[Peace-discuss] Fwd: INVEST IN HEALTH NOT WAR - CALL FOR GLOBAL
DEMONSTRATIONS ON 24 JUNE
Alfred Kagan
akagan at uiuc.edu
Mon Jun 14 11:12:41 CDT 2004
>Date: Mon, 14 Jun 2004 11:37:47 -0400
>From: South Africa Development Fund <freesa at igc.org>
>Subject: INVEST IN HEALTH NOT WAR - CALL FOR GLOBAL DEMONSTRATIONS ON 24 JUNE
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>>Subject: INVEST IN HEALTH NOT WAR - CALL FOR GLOBAL DEMONSTRATIONS ON 24 JUNE
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>>Invest in Health Not War
>>
>>
>>
>>14 June 2004
>>
>>Full details:
>><http://www.tac.org.za/healthnotwar.htm>http://<http://www.tac.org.za/healthnotwar.htm>www.tac.org.za<http://www.tac.org.za/healthnotwar.htm>/HealthNotWar.htm
>>Queries, endorsements and event information:
>><mailto:healthnotwar at tac.org.za>healthnotwar at tac.org.za
>>
>>Call for Global Demonstrations on 24 June 2004 to Demand that the
>>Bush Administration:
>>
>>Reduce Military Spending and War Actions: Spend More Money on AIDS,
>>Tuberculosis, Malaria, Malnutrition and Poverty;
>>Help Ensure that the World Health Organization's Plan to Treat
>>Three Million People with AIDS by 2005 Receives the Resources it
>>Needs to Succeed;
>>Stop Undermining Public Confidence in Safe, Effective Anti-AIDS Medicines;
>>Stop Using AIDS Money to Marginalise Minorities and Undermine
>>Access to Condoms and Reproductive Choices;
>>Stop Pursuing a Pseudo-Scientific Response to the HIV Epidemic;
>>Stop Using Bilateral Pressure to Undermine the Doha Declaration on
>>TRIPS and Public Health;
>>Give the Promised $15 Billion for AIDS to the Global Fund to Fight
>>AIDS, TB and Malaria (GFATM) - Not the US President's AIDS fund
>>(known as PEPFAR).
>>
>>
>>We, the undersigned, are organisations from around the world that
>>campaign for human rights, the alleviation of the HIV epidemic and
>>women's rights to reproductive choices. We are deeply disturbed by
>>the actions and policies of the Bush Administration that undermine
>>the prevention and treatment of AIDS. The effect of the US
>>government's unlawful war in Iraq has been to divert international
>>attention away from global health and poverty. Hundreds of billions
>>of dollars are being spent on the military instead of investing
>>resources in the biggest threats to human security today: AIDS, TB,
>>malaria, malnutrition and poverty.
>>
>>In 2003, the United Nations estimated that 2.5-3.5 million people
>>died of AIDS, one million of malaria and two million of TB, yet
>>these diseases can be treated. An estimated 800 million people
>>endured malnutrition, which continues to play a major role in half
>>of the more than ten million annual child deaths in the developing
>>world. In many countries women undergo back-street abortions and
>>risk death because they are denied the right to make reproductive
>>choices. Inappropriate moral judgments stigmatise condom use and
>>distribution, thereby putting millions of people at risk of HIV and
>>other sexually-transmitted infections. The spread of HIV is fuelled
>>by the oppression of sexual minorities and draconian legislation
>>aimed at sex workers and intravenous drug users. Successfully
>>reducing HIV infections and giving more people with AIDS access to
>>life-saving medicines requires the promotion of human rights and
>>investment in developing world health systems. The World Health
>>Organization (WHO) has called for three million people with AIDS to
>>be treated with life-saving antiretroviral medicines by 2005, but
>>the Bush Administration has shown little political will for
>>promoting this objective or human rights.
