A logical consequence of the mounting debate on the access to drugs in poor countries, governments and backers must abandon the wait-and-see policy that they had maintained for 20 years. Thus, last April, Kofi Annan launched the idea of a global Fund intended to collect some 7 to 10 billion dollars a year for the fight against AIDS.

Patients in poor countries, NGOs and activists can then believe that this Fund will mark a turning point in the fight against the epidemic: to finally allow a change in scale of financing and medical care for the million patients who still do not have access to drugs.

Two months later, however, enthusiasm has waned. The Fund has been transformed: it will also be used for tuberculosis and malaria; the announced amounts are ridiculously low; there has been a dilution of objectives and a return to an all-prevention strategy.

For Gaëlle Krikorian of Act Up-Paris, ³this Fund looks like a diversion maneuver. It obscures the issue of production and access to generic drugs in poor countries, as well as the debate on the WTO TRIPS agreements and their dramatic medical consequences for years to come². Gaëlle Krikorian wonders whether ³the international financial backers hope to buy the silence of the seropositives and ensure the upholding of intellectual property by announcing a paltry hundred million for a nebulous ³global Fund² ²

Condemnation of the patients

Ridiculous amounts

The United States, the leading economic power in the world, set the tone last May by announcing a contribution of 200 million dollars, that is 2% of the amount set by Kofi Annan 1. Recent statements by Lionel Jospin, the French Prime Minister, echo this tone by proposing 130 million dollars over three years. The Japanese advance 100 million dollars. The strategy is clear. The Fund is thus deprived of its principal quality: financing of a new magnitude on a worldwide scale. The thundering initiative of Kofi Annan is first useful to the international financial backers, and in particular the countries of the North, which can easily give the illusion that they are mobilizing - the money is far from being released, financing will certainly come from existing allocations.

Dilution of objectives

Funds targeted to three diseases at the same time cannot meet the needs and the emergency that the AIDS epidemic imposes. Its too broad sphere of action will only lead to diluting the objectives and submerging the priority stakes such as access to treatment in a vast hodgepodge. Moreover, if governments are free to target their financing, the majority of them will probably direct it towards malaria or tuberculosis to the detriment of AIDS, towards prevention to the detriment of treatment, towards brand-name drugs to the detriment of generics. The recent statements of the American 2 and British governments, of officials of the European Union 3 or representatives of international agencies 4 have already indicated this.

Time to die

The initial deadline by the end of 2001 is illusory. Everything leads us to believe that the setting up of this Fund will require several years - the glorious experience of the International Therapeutic Solidarity Fund launched by Chirac in December 1997 is still in our memory. How many million patients will die while political leaders and international financial backers wonder about the objectives, management or ³governance² of this Fund? Will each actor wait for all of its ³partners² to act? The patients however do not have any time to lose.

Creation of an nth international coordination entity

One of the pretexts for the creation of this Fund is the coordination of the action of financial backers. The WHO and UNAIDS themselves have as a mandate the harmonization and coordination of international health and AIDS policies; neither of these agencies however manages to honour this mandate and to impose on Member States joint action adapted to the needs of the populations. Under no circumstances will the creation of an nth international entity, whose mission remains deliberately vague, make it possible to achieve this goal.

The setting up of a global Fund should not be the sine qua non for a massive increase in financing. Rich countries do not need a global Fund to increase by tenfold their efforts in the fight against AIDS. On the other hand, they are likely to seize this opportunity to continue a massive disengagement in development aid, covered up by the launching of international initiatives that are media-worthy rather than operational.

What the Fund hides Policies unworthy of aid to development

For 10 years, rich countries have drastically reduced their official development assistance (ODA), a part of which is intended for the fight against AIDS. Rare are the countries that devote to it 0.7% of their GNP, their minimum commitment. In France, the amount of APD has decreased steadily since 1995 and represents today 0.31% of the GNP. As for the United States, it occupies the last rank among OECD (Organization for Economic Cooperation and Development) donors, with 0.1% of its GNP.

