E-drug: AIDS: G8 has to pay for Generic Drugs
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Act Up-Paris' Press document - 07/20/01
AIDS: G8 has to pay for Generic Drugs
A logical consequence of the mounting debate on the access to
drugs in poor countries, AIDS is on the agenda of the G8. Indeed,
governments and backers must abandon the wait-and-see policy
that they had maintained for 20 years.
However, as during the United Nations Special Session at the end
of June, announcements and discussions around the creation of the
Global Fund launched by Kofi Annan last April, are likely to elude
the real debate posed by access to health and drugs and
maintenance of intellectual property in poor countries.
On the one hand, money announcements from rich countries take
place while these countries have drastically reduced their official
development assistance (ODA), a part of which is intended for the
fight against AIDS, for the last 10 years.
On the other hand, according to Ga�lle Krikorian of Act Up-Paris,
announcements from governments look like a diversion manoeuvre.
It obscures the issue of production and access to generic drugs in
poor countries, as well as the debate on the WTO TRIPS
agreements and their dramatic medical consequences for years to
come. And Ga�lle Krikorian wonders whether the international
financial backers hope to buy the silence of the people with HIV
and ensure the upholding of intellectual property by announcing a
paltry hundred million for a nebulous global Fund.
Today, one of the priorities of the fight against AIDS is the
launching of an international invitation of open tender for generic
drugs and copies manufacturers, allowing purchase of drugs at the
lowest price through economies of scale and competition between
manufacturers. The financing of such an operation does not require
the creation of a "global and omnipotent" Fund, but a simple
program within an existing organization. (1)
Beyond this measure and since the WTO agreements seem to be
unable to permit the defense of health interests, the fight against
AIDS imposes the abolition of intellectual property everywhere
where it kills.
Kofi's Fund as a diversion manoeuvre
Thus, last April, Kofi Annan launched the idea of a global Fund
intended to collect some 7 to 10 billion dollars a year for the fight
against AIDS.
Patients in poor countries, NGOs and activists can then believe that
this Fund will mark a turning point in the fight against the epidemic:
to finally allow a change in scale of financing and medical care for
the million patients who still do not have access to drugs.
Now, though, just as the G8 summit arrives in Genoa, enthusiasm
has waned. The Fund has been transformed: it will also be used for
tuberculosis and malaria; the announced amounts are ridiculously
low; there has been a dilution of objectives and a return to an
all-prevention strategy.
Ridiculous amounts
The United States, the leading economic power in the world, set
the tone last May by announcing a contribution of 200 million
dollars, that is 2% of the amount set by Kofi Annan.(2) Statements
by Lionel Jospin, the French Prime Minister, echo this tone by
proposing 130 million dollars over three years. The Japanese
advance 100 million dollars. The strategy is clear. The Fund is thus
deprived of its principal quality: financing of a new magnitude on a
worldwide scale.
The thundering initiative of Kofi Annan is first useful to the
international financial backers, and in particular the countries of the
North, which can easily give the illusion that they are mobilizing -
the money is far from being released, financing will certainly come
from existing allocations.
Dilution of objectives
Funds targeted to three diseases at the same time cannot meet the
needs and the emergency that the AIDS epidemic imposes. Its too
broad sphere of action will only lead to diluting the objectives and
submerging the priority stakes such as access to treatment in a vast
hodgepodge.
Moreover, if governments are free to target their financing, the
majority of them will probably direct it towards malaria or
tuberculosis to the detriment of AIDS, towards prevention to the
detriment of treatment, towards brand-name drugs to the detriment
of generics. The recent statements of the American(3) and British
governments, of officials of the European Union(4) or
representatives of international agencies(5) have already indicated
this.
Time to die
The initial deadline by the end of 2001 is illusory. Everything leads
us to believe that the setting up of this Fund will require several
years - the glorious experience of the International Therapeutic
Solidarity Fund launched by Chirac in December 1997 is still in our
memory. How many million patients will die while political leaders
and international financial backers wonder about the objectives,
management or "governance" of this Fund? Will each actor wait for
all of its "partners" to act? The patients however do not have any
time to lose.
Creation of an nth international coordination entity
One of the pretexts for the creation of this Fund is the coordination
of the action of financial backers. The WHO and UNAIDS
themselves have as a mandate the harmonization and coordination
of international health and AIDS policies; neither of these agencies
however manages to honour this mandate and to impose on
Member States joint action adapted to the needs of the populations.
Under no circumstances will the creation of an nth international
entity, whose mission remains deliberately vague, make it possible
to achieve this goal.
The setting up of a global Fund should not be the sine qua non for a
massive increase in financing. Rich countries do not need a global
Fund to increase by tenfold their efforts in the fight against AIDS.
On the other hand, they are likely to seize this opportunity to
continue a massive disengagement in development aid, covered up
by the launching of international initiatives that are media-worthy
rather than operational.
What the G8 hides
Policies unworthy of aid to development
For 10 years, rich countries have drastically reduced their official
development assistance (ODA), a part of which is intended for the
fight against AIDS. Rare are the countries that devote to it 0.7% of
their GNP, their minimum commitment. In France, the amount of
APD has decreased steadily since 1995 and represents today
0.31% of the GNP. As for the United States, it occupies the last
rank among OECD (Organization for Economic Cooperation and
Development) donors, with 0.1% of its GNP.
In this context, G8 countries announcements are hardly credible.