>>
>>In January 2003, the Bush Administration promised $15 billion over
>>the next five years to alleviate the HIV epidemic. This was
>>cautiously welcomed by human rights and AIDS organisations. Yet the
>>expenditure approved by the US Congress as part of this commitment
>>for 2004 is only $2.4 billion. The total amount of US aid money for
>>2004 is $17.55 billion. Yet the military budget approved for 2004
>>is already $368.2 billion, an amount that does not reflect the $87
>>billion war supplemental requested by the Bush Administration. Much
>>of this military budget is being used to fight the so-called War
>>Against Terror and to sustain the occupation of Iraq. We
>>acknowledge the threat of terrorism. However, the most important
>>and widespread threats to global security are the ones exacerbated
>>by poverty and lack of development: the HIV, malaria and
>>tuberculosis epidemics, as well as malnutrition. Alleviating these
>>problems together with promoting human rights and negotiating
>>solutions to world problems through international institutions is
>>the best way to ensure long-term global security. This was
>>partially recognised by the Clinton Administration when it declared
>>AIDS a national and global security threat in late April 2000.
>>
>>Unfortunately, the Bush Administration has shown insufficient
>>regard for these problems, as well as for the expertise of
>>international institutions such as the United Nations, the WHO and
>>the GFATM. The Bush Administration's stance on key prevention and
>>treatment issues contradicts the extensively researched positions
>>of these international institutions. For example, a third of
>>PEPFAR's prevention funds are earmarked for
>>abstinence-until-marriage programmes. While promoting delayed
>>sexual activity is an important part of life-skills education, this
>>should not be framed in moral judgments concerning marriage or at
>>the expense of condom promotion and distribution, especially to
>>youth. The Bush Administration refuses to acknowledge the vital
>>importance of access to and information about condoms in the
>>general population and it has been party to unscientific actions
>>and statements questioning the efficacy of condoms, for example
>>removing information on condoms from the website of the US Centers
>>for Disease Control. President Bush has also taken the
>>extraordinary step of reinstating and extending the Reagan-era
>>Global Gag Rule on family planning organisations, cutting US
>>funding as well as donations of contraceptives when these
>>organisations provide information on abortion to their patients. We
>>are concerned that current US policy is informed by a religious
>>fundamentalist agenda. Furthermore, obstacles continue to be placed
>>in the way of accessing more affordable medicines, by blocking
>>competition between generic medicines and patented brand-name
>>drugs. In particular, the Bush Administration is blocking access to
>>generic fixed-dose combination medicines that will allow more
>>people with AIDS in the developing world to go onto life-saving
>>antiretroviral treatment and reduce the number of pills they need
>>to take on a daily basis.
>>
>>The Bush Administration has placed religious fundamentalist
>>convictions above science, undermining access to and use of
>>condoms, reproductive choices and access to generic medicines. This
>>has lead to a critical editorial in the prestigious medical journal
>>The Lancet describing US policy on HIV/AIDS as "perhaps one of the
>>best examples of ideology impeding sound public health policy."*
>>While the South African government has been correctly criticised
>>extensively for its unscientific approach to the HIV epidemic
>>(which now seems to be changing slowly), it is the Bush
>>Administration that now champions irrational responses to the
>>epidemic.
>>
>>We therefore call for an International Day of Action on 24 June
>>2004 to say to the Bush Administration: Invest in Health, Not War!
>>
>>
>>
>>* Lancet Reference: 2002 Jul 13; 360 (9327): 97.
>>
>>
>>Questions and Answers
>>
>>
>>
>>
>>How much money did the Bush Administration pledge to alleviating
>>AIDS in Africa and the Caribbean and how much has actually been
>>given?
>>
>>
>>
>>In his annual State of the Union address in January 2003, President
>>Bush announced the provision of an additional $10 billion to AIDS
>>programmes in Africa and the Caribbean. This should have brought to
>>$15 billion the US government's total commitment following a $5
>>billion allocation under the Clinton Administration that had yet to
>>be disbursed. The US Congress eventually appropriated $2.4 billion
>>in 2004, and the total amount released so far is just $350 million.
>>
>>To whom is the money being given?