In this context, this new project of a global Fund is hardly credible.

A real awareness of the seriousness of the AIDS epidemic would impose:

• an immediate ten-fold increase in bilateral aid to the programs of global medical care for people living with HIV/AIDS in developing countries,
• implementation as soon as possible of the EU action plan for the fight against AIDS, tuberculosis and malaria (this plan is still not budgeted),
• massive financial and technical support for drug policies targeting generics.

The refusal to question intellectual property in poor countries

The interminable discussions around the creation of the Fund, during the United Nations Special Session or the G7-8 in July, are likely to elude the real debate posed by access to health and drugs and maintenance of intellectual property in poor countries.

The monopoly of some manufacturers on ³the AIDS market" is contrary to broad and durable access to drugs for all the patients who need them. Today, certain countries of the South have the capacity to manufacture copies of antiretrovirals at prices much lower than those of the major producers. Only competition between different manufacturers will permit a drastic and durable decrease in the prices of pharmaceutical products - this dynamic of competition has already obliged Western manufacturers to align their prices with those of manufacturers of generics for a certain number of molecules.

The Kenyan Coalition recalled this in its press release of May 27 during the visit of the American Secretary of State Colin Powell: ³one of the major reasons that explains the death of such a large number of people is the price of antiretrovirals and other essential drugs, which remain inaccessible. Although manufacturers of generics sell triple therapies in certain African countries (Cameroon, Nigeria) for USD 350 per patient per year, in Kenya, the lowest price that hospitals have been able to negotiate is between USD 1,330 and 1,620 per patient per year ². 5

Today, patients in developing countries should be able to benefit as soon as possible from the entire range of therapies against HIV/AIDS at cost. The urgency of treating the millions afflicted with AIDS in developing countries necessitates a rapid multiplication of sources of production in countries of the South and the development of South/South exchanges.

However, the political pressure that still surrounds the issues of intellectual property blocks the initiatives of the poor countries that want to produce or import copies of drugs ­ witness the action recently brought by the United States against Brazil before the WTO. 6

Thus, the breaches provided for by international agreements on intellectual property - compulsory licenses or parallel imports - as many parapets against the monopoly of major manufacturers, remain unexploitable given the current balance of power. Intimidation is the rule, and examples of aborted attempts abound.

Intellectual property rights should allow commercial exploitation of pharmaceutical products to generate reinvestment in research and ensure the broadest access to innovations in the health field. In reality, patents guarantee only one thing: profits for a few multinationals benefiting from a 20-year monopoly for the exploitation of drugs, while restricting access to patients who can afford them, the others depending on the sporadic charity of these multinationals.

It is from this reality that the media coverage of the global Fund today diverts us.

Recent events at the World Assembly on Health in Geneva (May 15 - May 22) illustrate this: while Kofi Annan had just re-announced the creation of the Fund to a room of enthusiastic Ministers of Health, behind the scenes, Americans and Europeans were agreeing to force Brazil or South Africa to give up the concrete resolutions that they proposed for access to generics or strengthening health care systems in developing countries.

Today, one of the priorities of the fight against AIDS is the launching of an international invitation to tender open to manufacturers of generics and copies, allowing purchase of drugs at the lowest price through economies of scale and competition between manufacturers. The financing of such an operation does not require the creation of a ³global and omnipotent² Fund, but a simple program within an existing organization.

Beyond this measure and since the WTO agreements seem to be unable to permit the defense of health interests, the fight against AIDS imposes the abolition of intellectual property everywhere where it kills.

Act Up-Paris requires:

• the release of promised financing as soon as possible without waiting for the implementation of the global Fund;
• the launching by UNICEF of an international invitation to tender open to manufacturers of generics for the wholesale purchase of drugs intended for poor countries;
• the abolition of intellectual property for pharmaceutical products in all poor countries.