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Concerns about liability also deter invetors from funding microbicide development. Investors worry that if the product does not meet expectations and fails to protect against HIV and other STDs, they could be held responsible. There is also some concern about how agencies such as the FDA will regulate the licensing process and monitor production. The cost of microbicide production must be low enough for pharmaceuticals to make a profit.
Investors fear that, as with antiretroviral drugs, they, or the pharmaceutical companies in which they invest, will be required to provide microbicides at little or no cost to groups in developing nations. Again, their profit potential is seen as constrained. According to the Boston Consulting Group, however, even if only 10% of sexually actively women in industrialized and developing countries used a microbicide, the global market size would grow to $900 million by 2011. By 2020, they expect, this market size would double.
Not only would the pharmaceutical industry benefit from a microbicide, but countries themselves would reap great economic returns. Researchers at the London School of Hygiene and Tropical Medicine employed conservative mathematical models to estimate the number of HIV infections that could be prevented by microbicide use. Assuming that the product is 60% effective against HIV and STDs and is used by 20% of individuals who can be reached through existing health services and used in 50% of sexual encounters where condoms are not, a microbicide could prevent 2.5 million HIV infections in women, men, and children over a period of just three years. If the assumed number of individuals using the product increases to 30 percent, the number of HIV infections the microbicide could prevent over three years rises to 3.7 million.
Lowering the number of HIV infections would decrease a country’s medical expenditures on HIV/AIDS-related hospitalizations, treatment for opportunistic infections, and home-based care. The Rockefeller Foundation estimated that prevention of 2.5 million HIV infections with a microbicide could save $2.7 billion. An additional $1 billion could be saved in employment-related productivity benefits. The fewer HIV infections there are, the greater the number of individuals who can contribute productively to their economies.
The current state of the AIDS pandemic is appalling. What we’re doing right now isn’t working. Development of a vaccine is far off in the future, and tens of millions more will die before it becomes available. Antiretroviral medications certainly help, but they are only a superficial solution to the problem; they prolong lives but have no ability to prevent new infections. Male condoms are widespread, but are difficult to promote or enforce in the face of cultural barriers. Female condoms exist, but are impractical, ineffective, and often considered socially unacceptable, leaving women with very few options. Only a microbicide can give women the opportunity to choose to protect themselves.
Emily Morell and Rachel Hansen are freshmanat Yale University.