South Africa fights AIDS drug apartheid
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Access to cut-price HIV pills would save millions of lives worldwide.
Why do rich pharmaceutical firms refuse them, asks Nick Mathiason
Special report: AIDS
Source: http://www.guardian.co.uk/Print/0,3858,4116798,00.html
Sunday January 14, 2001
The Observer
Zackie Achmat a 38-year-old black South African, is probably the
world's most extraordinary drug smuggler.
As far as anyone can tell, he's the only illegal importer of drugs
who has ever voluntarily handed himself in, offered a video of him-
self clearing Customs and given over all receipts of his transactions
to the authorities.
Last October, Achmat, who has the Aids-related virus, HIV, flew to
Thailand and bought 5,000 pills to treat people dying of Aids. He
then flew back to South Africa and handed his drugs over to his coun-
try's government.
The drug was Biozole, an anti-fungal treatment whose patent is owned
by pharmaceuticals giant Pfizer.
To buy a Pfizer pill over the counter in South Africa would cost
about GBP 9. In Thailand, Achmat scored the same generic drug for
15p.
In trade-law-speak, Achmat's 'parallel importation' of Biozole is a
vivid symbol of a growing healthcare scandal of epic proportions.
Aids is sweeping through Africa much like the Black Death plague that
wiped out so much of medieval Europe. Eminent African doctors are now
saying that HIV will do more harm to Africans than slavery did.
Of the world's 34 million people infected with HIV, 25 million live
in sub-Saharan Africa. Yet only 25,000 Africans (0.001 per cent of
those infected) receive the drugs known as anti-retrovirals which
prolong the lives of people with HIV and are freely available in the
developed world.
Last week, Achmat was badly ill. Speaking in a whisper from his home,
he said: 'Hundreds of people are dying every day in our country be-
cause they can't get access to the right drugs. The only thing that
is stopping them is the price. I think it's immoral that people are
dying just because they're poor.'
Controlling the distribution of HIV drugs are some of the world's
most powerful pharmaceuticals companies which, combined, make profits
running into tens of billions of pounds.
But in a move that will make Achmat's 'crime' seem utterly insignifi-
cant, the might of the world's drug industry, including the UK's
GlaxoSmithKline, will, on 5 March, take the South African Government
to court over alleged violation of intellectual property rights - es-
sentially, the same principle that got Achmat into trouble.
The constitutional case, which has been rumbling since 1997, will be
heard at the Pretoria High Court and could, if appeals are exercised,
run for years. Whoever eventually loses will not face damages, but
costs running into tens of millions of pounds.
At the heart of the case is a law passed by former President Nelson
Mandela giving his country the right to buy huge amounts of generic
drugs and sell them cheaply in South Africa. In addition, South Af-
rica could compulsorily license HIV drugs and manufacture them within
its borders, undercutting the multinational pharmaceuticals compa-
nies. The threat of legal action has so far prevented South Africa
acting on this right.
Pharmaceuticals companies believe these measures represent a threat
to their balance sheets although, at present, just 1 per cent of drug
revenues come from the entire African continent.
But money lost through cheap generic could, drug firms say, be
ploughed into more research and development which may ultimately lead
to a cure for HIV.
Sanctioning cheap HIV drugs may also irritate hard- pressed health
authorities in the western world, which spend up to 10 times more on
their anti-retrovirals, and also alert the public as to the true -
low - cost of medical drugs.
Furthermore, argue the drugs firms, it is no good farming out cheap
pills to countries that don't have robust health infrastructures.
Drugs have to be monitored with scans and therapies. If that can't be
done, drugs are useless.
But African HIV campaigners argue that drug companies are putting
their profits before the health of a whole region.
For the South African government, eager to play a leading role in the
global economy, court action is the last thing it wants. South Africa
is a fully paid up member of the World Trade Organisation and signed
the Trade Related Aspects of Intellectual Property Rights (Trips)
agreement, which forces national governments to respect the rights of
patent holders. Within the South African government there are major
tensions between the health and trade ministries.
'This country has no intention of perpetrating a wholesale violation
of intellectual property rights,' said Mark Heywood, head of the Aids
Law Project at the University of Witwatersrand. 'It doesn't want to
be seen as the Mugabe of the South. But the South African government
has a duty to provide care for its citizens, and this is why they
passed this law.'
