艾滋病防治:被损害与被遗忘的
http://www.sina.com.cn 2008年12月03日 23:43 《环球企业家》杂志
在席卷全球的金融危机中,中国一项特殊的“FDI”也面临饥渴困境:艾滋病防治
《环球企业家》 李晨蕾
40多岁的刘屹沉默寡言,个子不高,关节粗大的一双手诉说着他所承受的压力。他是一个农民,一个艾滋病病人,一个艾滋病互助组织里的热心人。在其身后是中国超过80万人的艾滋病感染者,且近三年来以年均超过25%的速度在增加。现在,他的命运跟远在大洋彼岸的奥巴马联系在一 起。
5年前中国开始为艾滋病感染者提供免费治疗,刘屹是第一批受益者,为此他被免除了数万元的治疗负担。但不久前刘屹体内的病毒产生了耐药性,他必须更换二线替代药物——通常比一线药物贵几倍,且一旦服用不能中断。中国去年开始进行二线药免费发放的试点,进行有限的供给,刘屹再次成为幸运者。但现在,这一昂贵试点的资助者全球基金——一个流行疾病领域类似“联合国”的机构却陷入筹资困难的窘境。与在联合国会费的角色一样,美国是全球基金的最主要资金来源。
每年中国用于防治艾滋病的经费中,至少有一半来自国际NGO和基金的援助,其中全球基金自2003年将中国纳入其援助对象以来, 5年内捐赠了2亿多美元。但金融危机让美国财政部掏出7000亿美元,全球基金的筹资面临极大的困难。这给即将到来的12月1日国际艾滋病日蒙上了不祥的阴 影。
11月8日,在印度德里举行的全球基金第18次理事会理事会,用挨个削减项目申请书预算的方式解决僧多粥少的难题。相应地,全球基金第9轮项目申请书的批准日期,将延后6个月。曾专门赴肯尼亚检验艾滋病的奥巴马被认为是支持艾滋病防治的激进领导人,全球基金的理事们寄希望于奥巴马能够迅速将美国经济带出困境,同时也能延续美国在艾滋病防治上的应有责任。但即使奥巴马会不辜负他们的期望,也要等到1月份真能正入住白宫。
刘屹似乎已经等不及了。不久前当他代表病友有机会坐在艾滋病“鸡尾酒疗法”之父何大一面前时,他的CD4指标只有87(健康人CD4值在500至1600之间),随时可能因一场并发症而死去。在谈论中,何大一惊讶地发现,在其援助的项目中,实施人刘屹的健康状况成了项目最大的风险。何大一亲自配制并提供给刘国际上最先进的二线药品半年的药量。
刘屹却高兴不起来。他不能确定,如此稀缺的药品一旦服用,是否在半年之后还能再找到?若找不到,新药为其体内病毒带来的耐药因子会让他送命。刘屹指着自家猪圈里的几头猪算了一笔账:一头100多公斤的猪才能赚五六百块钱,而圈里的4头猪甚至不能换取何大一提供配方的半月剂量。若没有免费、持续的供药,他将难以为继。
中国实行免费的艾滋病治疗至今已经5年,与刘屹一起的约5万名艾滋病病人只要健在大多已到了耐药临界点。 5年来中国用于防治艾滋病的专项资金已经超过40亿元。但这对于艾滋病感染人数从2001年的45万人上升到80万人的巨大增量而言仍显不足,更不用说应付逐年增加的耐药人群的消 耗。
“全球基金官方已认识到基金内部正面临经济困难,筹集困难短期内无法解决。”中国全球基金观察项目首席执行官贾平告诉《环球企业家》,金融危机的影响远未结束,环球基金的行动迟钝实际上是NGO和慈善基金筹资额的风向标,其他基金如盖茨基金、中英项目、克林顿基金正处在新项目年谈判的关键期,是否也会步环球基金的后尘?
