An opportunity for Africa to respond to Aids

When African leaders discussed economic growth in Africa at this week’s African Union Summit, their options were constrained by the Aids epidemic and slow progress on reaching the millennium development goals (MDGs).

For example, over the years agricultural output has been declining as people were unable to till their fields or had to sell their land to take care of themselves and their families.

But it could be different. At the beginning of this year I visited Khayelitsha where I met Thobani, who was treated for TB and now has access to Aids treatment. Now he is able to take care of his son and contribute to his community.

There are more than three million people like Thobani who are able to contribute vitally to Africa’s economic growth because they have access to life-saving medicines.

About 22-million people are living with HIV in Africa.
But for every two people who start antiretroviral treatment, there are five new infections. This means the number of people in need of treatment will remain on the upward trend.

To break the trajectory of the epidemic focus must be on prevention and treatment must be made more affordable. The demand for treatment on the continent is high. About 80% of the four million people on treatment globally live in Africa, but 80% of the drugs distributed in Africa come from abroad.

The queue for Aids treatment is growing exponentially. Add to this the other top killers in Africa, such as tuberculosis and malaria, and the treatment bill is unsustainable.

The drugs are expensive and they do not work perfectly for all patients. Patients will often, after a period, need to move from first-line treatment for Aids which today costs $92 per patient per year—well out of reach of people living on $2 a day—to second-line treatment which costs more than $1 000.

In Africa less than 4% of patients are on second-line therapy, far below what effective intervention requires. Again this is unsustainable. Africans will need these medicines for many years. And they need many others, which are not produced in Africa because of a lack of manufacturing capacity.

The demand for Aids treatment should become an opportunity for Africa to reform its pharmaceutical practices. Too often drugs made in Africa are of low quality.

What the continent needs is a single drug agency, similar to the European Medicines Agency, which regulates the pharmaceutical sector in Europe. This body would guarantee the quality of medicines on the continent.

The agency should have the power to enforce high-quality international standards. This would help close down the market for spurious drugs. Such an agency would also mean manufacturers do not need to run from country to country to get their products approved.

The African market would be integrated, attracting private sector investment for the production of medicines within Africa, as happened in Latin America.

It would ensure that there is a level playing field for manufacturers to compete and market products within Africa and beyond, as happens in India and China.

Finally, it could be a model for removing bottlenecks, not only for medicines, but also for wider development that would contribute to an Aids/MDGs movement in Africa. And all these efforts would work in the best interests of the people in need.

This could be a concrete step that African leaders would require the African Union to take. UNAids would mobilise the UN system, development partners, promote south to south cooperation and engage with the private sector to support the establishment of a regulatory agency.

In this economic crisis African leaders have an opportunity for innovation. Let Aids not be an obstacle. Rather let the Aids response provide an opportunity to transform the continent.

Michel Sidibe, a citizen of Mali, was appointed executive director of the Joint United Nations Programme on HIV/Aids (UNAids) in January

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