Made in Africa

When African leaders discuss economic growth in Africa at this week's African Union Summit, their options will be constrained by the growing AIDS epidemic and slow progress on reaching the Millennium Development Goals (MDG). For example, over the years we have seen agriculture output being impacted by people unable to till their fields or having to sell their land to take care of themselves and their families.

But it can be different. At the beginning of this year I visited Khayelitsha, a township in South Africa where I met Thobani, who was cured of TB and has access to AIDS treatment. Now he is able to take care of his son and contribute to his community. There are nearly 4 million people like Thobani, people who are vital to economic growth in Africa and elsewhere, thanks to access to lifesaving medicines.

There are 22 million people living with HIV in Africa. For every two people who start on antiretroviral treatment, five are newly infected with HIV. This means the number of people in need of treatment will always increase.

Therefore we need to break the trajectory of the epidemic by stopping new HIV infections. This means focusing on prevention.

We also need to make treatment more affordable and ensure sustainable access to quality medicines in Africa. The demand is high, as nearly 80% of the 4 million people on treatment globally live in Africa, but 80% of the drugs distributed in Africa come from abroad. The waiting line for AIDS treatment is growing exponentially. Add to this the other top killers in Africa like TB and malaria and the treatment bill is unsustainable.

The drugs are expensive, and they do not work for ever. Patients will, after a period of time, 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 two dollars a day) to second-line treatment which costs more than $1,000 for the AIDS drugs alone. In Africa, less than 4% of patients are on second-line therapy, which is far below what effective treatment would require. Again unsustainable.

Africans will need these medicines for a long time. They need many others, as well. Most of these drugs, however, are not produced in Africa for lack of stringent quality standards and manufacturing capacity. Demand for AIDS treatment should become an opportunity for Africa to reform its pharmaceutical practices. Too often, drugs made in Africa are spurious or low quality. What Africa needs is a single African Drug Agency, similar to the European Medicines Agency, which regulates the pharmaceutical sector in Europe.

What will this achieve? First, the quality of medicines will be guaranteed across the continent. The agency should have the power and independence to enforce high quality international standards. This will help close down the market for spurious drugs. Second, manufacturers will not need to run from country to country to get their products approved. Third, this will integrate the African market to attract private sector investments for manufacture of medicines within Africa just as we have seen in Latin America. Fourth, it will ensure that there is a level playing field for manufactures to compete and market products within Africa and beyond just as India and China are doing. Fifth, it can be a model for removing bottlenecks, not only for medicines, but for wider development that will contribute to an AIDS+MDG movement in Africa. And all of these efforts must work in the best interests of people in need.

This is a concrete step that African leaders can task the African Union to make. UNAIDS will mobilize the UN system, development partners, promote south to south cooperation, and engage with the private sector to support the establishment of the regulatory agency. In this economic crisis, African leaders have an opportunity for innovation, just as the G8 leaders have an obligation to fulfil their pledge made at Gleneagles to provide universal access to AIDS treatment by 2010. Every day, 3,000 new patients start AIDS treatment, thanks to the support of organizations such as the Global Fund and the United States President's PEPFAR initiative, which emphasize results. Africa can deliver.

Let AIDS not be an obstacle but let the AIDS response provide an opportunity to transform the continent.

Michel Sidibé
Executive Director, Joint United Nations Programme on HIV/AIDS (UNAIDS)