MAL: You have played a major role in helping to negotiate inexpensively priced generic AIDS drugs for the developing world. But what do we do about patient compliance? It's a big issue in the U.S. Isn't it even more of a problem in the developing world where people do not have the same access to health care and health care professionals?
BILL CLINTON: Essentially, there are over 40 million people who are HIV positive, and somewhere between 6.2 and 6.3 million who need medicine in the developing world. Everybody gets AIDS medicines in America, Europe, Japan, and Brazil. But if you look at the rest of the world, there were approximately 270,000 [receiving therapy] in 2003. Today, the most optimistic numbers are that 700,000 people are getting medicine, of which our foundation provides for 110,000. We'll be at 300,000 by the end of the year.
On the other hand, if you don't have compliance, you might as well not have the medicine. We train people before we distribute [the drugs]. For example, we're involved with the Indian Ministry of Health in India in training 700,000 doctors over the next year.
The second thing we've done is to negotiate steep reductions in the cost of testing. Otherwise, you don't know if the medicine is working and if you need to change it.
In America we pay for the complement of tests somewhere between $200 and $400 a year. We've got it down to $20 a year in the developing world.
Interestingly enough, these are not generic companies [involved here]. These are big companies that have volunteered to lower these costs. They think they can recover their base costs with high volume because we're going to get the testing out there to a lot of people.
We just negotiated with the Chinese, who provide the component products to the drugs used by the Indians and South Africans, a 20% reduction in the components. In addition, we made a commitment to do what we did with the Indian and South African companies.
We're sending in retired manufacturing executives and others trying to make sure that we get the Chinese capacity to produce generics to the point where they'll be approved by the World Health Organization. We may be able to lower the price as much as to a hundred dollars a person a year.
MAL: What about AIDS in Russia?
BILL CLINTON: We just started in St. Petersburg and we're about to start in the Ukraine. Their [HIV] rates are actually growing faster in Russia and the former Soviet Union than in any place else.
In Russia and throughout the former Soviet Union, we're almost starting from scratch. There is a little bit of treatment there. There is some local leadership on the prevention front. But we've got a long way to go. President Putin's government is beginning to take it seriously.
I know that President Yush-chenko in the Ukraine takes it very seriously because I had a long conversation with him about it. He believes the numbers that they have reported of [HIV] infections in the Ukraine are too low. He believes it's a bigger problem.
MAL: Are you surprised by the recent changes in National Institutes of Health policy that will restrict and, in some cases, prohibit, NIH scientists from receiving consulting fees from industry? There are also proposed restrictions on family investments in biotechnology and/or pharmaceutical stocks. NIH is having problems attracting and retaining talented researchers, and this new mandate is sure to exacerbate that problem.
BILL CLINTON: Yes, I am surprised. I think it was because they were getting a lot of criticism about the way the pharmaceutical industry worked with not just the NIH, but with universities, and the way drugs were priced. It also surprises me since this administration is so close to the pharmaceutical companies.
I think the more money you put into research the better. There has got to be a way to stop the conflicts.
Most of the new drugs that have been patented in the last six years did come out of government funded research, either at universities or at the NIH. And there was this strong feeling based on a book done by Marcia Angell [The Truth About Drug Companies] that a lot of abuses had occurred in pricing and in the FDA patenting processes. It looks to me like you could fix that. I mean the problem there is not that we're doing joint research.
Angell pointed out that these drugs were basically being priced out of the range of people when all the research had been done by government funded researchers. And then the rules permitted the drug companies to buy the patent from [academic researchers], like if Duke University had an NIH grant and they developed Drug X.
The drug company could come and say they had to earn an exorbitant amount on this drug that they spent no money developing. They spend more than twice as much on administration and marketing than on research.