E-drug: Essential AIDS Medications and Pharmaceutical Patents in India
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Appeared on. Issues in Medical Ethics. Vol. VIII. No.2. April-June
2000.
Essential AIDS Medications and Pharmaceutical Patents in India
Joe Thomas
Ninety per cent of people with HIV in India have no access to modern
pharmaceuticals, which can cost more than $10,000 per year. A
combination of denial, helplessness and complacence dominates the
issue of access to treatment for people living with HIV/AIDS in the
country.
Until recently, US drug trade policy was almost totally captive to the
pharmaceutical industry which cares little about marketing drugs in
developing countries such as India. They -- and their proxies in India --
ensured that generic versions of these medicines were not produced in
India as that might weaken its intellectual-property protection in the
US or other lucrative markets. Many Indian pharmaceutical companies
do have the technical capacity to manufacture these drugs, which
could sell for a tenth or less their current prices if it were not for
patent restrictions. While not a complete solution to the problem of
access to essential HIV medicines, this is certainly an area worth
exploring.
Many developing countries are seriously exploring the possibility of
dealing with policies related to drug sales and intellectual property
rights within the legal framework of the World Trade Organisation.
South Africa has taken a lead on this issue. These countries are at the
receiving end of a trade war unleashed by United States trade
representatives. Today, after a series of high-profile protests organised
by AIDS activists, US trade representatives have moderated their
aggressiveness against South Africa's efforts to expand access to HIV
medicine to its citizens.
However, this change applies only to South Africa. Indian AIDS NGOs,
community groups and policy makers have yet to take steps to
facilitate local production of essential HIV medication in India.
The Global Agreement on Trade and Tariffs (GATT) treaty has now
existed for about 50 years. However, the creation of World Trade
Organisation (WTO), an outcome of 'Uruguay Rounds' of global trade
negotiations, demanded that all countries impose US/European style
patents on pharmaceuticals. The result is that pharmaceutical
executives no longer look the other way if anyone, anywhere,
manufactures modern drugs without the permission of the patent
holder. Industry pressures the US government to use its great power
to force unworkable arrangements on poor countries, which cannot
possibly afford US-priced medicine, making health solutions impossible
and assuring millions of deaths.
But, the WTO treaty does include some safeguards like "compulsory
licensing" (which recognises the right of a sovereign government to
license use of a patent within its borders, in certain situations such as
a public health emergency or national security) or "parallel importing"
(which allows the governments to shop around for cheaper
medications). In the context of the HIV crisis in India the commerce
ministry should explore the possibility of using 'compulsory licensing'
of essential HIV medications.
Recently, at the opening of the 5th International conference of AIDS in
Asia Pacific, the Malaysian prime minister openly called for greater
political commitment from Asian leaders to address the issue of
'compulsory licensing of essential HIV medications in developing
countries to expand access to treatment for people living with
HIV/AIDS'.
Most protest on this issue has not been against the WTO, but against
US policy, which has gone well beyond the WTO treaty in supporting
the pharmaceutical industry's claim that its intellectual property
interests come before anyone's heath needs.
The pharmaceutical industry argues that what developing countries
need most is not drugs but medical infrastructure. Using this excuse
to retain intellectual property restrictions removes many promising
public-health options from consideration.
The pharmaceutical industry argues that without strong patent
protection, there will be no incentives to develop new drugs. In fact,
industry does much less medical research than is generally believed.
And what research they do gets tax benefits. Clinical trials are an
expensive part of medical research. Quite often, clinical trials of new
drugs are carried out in developing countries.
Another disturbing trend is the increasing influence of international
pharmaceutical industry over international AIDS service organisations
based in developed countries. The sponsorship they offer to these
organisations are part of their overall public relation efforts Staff and
leaders of these organisations have no qualms about taking this 'blood
money' as they and their loved ones do get the best treatment -- paid
by their own governments or as 'compassionate' (a compassion
restricted only for residents of developed countries!) effort from
pharmaceutical companies.
What can Indian AIDS NGOs, and community groups learn from this
issue?
Less than a year ago, the issue of pharmaceutical patents and
developing countries was nowhere on the agenda of AIDS workers.
Less than a handful of organisers in the whole region were working on
it, and almost no one had ever heard of or considered the issue. I
would like to propose the following action plan for the consideration
of the Indian AIDS NGOs, PWA groups and policy makers:
- UNAIDS and NACO should set up a working group to address the
issue of access to essential HIV medications in India
- NACO should form a technical resource group to look at the issue
of access to HIV medication for people living with HIV
- India should update the WHO's essential HIV medication list and
make this list available to health care providers
- India should shortlist the non-patented medications from the WHO
essential HIV medications list for tax rebates
- The ministry of commerce should call for compulsory licensing of
essential HIV medications in India
- The government of India should work with SAARC countries to
develop a parallel importing strategy on essential HIV medications
- Indian AIDS Activists and NGO should develop an understanding
of the issue of distribution patterns of essential HIV medications,
and evaluate the efficacy of international AIDS agencies working
India based on their commitment to the issue of access to
essential HIV medications
- India should declare the HIV/ AIDS crisis as public health
emergency.
Those who are interested to follow up these issues or interested to
get further technical briefing on issues related to how trade policies
are affecting the cost of essential HIV medicines in developing
countries, and details of the strategems and spoils of the global
pharmaceutical industry, please feel free to contact me.
I would also encourage you to join the Global Treatment Access
discussion forum (send an email to: treatment-access@hivnet.ch).
Joe Thomas
Joethomas@hivnet.ch
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