>>
>>
>>
>>Most of the money is intended for distribution through the
>>bilateral President's Emergency Plan for AIDS Relief (PEPFAR),
>>which currently targets 14 countries: Botswana, Cote d'Ivoire,
>>Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria,
>>Rwanda, South Africa, Tanzania, Uganda and Zambia. A relatively
>>small portion of the Bush Administration's pledge, just $1 billion
>>over five years, is intended for the GFATM.
>>
>>What is the GFATM?
>>
>>
>>
>>The Global Fund to Fight AIDS, TB and Malaria (GFATM) is an
>>independent, multilateral institution established in 2002 with the
>>purpose of funding programmes in developing countries aimed at
>>treating and preventing the three highest-mortality infectious
>>diseases in the world. Its success is necessary for the WHO to meet
>>its goal of treating three million people with AIDS by 2005. The
>>GFATM aims to constitute a major source of the $27 billion in
>>economic assistance to developing countries that the WHO Commission
>>on Macroeconomics and Health has suggested is needed by 2007
>>(growing to $38 billion by 2015), yet the GFATM remains
>>underfunded, receiving only $658 million so far in 2004. Partly
>>this is due to the US government failing to commit sufficient funds
>>to it, but the European Union, Canada, Australia and Japan all need
>>to contribute more money to the Fund.
>>
>>How has the Bush Adminstration undermined access to condoms in
>>developing countries?
>>
>>
>>
>>As early as mid-2001, the Bush Administration removed all
>>references to condom effectiveness from the US Centers for Disease
>>Control website. Subsequent funding allocations and policy
>>documents render it clear that the Administratrion views condom
>>promotion as appropriate primarily for so-called high risk groups.
>>In reality, individuals who engage in any kind of sexual activity
>>at any stage of their lives must have the information to protect
>>themselves and their partners and the ability to act on that
>>information through unrestricted access to contraceptives and
>>reproductive choice. While PEPFAR does not openly ban funding for
>>comprehensive sex education or condom promotion, a full 1/3 of the
>>Plan's prevention funds are reserved for promoting
>>abstinence-until-marriage (this restriction is advisory for 2004-5
>>but becomes mandatory in 2006). This funding structure is
>>unrealistic and refuses to take into account the complex social and
>>economic problems that put young people at risk for early sexual
>>activity and exposure to HIV.
>>
>>How has the Bush Adminstration undermined access to reproductive
>>choices in developing countries?
>>
>>
>>
>>The so-called Mexico City Policy, also known as the Global Gag
>>Rule, was first established by US President Ronald Reagan in 1984,
>>prohibiting any organisation receiving family planning funds from
>>the US Agency for International Development (USAID) from providing
>>information about abortion. The Global Gag Rule was later suspended
>>by President Bill Clinton, but reinstated in January 2001 as one of
>>the Bush Administration's first official acts. In August 2003,
>>President Bush extended the Gag Rule to cover US Department of
>>State funds as well. Many of the affected family planning
>>organisations that choose to reject the Gag Rule's restrictions
>>then find themselves unable to obtain donated USAID contraceptives
>>and are forced to cut services and raise fees.
>>
>>Why is the Bush Administration against reproductive choice and condom access?
>>
>>
>>
>>President Bush and many members of his Administration use religion
>>to excuse intolerant fundamentalist political policies. They
>>believe that abortion and condom use are wrong. They fail to
>>understand that access to condoms is an essential component of any
>>large-scale workable HIV prevention strategy and that reproductive
>>choices, including the right to an abortion, are critical for the
>>empowerment of women in the developing world.
>>
>>What are fixed-dose combination (FDC) antiretroviral medicines?
