforcement standards.” That will translate into much higher costs for developing countries, she said.

Patent Pool, Pharma Efforts

On 21 July, Ellen ‘t Hoen, senior advisor for the UNITAID Medicines Patent Pool Initiative, presented the strategy of the patent pool during the plenary session. According to her presentation posted to the A2K listserv, the cost of treatment is increasing because new AIDS drugs are likely to be patented in developing countries with high prices. Even in India new drugs might be patentable, as the leading generics producer’s 2005 implementation of the TRIPS agreement introduced patent protection on pharmaceuticals (though with safeguards).

Some provisions in bilateral or regional free trade agreements are aimed at limiting flexibilities in patent law “well beyond what is required by the WTO,” she said.

The webcast from the 21 July plenary session is available here.

UNITAID is a financing mechanism based on a solidarity tax on airline tickets and supported by 29 countries, she said. The Medicines Patent Pool Initiative is a mechanism where patent holders make licences available through the patent pool which will allow others producers to manufacture low cost generic versions of the patented antiretrovirals for developing countries. Royalties to patent owners will be due on the licences taken from the pool.

A press release from UNITAID said the patent pool will be managed by the Medicines Patent Pool Foundation, which will soon open for business. They will then start negotiations with patent holders.

In the meantime, the Financial Times reported that three of the world’s largest pharmaceutical groups have agreed to allow generic drug manufacturers use all their existing and experimental HIV medicines royalty-free to sell generics at low cost in developing countries.

And on 21 July, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched a UNAIDS High Level Commission on HIV Prevention. The commission’s goal will be to campaign towards a sustained support for effective HIV prevention programmes over the coming year. The commission’s co-chairs are Françoise Barré-Sinoussi, Nobel Laureate in Medicine for her role in the discovery of HIV, and Archbishop Emeritus Desmond Tutu, Nobel Peace Prize Laureate.

The biennial AIDS conference convened 248 sessions overall. The next AIDS conference will be held in July 2012 in Washington, DC.