The Aids and hepatitis epidemics are raging out of control in Russia. Yet Vladimir Putin has refused to pay for scaled-up access to treatments in a way commensurate with the situation in his country. He has delegated this responsibility to associations and financial institutions. He has refused to impose steep price cuts by authorizing the production and import of generic medicines.
1. According to the UNAIDS yearly report of December 2003 there were between 420 000 and 1 420 000 people living with HIV/Aids in Russia. In 2004, without major changes in the health policy and, in particular, without an enlarged access to treatments, the World Bank expected the percentage of HIV positive peope to reach 4.5% in 2010.
2. An absurdly limited access to treatment
In Saint Petersburg last year in 2004, 250 persons out of 25 000 officially registered people living with HIV/Aids benefitted from treatments paid by the city. In Tomsk in Siberia, out of the 700 HIV-infected persons only one was on treatment. According to various associations, 1500 persons in the whole country were on treatment in 2004 whereas at least 140 000 needed to be treated. For Russian officials only 4000 persons need to be on treatment.
3. Generic medicines now!
The only hope for the scaling up of access to treatments lies in international programs. The WHO and the World Bank announced they aimed at putting 50 000 people on treatment by December 2005. In 2004 the Global Fund to fight Aids, malaria and tuberculosis released 120 million dollars over five years to increase access to treatments. But the price of a therapy using brand-name medicines-12 000 dollars a year per person-reduces the impact of these programs.
The production and/or import of generics thus becomes a priority. Russian officials have been promising activists for a year that they will register generic medicines which would enable the price of a therapy to drop to 700 euros per year. Russian companies are naturally interested and some big companies are very eager to produce generic medicines. Such a promise has become a dead letter. It is a matter of the utmost urgency : the program of access to treatments funded by the Global Fund which was to start this coming summer on the basis of reduced prices by three pharmaceutical companies is today uncertain. As a matter of fact, BMS and Boeringer Ingelheim have made it known they will not accept any price cuts. As for Merck, this company claims it cannot provide the needed treatments before December. Once more the profit motive is stronger than patients’needs.
Vladimir Putin’s denial must stop. He must make the fight against Aids and different varieties of hepatitis a priority, and encourage access to treatments for all the persons who need them. One priority step among others is the registering of generic medicines by the health authorities in Russia in order to lower the prices of treatments and to improve the impact of international programs of access to medicines.