>>
>>
>>
>>Fixed-dose combination antiretroviral medicines are an important
>>breakthrough for treating people with AIDS, because they combine
>>some or all the antiretroviral medicines a patient has to take into
>>one pill. In general, three different antiretroviral medicines have
>>to be taken twice daily by people on treatment. This used to
>>require patients to take many pills a day -- as many as 18 not
>>being uncommon. Research in a South African hospital has shown that
>>the number of pills patients take a day is a critical factor
>>affecting patient adherence to their treatment. (AIDS. 2003 Jun
>>13;17(9):1369-75.) Patient adherence is critical to the success of
>>treatment and reducing drug resistance. With the gradual
>>improvement of antiretroviral technology, pill counts have come
>>down for most patients. Some fixed-dose combination medicines
>>reduce the pill count to two pills a day.
>>
>>Furthermore, because the only three-in-one FDCs are manufactured by
>>generic companies, they are frequently cheaper than the equivalent,
>>but separate, medicines produced by brand-name companies.
>>
>>How has the Bush Administration undermined access to generic
>>fixed-dose combination antiretroviral medicines used for treating
>>AIDS?
>>
>>
>>
>>The US government's undermining of access to cheaper medicines
>>precedes the Bush Administration. The pharmaceutical lobby is a
>>powerful force in US politics and contributes generously to
>>presidential elections, usually to both Democrat and Republican
>>candidates. Its primary interest is to protect itself against
>>competition from cheaper generic medicines, by lobbying for more
>>stringent patent protection both in the US and internationally.
>>Under the Clinton Administration, South Africa was placed on a
>>trade watch-list when it enacted legislation to make medicines more
>>accessible. Following activist pressure, the Administration
>>relented. (Since his Presidency, Mr. Clinton's foundation has
>>worked to reduce the prices of AIDS medicines, particularly
>>generics, as well as monitoring tools.)
>>
>>The Bush Administration has a worse record on blocking access to
>>affordable medicines than the Clinton Administration. It attempted
>>to stop a World Trade Organization agreement at Doha, Qatar, which
>>improves access to generic medicines for poor countries. Again,
>>following activist pressure and a firm, unified stance by
>>developing world negotiators, the US government backed down.
>>Paragraph 6 of the the Doha Agreement left certain matters
>>unresolved, so the Bush Administration advocated for a resolution
>>of the paragraph that would have restricted access to generic
>>medicines. Again activist pressure coupled with a firm stance by
>>developing world negotiators resulted in the US backing down.
>>Nevertheless, the Bush Administration continues to undermine the
>>Doha Declaration by pursuing bilateral trade agreements with
>>developing countries, reducing the options for making generic
>>medicines more accessible that these countries would otherwise have
>>under the Doha Declaration.
>>
>>The trend of attempting to foil efforts to access cheaper generic
>>medicines has continued over the past few months. Members of the
>>Bush Administration have undermined public confidence in the safety
>>and efficacy of fixed-dose combination (FDC) generic antiretroviral
>>medicines approved by the WHO. These medicines are an essential,
>>affordable tool for the treatment of HIV on a massive scale. The
>>Bush Administration clearly would prefer to use PEPFAR money to
>>purchase brand-name antiretrovirals, in order to satisfy the drug
>>manufacturers among its campaign donors. The Administration's
>>allegations against generic FDCs, particularly those announced by
>>Mr. Randall Tobias, the former CEO of Eli Lilly appointed by
>>President Bush to be the US Global AIDS Coordinator, are based on
>>pseudo-science. Despite the unity of expert opinion at the
>>US-initiated FDC conference in Botswana this past March that the
>>current standards in place for approving fixed-dose combinations
>>are acceptable, the Bush Administration has persisted with this
>>agenda.
>>
>>In late April, Mr. Tobias stated, "Maybe [FDC] drugs are safe and
>>effective. Maybe these drugs are, in fact, exact duplicates of the
>>research-based drugs [sold in the United States]. Maybe they
>>aren't. Nobody really knows." (Zavis, Associated Press, 28 April)
>>This is incorrect. The WHO has put in place a stringent process,
>>known as prequalification, for recommending antiretroviral
>>medicines that are safe and effective. The term prequalified is
>>used because it is still the prerogative of each country's own
>>regulating authorities to approve the drugs for domestic use. To
>>date, ten fixed-dose combination medicines have been prequalified.