博弈
祸不单行的是,中国治疗艾滋病药物的供应方的态度也在此时发生了微妙变化。“登上了月亮,办了奥运,你们也许不再需要完全享受发展中国家的优惠福利了。”去年底一家著名跨国医药公司在与卫生部关于艾滋病二线药品的采购谈判桌上开玩笑说。中方谈判者并未示弱,随即主动中止谈判,走出谈判室给东北制药总厂负责人打电话:随时准备强仿。
在免费防治体系中,中国一直按照国际艾滋病药品公司根据发展中国家现状制定的采购价格小批量购买二线药品。但这次中国政府拟以较低的价格大规模购买,以提供给像刘屹这样的耐药患者。双方的谈判在价格上僵持不下,二线药也就无法得到数量上的保证。这正是刘屹的治疗难以为继的原因。
刘屹很幸运,不久后他从政府那里得到了需要的二线药品,这完全归功于东北制药总厂,其本身就生产艾滋病药的半成品以供出口,得知中方代表电话内容后,外资药厂主动提出了继续谈判。结果不言而喻。
这一戏剧性变化的背景是,去年10月全国人大常委会经批准了《修改〈与贸易有关的知识产权协定〉议定书》。根据议定书,作为发展中国家中国可以在国内因艾滋病、疟疾、肺结核和其他流行疾病而发生公共健康危机时,实施专利强制许可制度,生产、使用、销售进口有关治疗上述疾病的专利药品。正在修改中的《专利法》也将正式体现这一原则。
过去5年中,中国所有的治疗艾滋病的药物全部依赖外资制药企业,这次谈判的小插曲,不过是再次提醒决策者其中蕴藏的风险。令国际制药企业不安的是,国务院防治艾滋病工作委员会办公室今年初专门召集具有强仿艾滋病药物的国内药企开会,这意味着强仿的大门可以随时开启。艾滋病药物一般也可用于更为庞大的乙肝人群,一旦中国决定进行“强仿”,他们失去的恐怕不仅是中国的艾滋病市场。
“艾滋病是个全球关注的社会现象,但国际药商也要盈利,因此定价很难拿捏。”中国性病艾滋病预防控制中心治疗室主任张福杰向《环球企业家》分析说,表面上这给中国具有仿制能力的本土药厂预留了空间。东北制药总厂负责政府事务的经理陈英相信,与国外专利厂商相比,中国本土药厂能够在保证药品效果的前提下,降低药品售价且稳定供应。但是,大多有强仿能力的药企主要收入来源仍是艾滋病和乙肝药品半成品的出口,直接强仿将冲击其下游客户的市场,对其而言往往得不偿失。因此就目前来看,强仿仍仅是谈判桌上的筹码。若下次谈判仍处僵局,这一杀手锏很难继续发挥作用。
退而求其次,张福杰认为应该回到一线药品上。如果能够利用廉价并供应相对充足的一线治疗的药品形成多种治疗组合,有可能延长艾滋病感染者对一线药的耐药时间,给二线药的购买或仿制争取更多的空间。但这也仅是延缓了艾滋病治疗体系在短时间之内面临大规模断药的风险,而不是杜绝。
隐忧
现在,中国运行5年的路线在金融危机面前必须回答一个问题:如果艾滋病治疗的经费得不到保障,而跨国制药公司也开始左右摇摆,那么每年新增的艾滋病感染者尤其是耐药患者的明天在哪里?“没有药,前期的检测和咨询都没有任何意义。”这是红树林感染者组织的创始人李想的回答。
不堪频繁救火重负的张福杰指出,对于艾滋病这一没有可治愈的药品也不存在有效疫苗的流行性疾病,即使药品能稳定保证,也应主动加强上游的预防和宣传,做到防患于未燃。这一点中国的情况也并不乐观。
5年来中国的艾滋病预防体系已形成政府+NGO的互补模式,并已初见成效:2007年新发感染人数约5万例,较2005年估计量减少了2万例。其中,国际经验和资金在整个防治链条上起着无可替代的作用,中国正在借助国际力量来迅速提高“抗病毒”能力,但最终可能会产生“耐药性”。贾平的一个调研结果颇令人尴尬:参与预防艾滋病最前线工作的非政府组织(NGO)所需资金九成以上来自国际社会,而来自国内的公益资金微乎其微。一旦国际资金大范围撤离中国,将留下一块难以弥补的天窗。
事实上,艾滋病援助项目撤离已经显露端倪。“原来一个女孩要获得援助要‘打败’两个对手,现在变成了五个甚至十个。原因是项目少了。”贾平说,在国际资金充沛的过去几年中,NGO组织如雨后春笋般遍地发芽,但正如今年房市中的泡沫一样,随着金融危机的蔓延它们很多都已消失了。
一位不愿具名国际项目的官员因项目资金没到位,而被迫将旗下的一个项目延迟了1年。他抱怨道,中国缺乏自给自足的艾滋病防治融资途径,即使地震激发了中国企业的慈善热情,艾滋病仍然在企业关注的视线之外。而政府似乎也未能在调配各种社会资源,共筑艾滋病防治的融资通道方面有太多建树。
一个健康、充满活力的NGO生成体系对于防治艾滋病的实际作用远非资金援助所能涵盖。艾滋病的预防和宣传具有特殊性,一些“排异性”很强的群体如男性同性恋群体、感染者群体以及性工作者群体对正面工作非常敏感,在这些群体中实现宣传和教育,只能通过由他们群体内部形成的NGO来实现。
刘屹正是其中的代表。1年来亲历艾滋病防治面临的重重考验后,刘屹希望自己能对防止体系有所贡献,在身体刚刚恢复一些时他又开始了工作。“我不能停下来。”刘屹说,反歧视是艾滋病防治的基础守则,“但很多时候,给我们一个拥抱仍会让人感到不 安。”
12 years http://www.sina.com.cn 2008 on 23:43 on 03, "Global Entrepreneur" magazine
In the Asian financial crisis, a Chinese special "FDI" is also faced with the plight of hunger and thirst: AIDS
"Global Entrepreneurs" Lichen Lei
40-year-old Yi quiet, not tall, large joints of the hands to tell him the pressure. He was a farmer, one AIDS patient, AIDS, a mutual aid organization of enthusiastic people. China is behind in its more than 800,000 people infected with AIDS, and the last three years at an annual rate of more than 25% of the increase in speed. Now, his fate with the other side of the ocean linked to Obama.
