Africa's tenuous AIDS lifeline

Trying to make a difference in Tanzania, Abbott Laboratories finds that the biggest obstacles to good treatment are not so obvious

November 22, 2005|By David Greising, Chief business correspondent

MARAMBA, Tanzania — The drug Kaletra goes bad if it is not kept cold, so getting it to a 3-year-old AIDS patient named Juraji Bakari in this sun-baked African village 300 miles south of the equator is no mean feat.

The pills start their journey in Italy, where Abbott Laboratories of North Chicago, Ill., makes the active ingredient. Abbott presses the drug into capsules in Florida, labels and packages them in Britain, then flies them via a Netherlands logistics center to Dar es Salaam, Tanzania's biggest city.

From there refrigerated trucks bound over pitted roads, dodging potholes the size of donkey carts, on their way to regional medical centers such as the one in Muheza town, which serves Maramba and dozens of other villages. Hospital workers hustle the medicine into refrigerated storage. The African heat would turn the pills into useless dust.

Drugs did not arrive in time to save Juraji's mother. She died of AIDS. But they are saving his life.

"Now that there is availability of drugs, he should be OK," said Zuwena Ibrahim, 24, who adopted her nephew after her sister's death.

Difficult as it is, getting pills to Maramba is one of the simpler parts of attacking AIDS in Tanzania.

For five years now, Abbott has worked with Tanzania's government to alleviate the impact of AIDS. The experience has taught the company that the biggest obstacles are less obvious, and less readily overcome, than getting drugs to the villages.

Hospital laboratories are archaic. Treatment wards are overrun with patients. There is little capacity to treat AIDS-related illnesses such as tuberculosis and malaria.

Tanzania cannot adequately care for the orphans of AIDS victims. A social stigma against AIDS victims persists, which deters people from getting tested and treated for the disease.

"People who simplify this into just drop-shipping gobs of drugs into remote areas of Africa, they're nuts," said Miles White, Abbott's chief executive, during a trip to Tanzania last month to review the progress of Abbott's work. "It's a lot more complicated than that."

UN issues new report on AIDS

Indeed, a report released by the United Nations on Monday indicates that efforts by big drug companies to fight AIDS face steep challenges.

The number of people infected globally with HIV, the virus that causes AIDS, doubled over the past decade, to 40 million. The UNAIDS report noted decreased infection rates in Zimbabwe, Kenya and Burkina Faso, and improvements in affecting behavior, but the disease continues to outrun efforts to stop its growth.

In Tanzania, at least, the fight is at least partly about making the best use of the $35 million Abbott has pledged to help Tanzania's government fix mundane problems in the country's health system that enable AIDS to remain a monstrous threat.

The Tanzania program is part of a $100 million Abbott commitment to alleviating the impact of AIDS in Tanzania, Burkina Faso, Romania and India.

Pitfalls for donors in Africa

Dealing effectively in Africa also means avoiding pitfalls that have hit other donors.

The United Nations-supported Global Fund to Fight AIDS, Tuberculosis and Malaria early this year cut off support for five programs in Uganda, citing widespread mismanagement. In Kenya, skepticism over the government's ability to deliver drugs has led church-backed organizations to form a private distribution company.

Merck & Co. teamed with the Bill & Melinda Gates Foundation five years ago to launch a groundbreaking $100 million program to aid Botswana, where 37 percent of the adult male population has AIDS. But the donors have found it difficult to distribute money, in part because of bottlenecks and logistical difficulties.

Tanzania has as many people with HIV/AIDS, 1.6 million, as Botswana has people. The official infection rate is 7 percent of Tanzania's 36.7 million people, though the actual rate probably is twice that, health experts say.

Five years into its commitment, Abbott still fights to find new ways to address the complexity of the AIDS challenge. Abbott is focusing almost exclusively on infrastructure and on the orphans and children victimized by AIDS. The government sets the agenda, then Abbott designs, funds and runs the programs accordingly.

When an Abbott program works, the government rolls it out more broadly.

Tanzania's health minister, Anna Abdallah, would not have it any other way.

"We expect them to do what the government wants them to do," Abdallah said of Abbott and other donors. "They can't do whatever they want in Tanzania, because it's our program. It's a national program."

Few donors are willing to concede so much control.

"Most international players haven't quite realized that they have to be cooperative with players on the ground," said Josh Ruxin, director of the program to expand delivery of health services in developing countries at the Center for Global Health and Economic Development at Columbia University.