E-DRUG: ARV drugs for USD 350/year
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[The frontpage of NY Times today..
http://www.nytimes.com/2001/02/07/health/07AIDS.html?printpage=yes
Copied as fair use. NN]
NYTimes, February 7, 2001
Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa
By DONALD G. McNEIL Jr.
In a move that could force big drug multinationals to cut the prices of their
AIDS drugs in poor countries, an Indian company offered today to supply triple-therapy drug
"cocktails" for $350 a year per patient to a doctors' group working in Africa.
The Indian company, Cipla Ltd. of Bombay, a major manufacturer of generic drugs, made the offer to Doctors Without Borders, which won the Nobel Peace Prize in 1999 for its work in war-torn and
impoverished areas. In Africa the group sets up small pilot programs to develop models for broader
approaches to combat AIDS, and would distribute the Cipla drugs free.
As part of its program, Cipla would also sell the drugs to larger government programs for $600 a year per patient, about $400 below the price offered by the companies that hold the patents. "This is the way to break the stranglehold of the multinationals," said Dr. Yusuf K. Hamied, chairman of Cipla, who will meet with the doctors' group on Feb. 15 to discuss strategy.
For two years, Doctors Without Borders has led an aggressive campaign to force multinationals to cut prices on life-saving drugs for the world's poorest patients.
Other parties in the campaign are the Philadelphia and Paris chapters of the AIDS Coalition to Unleash Power, and the Consumer Project on Technology, a Washington group started by Ralph Nader.
The normal cost of the AIDS cocktail in the West is $10,000 to $15,000 a year. Last May five
multinationals, backed by the World Health Organization and other United Nations agencies, offered to sell their components to poor nations at sharply reduced prices.
But Cipla and other makers of generic drugs in Brazil, Thailand and other countries have not been part of the talks with W.H.O., a situation that Cipla hopes to change with its aggressive entry onto the scene.
The country-by-country negotiations about how the multinationals distribute the drugs have gone
slowly, and so far only Uganda, Senegal and Rwanda have agreements. The companies refuse to
release figures, but the cost of a typical cocktail in Senegal is $1,000 a year, according to Doctors
Without Borders.
Dr. Bernard Pecoul, director of the Access to Essential Medicines project for Doctors Without
Borders, said the Cipla offer, which he learned of only today, "will let us start up our pilot projects on a larger scale."
The doctors' group has 40 AIDS projects around the world, about half in Africa, where the infection
rate reaches as high as 36 percent. Only five of these pilot programs are giving out antiretroviral
cocktails. With the Cipla offer, or matching ones from other companies, up to 20 could be distributing the drugs by the end of year.
Cipla is offering to sell the agency as many doses as it is wants at $350 a year. Dr. Hamied said that his company would lose money at that price, but that he would supply "10,000 doses or 20,000 or 30,000, however many they want."
The $600 price to governments is near Cipla's break-even point, he said, but costs could drop with
greater production. If that happens, he would cut prices further.
In India he sells the same cocktail for about $1,100 a year. But he denied that he was trying to grab market share in Africa. "What do I want with market share?" he asked. "I don't have a monopoly, and the only way to make real money in drugs is with a monopoly. In this disaster, there is room for everybody."
Wide distribution of the drugs in Africa is not without critics, given the attendant need for careful
monitoring. Some experts argue that it would be better to spend the money on providing clean water, controlling malaria and increasing the use of condoms. But Doctors Without Borders says that the dangers and side effects of the drugs pale beside the immensity of the epidemic itself, and that Western testing standards are overcautious.
The typical AIDS cocktail is a combination of any three of about nine protease inhibitors or reverse
transcriptase inhibitors. The chemicals suppress the human immunodeficiency virus but, as with any chemical therapy, they are toxic and can damage the liver. In the West, doctors carefully monitor the levels of the drug in the blood, test for organ damage and check the levels of the virus in the bloodstream. If the virus mutates to resist the therapy, the combinations are changed. Careful
monitoring may not be possible in many African settings.
But with 25 million Africans infected with the AIDS virus, Doctors Without Borders and other agencies argue, imperfect treatment is better than none.
Dr. Pecoul pointed out that large numbers of infected Africans live in urban areas where, "with a quite simple clinic, you can deal with anti retrovirals."
He is also "not convinced" that the batteries of tests routinely ordered for Western patients are really necessary. "Some people suggest that H.I.V. testing and clinical followup can be enough," he added.
The Cipla drug combination is two tablets of 40 milligrams of stavudine, two tablets of 150 milligrams
of lamivudine and two tablets of 200 milligrams of nevirapine.
In the United States and many other countries, the Bristol-Myers Squibb Company holds the patent
on stavudine, also known as Zerit or d4T; Glaxo-Wellcome of Britain holds the patent on lamivudine, also known as Heptovir or 3TC, and Boerhinger Ingelheim G.m.b.H. of Germany holds the patent on nevirapine, or Viramune.
Western drug companies have shown themselves determined to defend their patent rights to be sole distributors throughout the world, and Dr. John Wecker, head of Boerhinger Ingelheim's efforts to negotiate cheaper prices in Africa, said he did not yet know what his company would do if Cipla
undercut its prices. "We offer a standard quality from the original manufacturer and can meet any
demand that exists out there that can be delivered with safe procedures," he said.
He refused repeatedly to say at what price Boerhinger Ingelheim sells nevirapine to Senegal or
Uganda, saying, "Affordability is an issue, but not the major issue."
Representatives from Glaxo-Wellcome and Bristol-Myers did not return phone calls, but the three
companies can be expected to wage a hard fight against the distribution of generic versions of their drugs.
Late last year, Glaxo-Wellcome threatened to sue Cipla when it tried to sell Duovir, its generic version of Glaxo's Combivir, a lamivudine/zidovudine combination, in Ghana.
Cipla offered the drug for $1.74 a day; Glaxo had cut its price to $2, from $16. But even though the
African regional patent authority said Glaxo's patents were not valid in Ghana, Cipla backed down and stopped selling Duovir.
Asked what he would do if the three drug companies sued to stop him, Dr. Hamied said: "We won't
fight it. I don't look at it as a fight. There's room for everybody. This is a holocaust in Africa. It's like
the earthquake in India right now � everybody is helping out. I'm not looking to pick anybody's
business; there's room for the multinationals at their price and room for us at our price, a partnership."
Copyright 2001 The New York Times Company
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