5 years ago, China started to provide free AIDS treatment, Yi is the first batch of beneficiaries, for which he was relieved the burden of treating the tens of thousands of dollars. Not long ago, but Yi's body had a virus resistance, he must replace second-line drug alternative - usually a few times higher than the first-line drugs, and can not be taken as soon interrupted. Last year, China began to carry out second-line drugs free of the pilot, a limited supply, Yi once again become a lucky person. But now, the expensive pilot of the sponsors of the Global Fund - a disease similar to the popular "of the United Nations," the agency has a fund-raising difficult dilemma. And the role of the contributions of the United Nations, the Global Fund to the United States is the main source of funding.
China every year for AIDS prevention and treatment funding, at least half of the funds from the international and NGO aid, of which the Global Fund since 2003 to aid China in its object, 5 years donated more than 200,000,000 U.S. dollars. However, the financial crisis in the United States out of the Ministry of Finance 700,000,000,000 U.S. dollars, the Global Fund's financing is facing great difficulties. This coming December 1 of the International AIDS Day has cast an ominous shadow.
November 8, to be held in Delhi in India, the Global Fund to the 18th Council of the Board, one by one to reduce the project budget for the application of the solution to the shortage of challenges. Accordingly, Article 9 of the Global Fund project application approval date will be postponed for 6 months. Kenya has been devoted to AIDS testing is considered to be Obama's support AIDS prevention and control of the radical leaders of the Global Fund's directors hope Obama will be able to quickly bring out the plight of the U.S. economy, but also can be sustained in the United States on AIDS The responsibility should be. But even if Obama will live up to their expectations, I have to wait until January to live in the White House.
Yi seems to have a wait. Not long ago, when he had the opportunity on behalf of the people who were sitting in the AIDS "cocktail" in front of the father of David Ho, he's only 87 targets CD4 (CD4 value of the health of people in between 500-1600), at any time may be a result of complications Dead. Talking about, Ho was surprised to find that its assistance projects, implementation of the Yi people's health status has become the largest project risks. Ho personally prepared and made available to Liu the most advanced second-line drugs six months of the dose.
Yi was not happy with. He can not be identified, so the scarcity of drug use once, it can in half a year later to find? If not found, the body of its new drug-resistant virus brought about by factors let him die. Yi, pointing to their pigsties in a few pigs calculations account: a more than 100 kilograms of pig Wu Liubai in order to earn dollars, and the circles of 4 pigs can not even David Ho, in exchange for the provision of the half-dose formulations . If not free, and continued for the drug, he will be hard to sustain.
China's free AIDS treatment has been 5 years, Yi, together with about 50,000 AIDS patients alive as long as most of the resistance has reached a critical point. 5 years for China's AIDS prevention and treatment of special funds has more than 4,000,000,000 yuan. This is not good for the number of AIDS infections in 2001 from 45 million up to 80 million people still lack the tremendous increase in terms, let alone cope with the increasing resistance of the people of consumption.
"The Global Fund has recognized that the official in-house fund is facing financial difficulties, difficulties in raising a short period of time to solve." China Global Fund Observer, CEO of Ping Jia told the project "Global Entrepreneurs", the impact of financial crisis is far from over, the Global Fund Action was slow in practice NGO and charity fund-raising amount of the fund wind vane, other funds such as the Gates Foundation, the Sino-British project, the Clinton fund new projects are in a critical period in the negotiations, it will follow step-by-step Global Fund?
Game
Misfortunes never come singly, the Chinese treatment of AIDS drug supply-side approach is also at this time there have been subtle changes. "On the moon, the Office for the Olympic Games, you may no longer need to fully enjoy the benefits of developing the well-being." To the end of a well-known multinational pharmaceutical companies with the Ministry of Health on the second-line AIDS drugs procurement joked to the negotiating table. Chinese negotiators did not show weakness, then take the initiative to suspend the negotiations, the negotiations out of the room to the Northeast Pharmaceutical Factory in charge of people called: strong stand ready to imitation.
Free of charge in the prevention and treatment system, China has been in accordance with the International AIDS drugs in developing countries in accordance with the status quo established by the purchase price to buy second-line drugs in small quantities. However, the Chinese government to be at a lower price to buy a large scale in order to provide such as Yi-resistant patients. The two sides in the negotiations on the price of a stalemate, second-line drugs can not be a guarantee on the number. This is Yi's difficult to continue treatment.