Not only can money be saved, but the report says that drugs developed by public–private groups working together were found to have a higher health impact compared with those developed by industry or public groups alone. Current policy thinking assumes that the capability in drug development lies with multinational pharma companies, who must be brought back into the neglected disease field to revitalise drug development. As a result, governments have proposed multibillion dollar strategies to lure multinationals back into developing drugs for neglected diseases in a for-profit model. According to the report, this would be paying them to do what they’re already doing. Instead, Moran’s team recommends the creation of a public fund for R&D of neglected disease drugs within
public–private partnerships, which they estimate would cost less than $200 million per year for the next 10 years. In addition, they suggest examining the feasibility of a package of incentives to encourage research by small or medium sized companies, who are becoming increasingly important in the neglected disease field. Guy Willis (International Federation of Pharmaceutical Manufacturers and Associations) told TLID: “The pharmaceutical industry is interested to see how governments respond to these suggestions. However, pharmaceutical companies’ growing body of experience with medicine access programmes in the developing world shows that the general lack of health-care infrastructure is perhaps the biggest single obstacle to overcome”. Moran’s team hope their report will go some way towards updating cur-
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Trypanosoma brucei protozoa, the cause of sleeping sickness, amid red blood cells
rent policy thinking. “The partnered model works well for companies and the public from both a cost and effectiveness perspective but if governments persist in putting up large incentives for companies to develop drugs alone, then that’s what they’ll do”, says Moran.
Rosie Taylor
Lawsuit against HIV/AIDS funding policy On Sept 23, the New York-based Open Society Institute (OSI) filed a lawsuit in a New York City district court against a US Agency for International Development’s (USAID) policy that requires grantees of federal HIV/AIDS service funding to sign a pledge opposing sex work. “Almost all of the recipients of the US HIV/AIDS funding are bound by the pledge requirement—the reach of the pledge requirement is really quite broad”, Zoë Hudson of OSI explained. United Nations’ agencies and other multilateral institutions are exempted. The US government has launched a US$15 billion global AIDS programme (Lancet Infect Dis 2003; 3: 396). Laws on pledge requirement were passed by the US Congress in 2003, but their implementation started in June this year after the Bush administration called organisations providing HIV/AIDS care in other countries to sign a pledge explicitly opposing sex trafficking and sex work. http://infection.thelancet.com Vol 5 November 2005
“The lawsuit [by OSI] is an important step”, says Chris Beyrer (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA) because many organisations have found it very difficult to work with the prostitution pledge. “On the ground it does appear to be limiting activities like condom distribution that may not have been the intent of the legislation”, he said. According to Beyrer, reaching out to sex workers through non-judgemental and peer-based approaches works to reduce their health risks and to assist those who want to get out of sex work. “The prostitution pledge, and its demand to oppose prostitution, is vague enough such that it can, and may already have been used to, limit programmes worldwide that use pragmatic and public-health-based approaches. [The requirement] has the potential, in some settings, to make health and human rights conditions worse for the very people it seeks to protect”, he concluded.
Susan Cohen (Guttmacher Institute, Washington, DC, USA) believes that in the absence of any political will in today’s climate on Capitol Hill, a legal challenge to the “pledge” is extremely important since it appears to be the only available way to invalidate at least a part of this condition on eligibility for federal HIV funding that has absolutely no public-health justification. She pointed out that coercing organisations to adopt the US government’s position in opposition to prostitution is not likely to have any effect on prostitution but it clearly can interfere with an organisation’s ability to gain the trust of some of the world’s most marginalised and stigmatised people. “Conversely, those organisations that may reject the idea that they must become the mouthpieces for the US government on this topic must pay the price of sacrificing all US HIV funding, meaning the end of their HIV/AIDS programmes”, she said.
Khabir Ahmad 675