[Congressional Record Volume 146, Number 96 (Friday, July 21, 2000)]
[Senate]
[Pages S7421-S7422]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             BOEHRINGER INGELHEIM OFFER OF FREE NEVIRAPINE

  Mrs. FEINSTEIN. Mr. President, in May I stood on this floor and 
castigated the pharmaceutical industry for going behind the scenes and 
killing an amendment that Senator Feingold and I had introduced, and 
which was part of the African trade bill. They killed this amendment in 
conference.
  This amendment essentially would have allowed countries in the midst 
of a national HIV/AIDS emergency to use the cheapest possible drugs to 
fight that national health emergency by allowing the country to 
distribute the drugs through ``parallel importing'' and ``compulsory 
licensing.''
  Fortunately, the President put forward an Executive order to carry 
out the intent of our amendment.
  Since that time, some substantial things have happened.
  Because I was so critical of the industry I feel it is only fitting 
that I always come to the floor and acknowledge those that have 
responded to the crisis.
  When Senator Feingold and I began this fight last fall, 6 months 
after the World Health Organization declared HIV/AIDS the most deadly 
infectious disease in the world, very few people were aware at the time 
of the scope of the devastation as a result of HIV/AIDS in sub-Saharan 
Africa.
  Today, things have changed. Virtually not a day goes by without the 
media running a story about the HIV/AIDS crisis in sub-Saharan Africa. 
I will not recapitulate today all of the horrifying numbers behind this 
AIDS crisis. It suffices to say that more than 22 million people are 
infected with HIV/AIDS in sub-Saharan Africa, including over 30 percent 
of the adult population in many of the countries in the region. AIDS 
kills more than 2 million people a year in sub-Saharan Africa.
  The media, the public, and governments from around the world are now 
increasingly aware of the catastrophe that is unfolding on this 
continent. Of course, the pharmaceutical community is also aware.
  Today, I will discuss some of the positive steps the pharmaceutical 
industry is now taking to address this issue. I am very pleased and 
very grateful to see that the industry now recognizes its moral 
obligation and appears to be stepping up to the plate and taking the 
initiative to fight the HIV/AIDS pandemic in sub-Saharan Africa and 
other flashpoints throughout the developing world.
  On July 7, Boehringer Ingelheim announced that Nevirapine will be 
offered free of charge for a period of 5 years for the prevention of 
mother-to-child transmission of HIV in developing countries. They 
actually said that any country that asks for the drug will obtain it 
for free. That is a huge step forward. Reducing mother-to-child 
transmission can literally save millions of lives and reduce the rate 
of increase of HIV/AIDS in the developing world. In South Africa alone, 
according to a study published in the Lancet on June 17, as many as 
110,000 cases of HIV in infants could be prevented over the next 5 
years if all pregnant women in South Africa take a short course of 
antiretroviral medication such as Nevirapine during labor.
  Today, I believe there are literally millions of orphans in Africa, 
orphans whose mothers, fathers, and families have died of AIDS, orphans 
who are living without food, without water. It is a devastating 
situation. The initiative by Boehringer Ingelheim is part of the 
collaborative effort between the United Nations, the World Bank, and 
five pharmaceutical companies. I salute them today. Boehringer 
Ingelheim, Bristol-Myers Squibb, Glaxo-Wellcome, Merck, and Hoffman-La 
Roche are now trying, together, to expand access to HIV/AIDS treatment 
in the developing world. They deserve to be saluted by this body.
  If efforts by the international community to address the HIV/AIDS 
crisis in sub-Saharan Africa and other regions of the developing world 
are to be successful, they must be part of a coordinated effort, and 
that effort has to include education, prevention, and adequate health 
care infrastructure. They must also include access to affordable 
medication. This is where participation by the pharmaceutical industry 
is so essential.
  I am pleased to see that at long last pharmaceutical companies have 
recognized they have a profound social responsibility and moral 
obligation to meet the HIV/AIDS crisis, and that the lifesaving drugs 
they can provide are essential. We all know that AIDS drugs are 
extraordinarily costly. Therefore, access to low cost or generic drugs 
becomes critical.
  It is important, however, to sound a note of caution and place the 
initiatives of these pharmaceutical companies in perspective. According 
to Doctors' Without Borders, for example, past experience with the 
proposed Pfizer fluconazole donation shows that these programs 
sometimes come with conditions for national health ministries that make 
them unsustainable over the long term. Many of these conditions are 
worthy. For example, it is worthy that the drug companies actually try 
to prevent the distribution of these drugs on the black market, and I 
understand the requirement that these drugs only be dispensed by a 
physician.

[[Page S7422]]

 If a country doesn't have an adequate physician corps, it makes the 
dispensation of these drugs extraordinarily difficult, if not 
impossible.

  Because of these experiences, I believe it is critical that the 
United Nations and the national governments concerned work with the 
pharmaceutical companies to make sure that any future efforts, 
including Boehringer Ingelheim's offer on Nevirapine, do not include 
hidden conditions which may serve to undermine these important 
initiatives.
  Nevirapine, given in tablet form, as I understand it, does not have a 
lot of side effects and can be given in a way that encourages pregnant 
women throughout the continent to use it, and thereby in 90 percent of 
the cases prevent the transmission of the HIV virus to the unborn 
child.
  In addition, I believe alongside initiatives by the pharmaceutical 
industry, access to low cost and/or generic drugs embodied in the 
President's May 11 Executive Order is still very important. The few 
developing countries that have significant access to medicines for 
people with HIV/AIDS gained access by aggressively pursuing generic 
strategies. In Brazil, 80,000 people have been treated with generic 
drugs that have brought the cost of triple drug therapy down to 
approximately $1,000 a year. While in Uganda, where the Government was 
working with brand name drugs through a U.N. AIDS initiative, fewer 
than 1,000 people have been treated, due to cost constraints.
  Bringing the HIV/AIDS pandemic under control in sub-Saharan Africa 
and preventing HIV/AIDS from becoming a pandemic in other regions of 
the developing world is one of the great moral tests of our time. If 
governments, nonprofits, and the pharmaceutical industry work together, 
I believe we can control what will otherwise be the greatest 
preventable humanitarian catastrophe in history.
  Government and nonprofits are now beginning to take this crisis 
seriously. So are the pharmaceutical companies that produce drugs to 
treat HIV/AIDS. The offer by Boehringer Ingelheim to provide free 
Nevirapine to developing countries for 5 years to prevent mother-to-
child transmission of HIV, and the creation of a coalition of five 
major manufacturers of HIV/AIDS drugs to work with the United Nations 
to deliver drugs to victims of this crisis, are major steps in the 
effort to control the HIV/AIDS pandemic.
  I just want to say I am very grateful. I believe this Senate should 
also salute this action. I would like to encourage other pharmaceutical 
companies to follow the example these five companies are setting.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Frist). The Senator from New Mexico is 
recognized.
  Mr. BINGAMAN. I thank the Chair.
  (The remarks of Mr. Bingaman pertaining to the introduction of S. 
2905 are located in today's Record under ``Statements on Introduced 
Bills and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from Wyoming.

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