>>In South Africa, at least one FDC containing an entire
>>antiretroviral regimen is awaiting approval by the Medicines
>>Control Council (MCC), and it is already widely used through
>>special exemptions granted by the MCC. Tobias' statement, made in
>>South Africa, was aimed at fuelling the already confused debate in
>>the country about the safety and efficacy of antiretroviral
>>medicines.
>>
>>Generic medicines have to be shown to be pharmacologically
>>equivalent to brand-name medicines before they are approved. The
>>usual (and best) way of demonstrating this is through what is
>>called a bioequivalence test. The bioequivalence standard requires
>>similar quantities and availability of the active ingredient in
>>brand-name and generic formulations, and is defined by absorption
>>parameters generally falling between 80% and 125% of those obtained
>>with the brand-name drug under the same testing conditions. The
>>FDCs prequalified by the WHO have successfully passed
>>bioequivalence tests. Mr. Tobias certainly was not questioning the
>>use of bioequivalence for approving generics. Most generic
>>medicines approved by the US Food and Drug Administration (FDA) are
>>approved based on bioequivalence testing. Therefore, Tobias could
>>only have been calling into question the fact that generic FDC
>>antiretrovirals combine the two or three drugs against which they
>>are tested for bioequivalence into one pill. What he and other
>>apologists for the Bush Administration seem to be suggesting is
>>that generic FDC antiretrovirals can only be approved once they go
>>through clinical trials. But this is unacceptable because there is
>>no reason to believe that combining the medicines into one pill
>>materially affects the validity of bioequivalence. Many combination
>>medicines, both brand-name and generic, are approved by regulatory
>>authorities around the world (including the FDA) and there is
>>nothing inherent about drugs being in combination that affects
>>their safety or efficacy. Indeed, one of the most important
>>medicines in South Africa's public health system is a four-in-one
>>tuberculosis FDC. It has been used for a number of years and
>>benefited thousands of patients and it was approved on the basis of
>>bioequivalence, not full clinical trials. It is particularly ironic
>>that the Bush Administration has a sudden concern for the safety
>>and efficacy of extensively-tested essential medicines when it
>>certainly does not show the same concerns with regard to
>>genetically modified foods, which might in the long run prove safe
>>but certainly are not essential.
>>
>>Following criticism of Mr. Tobias' unsustainable arguments at a
>>recent high-profile WHO meeting, the Bush Administration has
>>retreated and released a statement saying that FDC manufacturers
>>can apply for fast-tracked approval through the FDA to become
>>eligible for purchase through PEPFAR funds. This was to head off
>>further embarrassment at a World Health Assembly meeting. However,
>>while this compromise suggests a position that is more reasonable
>>than the one articulated by Mr. Tobias, it is still insufficient.
>>The FDA is responsible for regulating medicines in the United
>>States, although some other countries take their cue from FDA
>>registrations. WHO prequalification should be sufficient for donors
>>and the decision to distribute FDCs should lie with countries' own
>>regulatory authorities. Applying for FDA approval is usually a
>>time-consuming and expensive process, costing hundreds of thousands
>>of dollars, and it is questionable whether there is sufficient
>>incentive for generic companies to pursue an FDA application. While
>>the statement admitted the possibility of waiving FDA fees and
>>reducing application times to six weeks, this has been stated in
>>vague terms. At least one US official has already stated that six
>>weeks is the best-case scenario and is only realistic for
>>combinations of separate drugs packaged in the same blister packs,
>>which are not the same thing as FDCs.
>>
>>This latest compromise by the Bush Administration is part of a long
>>history of blocking access to generics and then relenting when
>>faced with pressure. The trend has been that as the possibility of
>>distributing generic medicines has come closer, the US government
>>has done everything it can to create obstacles to their
>>availability.
