E-DRUG: Brazil pushes AIDS fight Beyond Borders
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[a review of CNN of Brazil's efforts to supply free ARVs to
its HIV+ people. Copied as fair use. Crossposted from
Pharm-Policy with thanks.
http://www.cnn.com/2001/WORLD/americas/04/26/health.brazil.aids.reut/index.html
NN]
Brazil pushes AIDS fight beyond borders
April 26, 2001
RIO DE JANEIRO, Brazil (Reuters) -- Little about the Evandro Chagas
Hospital housed in a sagging castle or the crumbling brick walls of the
Far-Manguinhos drug laboratory suggest that Brazil is on the cutting
edge in the fight against AIDS.
But inside the shabby buildings, doctors, scientists and government
officials have turned Brazil's AIDS program into a model for developing
countries around the world and a beacon of hope for AIDS activists in
industrialized nations.
And now, Latin America's biggest country is leading a fight to ensure
all developing nations, from South Africa to Haiti to India, are
guaranteed access to cheap AIDS drugs.
In a first step, the U.N. Human Rights Commission backed on Monday a
Brazilian resolution calling on all states to promote access to AIDS
treatment.
When the AIDS crisis exploded on the global health scene in the 1980s,
Brazil was seen as one of its main casualties. But within a decade,
Brazil stopped the disease in its tracks.
At the heart of Brazil's success is a program which provides AIDS drugs
free of cost, and the country's decision to start manufacturing them
rather than pay high industry prices.
"We can show developing countries that fighting AIDS is possible even in
the conditions that these kind of countries face," said Paulo Teixeira,
the director of Brazil's internationally hailed AIDS program.
"We are already negotiating with numerous African countries to provide
technical and practical assistance," he said.
And the thousands of Brazilians who never expected to be alive in 2001
are proof that a third-world country can give AIDS a first-world
treatment.
The right to live
"The doctor didn't bet anything on my survival," said Sonia Maria
Fonseca, who was diagnosed with the HIV virus in 1993, just a few days
after her husband died of what doctors initially thought was pneumonia.
"It was like being struck with one bomb after another," the elfin former
public servant said. By 1997, Fonseca was stretched out in a hospital,
weighing just 77 pounds .
But then, as part of Brazil's new AIDS program the Evandro Chagas
Hospital started treating Fonseca with a triple cocktail -- the
combination of antiretroviral drugs that has given AIDS victims around
the world a second shot at life. Instead of paying up to $15,000 a year,
Fonseca received them for free.
"I wouldn't be alive if it weren't for the program. I couldn't have
afforded the treatment," Fonseca said. "But it just seems to me that
everybody has the right to live."
Fonseca is just one of 95,000 Brazilians treated under the program --
which combined with aggressive prevention efforts has kept HIV infection
to less than one percent of the population in Brazil, contradicting dire
forecasts.
In absolute numbers, Latin America's largest country suffers from a high
rate of AIDS infection, with 200,000 cases of HIV registered and
estimates of up to 540,000 total cases.
But it has become a model in the AIDS fight with only 0.6 percent of the
adult population infected. That compares with an estimated 36 percent of
infection in Botswana, the world's highest rate, and about 20 percent in
South Africa.
Brazil spends $300 million a year to offer free treatment and drugs, but
says the program more than pays for itself by reducing hospitalizations,
cutting transmission rates and enabling thousands of people to remain in
the workforce.
United States cries foul
The program isn't without its critics.
To bring prices on AIDS drugs down, Brazil started urging state
laboratories to produce at least those drugs that were commercialized by
May 1997 -- which aren't protected under Brazil's patent law -- and now
Brazil makes eight of the 12 antiretroviral drugs used in the so-called
AIDS cocktail.
With heightened competition, the price of those drugs has plummeted 80
percent. A typical treatment now costs about $4,400 a year compared to
up to $15,000 in the United States.
To bring prices down even more, Brazil said last year it would violate
the patents on the remaining four drugs if their makers didn't offer to
lower prices themselves, a step which officials said would not break any
laws.
Brazil requires foreign firms to manufacture drugs -- or any other
patented product -- within Brazil or lose that right to a local
competitor after three years. Brazil can also get compulsory licenses to
produce drugs when a national emergency is invoked, paying royalties to
the patent holder.
Brazil's stance has pitted it against drug companies and the United
States, which spurred the World Trade Organization to establish a
dispute panel to look at Brazil's patent law.
The U.S. government and drugs companies say they do not object to
Brazil's AIDS program, but to its patent laws. Without patents,
companies would have no incentive to research new medicines, they say.
"We support Brazil's leadership in the AIDS fight," said Greg Reaves, a
spokesman for U.S. drug maker Merck and Co . "But we believe patent
protection and affordable pricing are compatible."
Global commitment
But Brazil has not backed down. Eloan dos Santos Pinheiro, the feisty
scientist in charge of research and drug development for the country's
AIDS program, was preparing to produce two patented drugs in June
despite the WTO investigation.
"We can't be at the mercy of these big multinationals," Santos Pinheiro
said from her office at Far-Manguinhos state laboratory, a cluster of
squat, crumbling buildings in a working class Rio neighborhood that
looks more like a brick factory than a cutting-edge research center.
The U.N. resolution passed this week was seen as a victory against
Washington. It called on all countries to ensure "that the application
of international agreements is supportive of public health policies
which promote broad access ... to affordable pharmaceuticals and medical
technologies."
Brazil rallied the support of 52 countries with only the United States
abstaining.
On the home front, Brazil celebrated another victory when Merck agreed
last month to slash prices on Efavirenz, one of the drugs Far-Manguinhos
was going to make, by 59 percent.
But Brazil says that the battle has only just begun and is pushing for
an international accord that would spell out guarantees of low drug
prices for developing countries and the right to manufacture drugs in
emergencies.
The accord, which Brazil has pitched to the United Nations and the WTO,
would also commit rich countries to providing technical support and AIDS
research for developing economies and to creating an AIDS fund.
"These issues now have to become a global commitment not just isolated
victories," Teixeira said.
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