By Charles King (USA & North America NGO Delegate)
The first meeting of the UNAIDS and Lancet commission was held in Lilongwe, Malawi between June 28 and 29th, convening a diversegroup of stakeholders including the President of Malawi, former heads of state, global policy makers, people living with HIV, young people, development experts, scientists, and representatives of the pharmaceutical industry and international nonprofit organizations. on HIV/AIDS. The discussion focused on how the response to AIDS can serve as a transformative force in the future of global health and development in the post 2015 agenda.
The theme of the meeting, hosted and co-chaired by the President of Malawi, Her Excellency Joyce Banda was, “from AIDS to sustainable health”. The conversation focused on harnessing global and regional resources for health, patent and commodity security, and the need to democratize global health.
The key issue of controversy was imbedded in the commission’s title, particularly the phrase, “sustainable health’. There appear to be three interpretations, representing on a continuum three perspectives on the future. It was clear that some participants really see more of what is already being done, only doing more of it. A second perspective called for a whole new paradigm that looks at the whole person, the whole community, and calls for a more integrated approach that puts human rights, poverty and social drivers in the forefront. A third perspective leaned toward folding HIV into a much broader set of goals around the development of an integrated health care system.
The second issue of controversy was financing and the definition of global solidarity and country responsibility and accountability. There was no serious discussion of a global transaction tax, though there was considerable mention of various country tax and social insurance schemes. The fact of the matter is that the most impacted countries, and this includes some of the middle income countries, are never going to be able to meet more than 40% to 50% of the financial burden. Regionalization and capitalization on shared delivery streams for vaccines, ARV’s, maternal health, etc… could conceivably save enough to get the domestic share of the burden up to 60%. But that leaves 40% that would have to be raised through some form of global solidarity, and that needs to be something more sustainable than the present systems.
The third issue was closely linked to the second, and that is drug-pricing. One discussant, speaking from the perspective of the pharmaceutical industry, indicated a potential willingness to consider other alternatives to the present patent system so long as “incentives for innovation” are not taken away. However, another participant put forward a proposal for an R&D treaty, for essential drugs that would pay for development thus allowing these drugs to be sold on the market at an affordable price, with generic-type profit margins.
The fourth issue that arose, tied to the first, is how far the commission will be willing to go in calling for linking the fight against poverty with the fight against AIDS. The reality is that the social drivers have economic consequences that are what cause HIV to persist in key populations. As was noted by more than one participant, it is well and good to talk about the importance of women and girls, and of gender equity. But without a significant investment in social support or targeted development, little will change. The reality is that homelessness and other forms of displacement, food insecurity, and lack of access to education and economic opportunity are what keep many people at risk of infection, deprive them of access to treatment, and keep them from living whole lives even if their HIV is under control.
Next steps for the Commission are not clear. The next and final in-person multi-day meeting will be in Brazil, in February. In the meantime, presumably there will be informal talks as well as some drafting activity, with a goal of publishing the Commission’s report in Lancet next June. The NGO Delegation had a presence in Lilongwe in the role of “special advisor”. Subsequent to that meeting, the NGO Delegation was granted a Commissioner’s seat. The Delegation hopes to have a meaningful impact on the work of the Commission going forward and a hand in shaping the final report.