A real awareness of the seriousness of the AIDS epidemic would
impose:
- an immediate ten-fold increase in bilateral aid to the programs of
global medical care for people living with HIV/AIDS in developing
countries,
- implementation as soon as possible of the EU action plan for the
fight against AIDS, tuberculosis and malaria (this plan is still not
budgeted),
- massive financial and technical support for drug policies targeting
generics.
The refusal to question intellectual property in poor countries
The monopoly of some manufacturers on "the AIDS market" is
contrary to broad and durable access to drugs for all the patients
who need them. Today, certain countries of the South have the
capacity to manufacture copies of antiretrovirals at prices much
lower than those of the major producers. Only competition between
different manufacturers will permit a drastic and durable decrease in
the prices of pharmaceutical products - this dynamic of competition
has already obliged Western manufacturers to align their prices with
those of manufacturers of generics for a certain number of
molecules.
The Kenyan Coalition recalled this in its press release of May 27
during the visit of the American Secretary of State Colin Powell:
"one of the major reasons that explains the death of such a large
number of people is the price of antiretrovirals and other essential
drugs, which remain inaccessible. Although manufacturers of
generics sell triple therapies in certain African countries (Cameroon,
Nigeria) for USD 350 per patient per year, in Kenya, the lowest
price that hospitals have been able to negotiate is between USD
1,330 and 1,620 per patient per year"(6).
Today, patients in developing countries should be able to benefit as
soon as possible from the entire range of therapies against
HIV/AIDS at cost. The urgency of treating the millions afflicted with
AIDS in developing countries necessitates a rapid multiplication of
sources of production in countries of the South and the
development of South/South exchanges.
However, the political pressure that still surrounds the issues of
intellectual property blocks the initiatives of poor countries that
want to produce or import copies of drugs - witness, for example,
the case against Brazil recently brought before the WTO by the
United States.(7)
Thus, the breaches provided for by international agreements on
intellectual property - compulsory licenses or parallel imports - as
many parapets against the monopoly of major manufacturers,
remain unexploitable given the current balance of power.
Intimidation is the rule, and examples of aborted attempts abound.
Intellectual property rights should allow commercial exploitation of
pharmaceutical products to generate reinvestment in research and
ensure the broadest access to innovations in the health field. In
reality, patents guarantee only one thing: profits for a few
multinationals benefiting from a 20-year monopoly for the
exploitation of drugs, while restricting access to patients who can
afford them, the others depending on the sporadic charity of these
multinationals.
It is from this reality that the announcements made by rich
countries today diverts us.
Recent events at the World Assembly on Health in Geneva (May 15
- May 22) illustrate this: while Kofi Annan had just re-announced
the creation of the Fund to a room of enthusiastic Ministers of
Health, behind the scenes, Americans and Europeans were agreeing
to force Brazil or South Africa to give up the concrete resolutions
that they proposed for access to generics or strengthening health
care systems in developing countries.
Act Up-Paris requires:
- The financial involvement of G8 countries at the level
proportionate to the needs of poor countries;
- An immediate release of these funds;
- The launching by UNICEF of an international invitation to tender
open to manufacturers of generics for the wholesale purchase of
drugs intended for poor countries;
- The abolition of intellectual property everywhere it kills.
(1) UNICEF has experience with the wholesale purchase and
distribution of pharmaceutical products on a worldwide scale
and would be capable of organizing this invitation to tender.
(2) On the other hand, the debt of the United States to the WHO
is a hundred million dollars this year.
(3) "Africans do not know the meaning of time in the Western
sense. One must take these drugs at certain hours of the day,
or they do not have any effect. Many people in Africa have
never seen a clock or a watch in their life. If you give them a
certain hour in the afternoon, they do not understand what
you are talking about. They understand morning, noon and
evening and also the darkness of night. "Andrew Natsios,
director of USAID (United States Agency for International
Development), June 2001.
(4) Poul Nielson, European commissioner for development, thus
stated, on May 16, 2001, that one of the conditions for the
contribution of the European Union to the Fund was that
prevention of AIDS remains the priority.
(5) During the conference of the United Nations on June 4 in
Geneva, the WHO insisted on the fact that the funds should
be used primarily for the prevention of AIDS and treatment of
malaria and tuberculosis.
(6) The Kenyan Coalition for access to essential drugs includes:
Action Aid, The association of People with AIDS in Kenya
(TAPWAK); International Health Action (HAI Africa); Network
for People living with HIV/AIDS (NEPHAK); Women Fighting
AIDS in Kenya (WOFAK); Society for Woman and AIDS in
Kenya (SWAK); Nyumbani; International Federation of Women
Lawyers Kenya (FIDA); CARE International; Doctors Without
Borders (MSF); DACASA; Pharmacists Without Borders (PSF);
Medical Kenya Association (KMA); Consumer Information
Network; Campaigners for AIDS Free Society.
(7) The United States brought an action against Brazil before the
WTO on February 1, 2001, under the pretext that Brazilian
legislation on drugs violates international agreements. This law
provides for the granting of licenses for local production of
drugs when the companies owning the patents do not
themselves produce these drugs or that the prices charged are
abusive. This type of legislation, which is not contrary to
international agreements on intellectual property, exists in the
United States, Japan, as well as in most European countries.
In Brazil, 7 antiretroviral molecules out of the existing 13 are
currently produced by State laboratories. The free distribution of the
drugs by the government has allowed a 50% reduction in deaths
from AIDS.
Sylvain Coudret
Planet Africa
Commission Nord/Sud
Act Up-Paris
BP287
75525 Paris cedex 11, France
Tel: 01 49 29 44 75
Mobile: 06 88 77 42 46
Fax : 01 48 06 16 74
email: planetafrica@asso.globenet.org
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