E-DRUG: African AIDS Victims Losers of a Drug War
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[This front-page piece on AIDS and intellectual property issues
appeared in the Washington Post on Saturday, December 4, 1999.
Copied as fair use; copied from PHARM-POLICY with thanks. WB]
[moderator comment: After the political victory in Seattle, where the
rights of developing countries to use compulsory licensing and
parallel import under TRIPS were confirmed, and where the USA agreed
to drop bilateral pressure on countries that wanted to use these
rights, how are we now going to make use of these rights to
make lifesaving essential drugs available to the 30+ million HIV
infected people in developing countries?
The rights to compulsory licensing (CL) and parallel import (PI) can
only be used if they are incorporated into the national patent or
medicines legislation. Who is going to help developing countries with
this legal exercise?
We also need a good database of generic and brandname suppliers of
lifesaving drugs with prices, quality and contact details, so that
countries can assess the need for CL and/or PI.
Finally, for small countries and NGO projects: we will need some
international (preferably non-profit) wholesalers to market the
lifesaving drugs.
Let's discuss who should be doing what in the near future.
Wilbert Bannenberg
E-drug co-moderator
Email: WilbertBannenberg@compuserve.com
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http://www.washingtonpost.com/wp-srv/WPlate/1999-12/04/050l-120499-id
x.html
African AIDS Victims Losers of a Drug War U.S. Policy Keeps Prices
Prohibitive
By Karl Vick Washington Post Foreign Service Saturday, December 4,
1999; Page A01
NAIROBI-The body of Josphat Nyakundi features a concise history of
the century's three great plagues and the world's responses to them.
Just below his left shoulder is the faint circle left by a smallpox
inoculation. In the recesses of his memory lingers the taste of the
sugar cube placed on his tongue with the drops that would protect him
against polio.
And swimming in Nyakundi's spinal fluid--inflaming the lining of his
brain, keeping him braced in his Nairobi hospital bed against the
flashing pain that comes with the slightest movement--are rampaging
cells of cryptococcal meningitis, an opportunistic infection that
means he has AIDS.
But neither Nyakundi nor the other 22 million Africans infected with
HIV, the virus that causes AIDS, can get the medicine they need.
Medical advances that stalled the AIDS epidemic in the West are not
reaching Africa largely because these countries and their citizens
face a stark choice: buy drugs at their market price, far beyond the
means of all but a few Africans, or risk trade sanctions by the
United States for buying or developing generic drugs at lower
prices.
Critics have accused U.S. trade policy of placing the profits of
drug companies above public health, moving to block poor countries
from manufacturing the drugs themselves, despite international laws
that permit countries to do so when facing a public health
emergency.
Responding to this criticism, President Clinton, speaking to members
of the World Trade Organization on Wednesday, announced that the
government would show "flexibility" in granting countries the right
on a case-by-case basis to obtain cheaper drugs during a health
emergency.
But the government has yet to draw up the criteria for judging a
country's claim, and it is not clear what impact the change may
have. For now, even palliative treatments like fluconazole, which
would give Nyakundi the strength to make his way home to die, remain
out of reach.
<SNIP>
Access to drugs is more than a life-and-death issue on the continent
that accounts for two-thirds of the world's HIV infections. With
AIDS in Africa transmitted primarily through heterosexual sex, the
disease already has hurt economic development. Some countries stand
to lose a quarter of their populations to AIDS, which one observer
noted "is wiping out the middle class as quickly as it's created."
In Nairobi, where an estimated 14 percent of the Kenyan capital's 3
million inhabitants are infected, the leading public hospital refuses
to admit patients with AIDS-related meningitis unless they show up
with the drug to treat it. The hospital has no supply of its own.
Clinton administration officials, in defense of the policy, have
emphasized the importance of protecting patent rights in a
pharmaceutical industry that invests heavily in research.
<SNIP>
Developing countries say they are only beginning to appreciate the
public health consequences of joining the World Trade Organization,
which any have done in the 1990s. Before joining the WTO, they could
avoid the high retail prices charged by pharmaceutical companies,
which historically have viewed their primary market as the Western
nations where the price of drugs is typically covered by insurance.