Even a leading pharmaceuticals analyst in the City last week said
leading drug firms could afford to sanction cheap drugs tomorrow
without it impacting on their balance sheets.
Preferring to remain anonymous, he said: 'It does depend on the
amount of usages and the amount given away. These programmes would be
phased so that it didn't hit them that hard.'
This court case, which has paralysed HIV healthcare in South Africa,
highlights the problems of the entire continent. Many African coun-
tries rely on the generosity of overseas governments and pharmaceuti-
cals companies to subsidise HIV drug prices. So far, that aid has
been sparing.
Throughout the Nineties, a series of high-level meetings with execu-
tives of leading pharmaceuticals companies and Western governments
discussed dropping the prices of drugs. But the cost was deemed too
high
High-profile offers of cheap Aids treatment from Clinton's admini-
stration came with strings.
A GBP 700m offer of cheap drugs from the United States last year turned
out to be export-import loans, at commercial interest rates, to buy
American drugs at market prices. This offer, not surprisingly, was
turned down.
But progress is now discernible. Last May, five of the biggest drug
companies agreed to begin talks with African nations to reduce the
price of their drugs if countries agreed to health action plans drawn
up by a leading business consultancy, McKinsey.
So far agreements have been reached with Uganda and Senegal. Others
are set to follow. But rumours suggest that drug companies have sanc-
tioned an increase in drug production to save thousands, rather than
millions, of lives.
The British Government has done little to lobby for cheap drugs. Last
November, Trade Minister Richard Caborn refused to sanction African
nations circumventing Trips by citing 'national emergency' - which
they are within their rights to do.
'I don't believe that this or related measures such as parallel im-
porting are the answer here,' Caborn wrote to Ben Jackson, director
of London-based Action for Southern Africa (Actsa), last November.
Clare Short, the Minister for International Development, has no sub-
stantial initiatives planned in this area.
'Imagine witnessing devastating plague and sitting on a cure for fear
of incurring shareholder revolt,' said Ben Jackson of Actsa. 'That
essentially is the position of drug companies. Sure healthcare infra-
structures have to be in place but it is not an either-or argument.
These things can be done simultaneously.'
Within a decade the number of people infected with HIV could reach
more than 50 million, the equivalent of the population of France or
the UK.
With the South African court case scheduled to begin in less than two
months, the calls for pharmaceutical companies to move faster on
dropping the prices of HIV drugs to developing countries are sure to
get louder.
--
How Brazil took on the drugs giants - and is winning
In the early Nineties, Brazil faced a serious Aids crisis. The South
American country had the fourth-largest number of reported cases of
the disease in the world, with about 2.5 per cent of Brazilians in-
fected - in other words more than 3 million people.
But their chances of surviving were increased by a government which
undertook 'daring policies' that went against the orthodoxies of in-
ternational trade.
After years of military dictatorship and escalating foreign debt, the
newly elected Brazilian democratic Government defined healthcare as a
social right in 1988.
Three years later, Brazilian ministers decided to circumvent interna-
tional trade agreements. They bought and distributed huge amounts of
anti-retroviral drugs.
The desperate measure, which angered pharmaceuticals companies, paid
off. Under pressure, the World Bank in 1994 sanctioned a GBP 115 million
loan to help pay for Brazil's medical drug bill. This was topped up
in 1999 by a similar amount, making Brazil the second largest recipi-
ent of overseas HIV-focused loans after India.
Brazil's government used the loan to guarantee free HIV drugs to all
who needed them, to train health professionals, to manufacture drugs
and to develop infrastructure for free distribution and monitoring.
World Bank loans and Brazil's government policies have contributed to
a 38 per cent drop in the number of Aids-related deaths there since
1994. Throughout Brazil, there has been a reduction in hospital ad-
missions, lengths of stay and the incidence of opportunistic infec-
tions.
These benefits come at a price. In 1999, government expenditure on
access to treatment was GBP 245m.
But overall Brazil has actually saved �291m in three years through
fewer/shorter hospital stays, welfare payments and the continued eco-
nomic activity of those with HIV.
Guardian Unlimited (c) Guardian Newspapers Limited 2001
--
Reproduced under fair use by
Christian Labadie
mailto:CLabadie@t-online.de
Note:
If you wish to send your e-mail support to Zackie Achmat before the
March 5, 2001 trial in the South African high court re. parallel im-
ports and compulsory licensing of AIDS drugs, the e-mail address is:
<zackie@pixie.co.za>
--
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