China
Raises Estimates of H.I.V.-AIDS Cases to 1 Million
By
ELISABETH ROSENTHAL
 EIJING,
Sept. 6 — China took significant steps today in facing up to its
growing H.I.V.-AIDS epidemic, raising its estimate of the number
infected to 1 million and saying that it would manufacture a full
complement of AIDS drugs if Western patent-holders do not lower
their prices.
It was a striking reversal by Chinese health officials, who had
previously insisted that, as a new member of the World Trade
Organization, China had to be hypervigilant about respecting patents
and would not permit the use of generic AIDS drugs.
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But even as the government was articulating its new sense of
urgency and commitment to action, it once against displayed the
defensiveness that experts both in and out of China say has
precluded an effective response to the crisis. China's Bureau of
State Security confirmed that it had detained the country's most
outspoken advocate for AIDS patients, Wan Yanhai, who disappeared in
Beijing two weeks ago.
In their announcements today, officials for the first time
publicly asked for international help with the country's AIDS
problem, which they had insisted they could handle on their own.
"We need international organizations to help us in this battle to
control AIDS," said Qi Xiaoqiu, director general of the Department
of Disease Control at China's Ministry of Health. "We need more
capital support and expertise."
It is unclear exactly why the government decided to take the
plunge and talk more candidly, although China is in the process of
submitting a $90 million grant application to the Global Fund for
AIDS, Tuberculosis and Malaria and desperately needs to show some
good faith efforts on AIDS to help its application.
That money is earmarked for dealing with the rural AIDS epidemic
in central China, including cocktail therapy for AIDS sufferers,
said someone who has seen an early draft. China's first application
to the fund, seeking money to be used for AIDS prevention and
treatment among drug addicts, was rejected earlier this year partly
because of the government's closed attitudes about the problem,
leading to unreliable statistics and other shortcomings.
Mr. Qi said that "drugs and other medicine are especially needed
in places where there are a large concentration" of AIDS patients,
referring to poor villages in central China's Henan Province, where
large numbers of farmers contracted H.I.V. through unsanitary blood
sales.
Last week China licensed its first domestically produced
anti-AIDS drug, a version of the medicine A.Z.T. Mr. Qi said a
shipment had already gone off to Henan, where it was being used by
patients, although he did not say how many had access to the drug.
Dr. Wan, whose arrest was confirmed today, had posted on the
Internet in late August a classified document prepared by the Henan
Health Bureau, showing that officials in that province were well
aware of a serious H.I.V. problem as early at 1995. Selling blood
was officially banned in that year, although it continued for
several years in a number of villages, people from Henan say.
Dr. Wan, who had been followed and harassed by security officials
all summer, disappeared off a Beijing street on Aug. 24. He founded
Aizhi Action, a small organization that ran a Web site and conducted
AIDS advocacy work in China and and was to receive a prestigious
Canadian human rights award this month. On Thursday state security
officials told one of his colleagues that he was being held for
revealing the secret report.
"Finally someone admits that Wan is in their hand," his wife, Su
Zhaosheng, who is studying in Los Angeles, wrote in an e-mail.
The main focus of today's news conference was on the AIDS crisis
among farmers in central China and on the need to provide patients
with affordable drugs, two hard-to-solve problems that health
officials had previously mostly sought to avoid.
At today's news, Mr. Qi emphasized that China was taking the
epidemic seriously, calling the situation "very dangerous." He
revealed that the Communist Party's Central Committee had
commissioned a special study on the epidemic, the first time it has
lavished that kind of attention on a disease. He said that the
central government had already earmarked 80 million yuan, about $10
million, to be directed toward Henan to combat AIDS.
But perhaps the biggest breakthrough was Mr. Qi's indication that
China would consider bypassing patents to produce its own cheaper
versions of AIDS drugs, especially the expensive Western medicines
used in the AIDS cocktail, if the major Western producers do not
reduce prices by the end of the year.
Until now China had vehemently rejected that route; it has tried
to get cheaper drugs only by negotiating discounts from foreign
manufacturers.
China has stubbornly maintained this position even as many other
developing countries, including Thailand, India and Brazil, have
started to produce or buy generic versions of the drugs, making
effective treatment affordable for victims in those countries and
saving countless lives.
Earlier this year, the World Trade Organization basically granted
countries the right to bypass drug patents if the medicines were
declared essential to combating a national health emergency and were
otherwise unaffordable.
To date, China's negotiations with drug companies have yielded
only piecemeal results, bringing the price of the AIDS cocktail here
from an exorbitant $8,000 a year to a merely unaffordable $3,000 to
$4,000, not including the testing that being on such drugs involves.
The same medicines, in generic form, cost about $300 in Thailand.
As a result, Mr. Qi acknowledged that only about 100 patients in
China were now on the AIDS cocktail, and most of that had been
donated by foreign groups.
"We are ready to negotiate with the pharmaceutical companies, but
if affordable prices cannot be reached, we will need to go that
other route," Mr. Qi said. When asked how much longer the Chinese
were willing to negotiate, he said: "Until the end of this year."
To activists here, poor access to medicines has been particularly
galling, since China has a strong pharmaceutical manufacturing
industry, one that is notorious for expertise in copying expensive
Western drugs. One Chinese company, Shanghai's Desano Co. Ltd,
already legally makes the raw ingredients for many of the pills in
the AIDS cocktail, which it then ships to India to be transformed
into generic pills that are unavailable to Chinese.
That anger has been generally mounting among China's experts as
well. "We need a group of drugs to treat patients now," Dr. Shao
Yiming, one of China's leading AIDS specialists said recently on
China Central Television. He added: "It's a dead end to wait for
patents to expire. It's up to our government, under the appropriate
circumstances, to invoke the W.T.O. clauses."
If Chinese manufacturers started producing generic medicines, it
still remains unclear how much benefit patients might reap, since
all hope to make profits from the venture. A spokesman for the
Shenyang Dongbei Pharmaceutical Company, which is newly licensed to
make A.Z.T., refused to say how much the newly marketed generic is
selling for, calling that a "commercial secret."
At the news conference today, Mr. Qi also discussed in greater
detail than ever before the AIDS epidemic's relationship to the
selling of blood in rural China.
Based on government statistics, he estimated that in one severely
affected part of Henan, Shangcai County, about 10,000 people had
contracted AIDS and that 1,000 had died.
Poor farmers sold their blood for about $5 a bag. They were
infected with H.I.V. because the government-affiliated blood
stations often used highly unsanitary processing practices that
involved harvesting the fraction of blood used to make medicines and
then re-injecting a portion of pooled blood to the sellers.
But, as before, the details provided were at best sketchy and
government estimates still seemed well below those suggested by the
few independent experts who have quietly worked in the area. These
experts say that the majority of adults in some villages now carry
H.I.V. and that there may well be over a million people infected in
the province.
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