If those prices were beyond the means of places like Africa, which
accounts for just 1 percent of drug industry sales, poor countries
were free to shop for generic equivalents sold for a fraction of the
price by nations that did not observe international patent laws.
India, for example, makes a $2 version of fluconazole, the drug that
the 42-year-old Nyakundi would take every day for his meningitis if
his family could afford the $17 retail price charged by Pfizer Inc.,
which holds the patent.
But in joining the WTO, a country agrees to honor foreign patents
and acknowledges it would face sanctions for dealing in generics
produced before a patent expires. The thrust of the patent agreement,
known by the acronym TRIPS, requires every country to pay full
retail price. However, to countries facing a health emergency, the
agreement held out a loophole: A desperate country could make (or
commission) the drugs itself, provided it paid a negotiated royalty
to the patent holder.
This do-it-yourself alternative, called "compulsory licensing," was
intended as a lifeline. But in practice, any country reaching for it
has been handcuffed by U.S. trade negotiators.
U.S. officials have explained that, although the United States
signed the TRIPS agreement, they have regarded its provisions as a
minimum standard, and the office of the U.S. Trade Representative has
urged that countries follow a higher standard--payment of full
licensing fees. In negotiations with individual countries, the trade
representative can threaten the loss of U.S. trade if the nation
goes forward with compulsory licensing.
The threat worked against Thailand last year: It dropped plans to
produce the anti-AIDS drug ddI after U.S. officials threatened
sanctions on key Thai exports.
And last year when South Africa, where one in 10 people is HIV
positive, passed a law permitting the government to make drugs it
deemed too expensive, U.S. Trade Representative Charlene Barshefsky
reacted swiftly. At the urging of the U.S. pharmaceutical lobby,
South Africa was placed on the "301 watch list," which is seen as a
prelude to trade sanctions.
South Africa's case was buttressed when activists from the advocacy
group ACT-UP began pushing the cause and found a target in the
presidential campaign of Vice President Gore. After protesters
repeatedly disrupted campaign appearances, Gore met privately with
South African President Thabo Mbeki. On Sept. 17, the United States
removed South Africa from the sanction watch list.
<SNIP>
The U.S. policy has been attacked by humanitarian organizations, led
by Doctors Without Borders, the Paris-based aid group that won the
Nobel Peace Prize last month. Its campaign to broaden access to
"essential medicines" recently gained a significant ally in the
World Bank, which under President James D. Wolfensohn has put new
emphasis on health care in the poor and emerging countries it is
mandated to help.
Ok Pannenborg, the World Bank official who oversees health
investments in Africa and the bank's purchase of up to $800 million
a year in pharmaceuticals, said the drug-price structure "shows an
increasing disconnect with the needs of the majority of the people
in the world."
Calling the South Africa outcome "a symptom that times are
changing," Pannenborg said the World Bank "is comfortable" with
compulsory licensing and a second practice permitted under TRIPS,
known as "parallel importing," or shopping abroad for the best
retail price on patented drugs.
By supporting cheaper alternatives, Pannenborg said the
pharmaceutical industry might be nudged toward a "tiered pricing"
arrangement in which the West would pay one price for a drug, and
developing countries another.
<SNIP>
Doctors say that is where high drug prices hit hardest in Africa.
The meningitis that freezes Josphat Nyakundi to his bed is the
third-leading cause of death in Kenya, behind two other AIDS-related
ailments--tuberculosis and diarrhea. He took fluconazole until his
family ran out of money, then landed back in the hospital while
waiting for a friend who works for Kenya Airways to return from
abroad, where many drugs are cheaper.
Christopher Ouma, the doctor who admitted him, said that at a public
hospital where half the patients cannot pay the $2.60 daily bed
charge, he usually does not even tell patients' families the drug
exists.
"This is where the doctor's role goes from caregiver to undertaker,"
said Ouma. "You talk to them about the cheapest method of burial.
Telling them about the drugs is always kind of a cruel joke."
Staff writers David Brown and John Burgess in Washington contributed
to this report.
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