>>
>>If the Bush Administration proceeds with its new policy that FDCs
>>must be registered with the FDA before PEPFAR funds can purchase
>>them, then it must at a minimum commit unambiguously to the waiving
>>of FDA fees and registration within no more than six weeks of
>>application. Bureaucratic delays in distributing medicines to
>>developing countries have a very tangible cost: lost lives.
>>
>>If the Bush Administration donated most of its AIDS relief funds to
>>the GFATM, which can and does fund the purchase of generic
>>antiretrovirals, the issue of PEPFAR being restricted to
>>FDA-approved drugs would largely disappear.
>>
>>What Actions are Planned for 24 June?
>>
>>
>>
>>Organisations in different countries are encouraged to plan their
>>own events. An updated list of actions is available on
>>http://www.tac.org.za/HealthNotWar.htm. To have your action added
>>to the list of events, please send an email with full details of
>>the event to
>><mailto:healthnotwar at tac.org.za>healthnotwar at tac.org.za.
>>
>>Suggested Actions: Pickets at or marches to US consulates and
>>embassies, letter-writing and fax campaigns to the White House, US
>>embassies and consulates, press conferences, awareness events.
>>
>>The following organisations have called for the International Day
>>of Action on 24 June:
>>
>>
>>
>>(To endorse this statement, please send an email to
>><mailto:healthnotwar at tac.org.za>healthnotwar at tac.org.za with the
>>name of your organisation and contact details)
>>
>>Action for Southern Africa (ACTSA), UK
>>Advocators of Processes of HIV/AIDS Programs, Kenya
>>Africa Action, USA
>>AIDS Consortium, South Africa
>>AIDS Law Project, South Africa
>>AIDS Law Unit, Namibia
>>AIDS Legal Network, South Africa
>>AIDS Task Force of Africa Japan Forum, Japan
>>American Friends Service Committee (AFSC), USA
>>Association de lutte contre le SIDA (AIDES), France
>>Basic Income Grant Coalition (BIG), South Africa
>>Blue Diamond Society, Nepal
>>BUKO Pharma-Kampagne, Germany
>>Children First, South Africa
>>Childolescent & Family Survival Organization (CAFSO
>>Community HIV/AIDS Mobilization Project (CHAMP), USA
>>European AIDS Treatment Group (EATG), Europe
>>Friends of TAC (FoTAC), UK
>>Friends of TAC (FoTAC), USA
>>Gays and Lesbians of Zimbabwe (GALZ), Zimbabwe
>>Georgian Plus Group, Georgia
>>Global AIDS Alliance, USA
>>Globalise Resistance, UK
>>Gruopo Portugues de Activistas sobre Tratamentos (GAT), Portugal
>>Grupo de Trabajo sobre Tratamientos del VIH/SIDA (gTt), Spain
>>Health GAP, USA
>>Hispanasida, Spain
>>HIV i-Base, UK
>>Housing Works, Inc., USA
>>International Community of Women Living with HIV/AIDS (ICW), UK
>>New Mexico AIDS InfoNet, USA
>>Pan African Treatment Access Movement (PATAM), Africa
>>Plus and Minus Foundation, Bulgaria
>>Positive Movement Belarus, Belarus
>>Positive Muslims, South Africa
>>Progressive Organization of Gays in the Philippines, Philippines
>>South Africa Development Fund, USA
>>South African Communist Party (SACP), South Africa
>>Southern African Contact, Denmark
>>Thai AIDS Treatment Action Group (TTAG), Thailand
>>Thai Drug Users' Network (TDN), Thailand
>>Treatment Action Campaign (TAC), South Africa
>>Union Aid Abroad (APHEDO), Australia
>>Youth Empowered to Succeed (YES), Kenya
>>
>>For further details, please phone: +27 (0) 21 788 3507 or Njogu
>>Morgan on +27 (0) 73 358 1282
--
Al Kagan
African Studies Bibliographer and Professor of Library Administration
Africana Unit, Room 328
University of Illinois Library
1408 W. Gregory Drive
Urbana, IL 61801, USA
tel. 217-333-6519
fax. 217-333-2214
e-mail. akagan at uiuc.edu
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