The Mr. Bills Show

J0409560 TORONTO, ONTARIO – On the first full day of the XVI International AIDS Conference, a panel was held of two distinguished men named Bill – one was Bill Gates and the other was Bill Clinton.   For an hour and a half, the two men discussed everything from their motivation to be involved in AIDS to specific issues respecting treatment and prevention in developing countries.

On that topic, both of the Mr. Bills went out of their way to give vigorous support to PEPFAR.  PEPFAR is important if you are the FDA, the pharmaceutical industry, the generics industry or a person with HIV outside of the developed world. 

For those of you not familiar with it, PEPFAR stands for the President’s Emergency Plan for AIDS Relief.  It is an extraordinary effort that is aimed at getting affordable drugs to the countries bearing heavy disease burden for HIV.  Per the Web site, "The Emergency Plan is the largest commitment ever by any nation for an international health initiative dedicated to a single disease – a five-year, $15 billion, multifaceted approach to combating the disease in more than 120 countries around the world."  It is a highly impactful commitment, should it be lived up to.

Yet on the opening night, when Bill Gates mentioned PEPFAR and the efforts of the Bush Administration, that part of his speech was booed, actually not long after his stunning standing ovation.  What causes the mercury to rise and the voices to lower in such a short time?

First, PEPFAR is an extraordinary effort.  It truly is bringing money into play and is a big player doing it.  But an essential component of it is called ABC, which requires that a large percentage of the funding be devoted to the ABCs – Abstinence, Being Monogamous, and Condoms – with priorities in that order.  And the truth is, that anyone involved in HIV prevention knows that sooner or later, people do have sex, and when they do, they should understand how to protect themselves when they are going to have it.  There is a lot of sentiment by those public health experts at the conference that the U.S. emphasis on abstinence over condoms is defeating to the main object – saving lives. 

And that is by both the Mr. Bills support PEPFAR.  The ABC component is dumb, but it is a small price to pay for the wonderful benefits of the program – access to crucial meds.   What PEPFAR lacks in prevention skills, it makes up for with treatment availability.

There are good reasons to applaud the PEPFAR treatment effort, if you can ignore the prevention component.

  • First, the fact that the FDA has successfully designated a number of generic AIDS medications for use by the program (kudos to the FDA)
  • Second, industry is speeding access for developing nations and making pricing modifications;
  • Third, the Clinton Foundation is expediting pricing efforts;
  • Fourth, the Gates Foundation is funding extraordinary research efforts;
  • Fifth, while there is much more to do than has been done, great strides have been made.

It did seem that a corner was turned.  The crowd of several thousand took the Bills very seriously and I believe that with their joint appearance, at least among the crowd, were able to communicate that, though PEPFARs prevention efforts may be far from optimal, treatment is much improved because of the U.S. commitment.  It is a message that all of the stakeholders involved – industry, FDA, the Administration and others need to carry onward.

Cheers from Toronto!

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