E-DRUG: The Guardian on access to cheaper AIDS drugs
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US attempts to stop developing countries producing cheap Aids drugs
have become a political time bomb
by Sarah Boseley, Health Correspondent
The Guardain, Wednesday August 11, 1999
Al Gore's presidential bandwagon has fallen into a sudden and
unexpected mire. Two of the most powerful lobbying groups in the
United States - HIV campaigners and black rights activists - are on
his case. Gore stands accused of conspiring to help his supporters in
the rich and powerful American pharmaceutical companies at the
expense of the lives of impoverished Africans who are dying in their
millions of Aids. The issue is the price of a medicine - against the
price of a human life. Without the anti-retroviral drugs, from AZT to
Ritonavir, which have restored the HIV-positive to health in the west
and removed the terrifying spectre of Aids, the 26m people infected
in sub-Saharan Africa face illness and early death.
We have the medicines - they have the disease. Illness and early
death go hand in hand with poverty, and Aids drugs are very
expensive. If you ask a pharmaceutical company why they are
expensive, it will talk of the enormous sums of money invested in R&D
to produce them. But this is disingenuous. A best-selling drug easily
recoups this investment, while some of the drug companies are
wealthier than certain nation states. In any case, Aids drugs, such
as Ritonavir and ddI, were developed with government money and then
handed to a pharmaceutical company to produce. On the side of the
angels, some companies are donating drugs - albeit not enough and not
exactly their newest lines - to developing countries. But there is
devilish work afoot too. The American pharmaceutical industry is
attempting to stop countries such as South Africa and Thailand from
developing their own versions of Aids drugs at a fraction of the
usual price. And until this year, the World Health Organisation,
which might be expected to champion the sick and the dying, has said
it cannot interfere when trade is at stake.
For some time now, organisations such as M�decins Sans Fronti�res -
whose doctors on the ground are struggling against tidal waves of
disease in the developing world without adequate drugs - have been
trying to draw attention to the savage barter over human life going
on in the name of trade. Thanks to Al Gore's ambitions, they may
finally have succeeded. As far as American businessmen and
politicians are concerned, trade is trade and health is something
you work out in the gym. In 1997, the world trade agreements,
designed as a step towards a world free trade economy - were signed
by members of the World Trade Organisation. One of them, Trips
(Trade-Related Aspects of Intellectual Property Rights), guarantees
a 20-year patent for drugs. But there is a get-out clause: Article
31 allows a government, in the national interest, to override the
patent and produce a cheap, generic version of a medicine on payment
of "adequate remuneration" to the patent holder. The government
issues a "compulsory licence" to a local company to produce the
drug.
South Africa and Thailand, have been doing exactly that, but
have come under huge pressure - including, some say, threats - from
the American government, which is hand-in-wallet with the
pharmaceutical industry, to stop.
Thailand has produced good-quality versions of vital drugs, which
have forced multinational companies to drop their prices locally.
Pfizer used to charge $14 for a daily dose of fluconazole, an
antibiotic that can fight off a fatal form of meningitis contracted
by one in five Aids sufferers in Thailand. Last year, three local
companies began making it and the price dropped to just over $1.
Likewise the monthly cost of the Aids drug zidovudine has been forced
down, from a prohibitive $324 in 1992 to $87 in 1995. But the
Americans have borne down on Thailand with all their superior
economic might. US threats of trade sanctions - and 25% of Thai
exports go to the US - have succeeded in persuading the government to
ban compulsory licensing, in spite of the fact that Thailand will not
officially be bound by the Trips agreement until January.
In 1997, the South African government, facing the decimation of its
young people from Aids, proposed new legislation to allow compulsory
licensing. It has been in dispute with the US ever since, with Gore
leading the negotiations. It is his bandwagon that has got mired, but
it could have been anybody's. The drugs industry is lavish in its
support of both the Democratic and Republican parties.
The light now being shone on these murky goings-on may help reformers
at the WHO to get moving. Last year there was an unprecedented row at
the annual assembly when it was suggested that the WHO dirty its
hands with trade matters, with the US threatening to withdraw from
the WHO. By May this year, they had been persuaded to change their
minds and the assembly agreed to talk to the WTO. But if this talking
turns into polite chit-chat, the cause will be lost. The WHO must
champion the impoverished sick, advise developing countries of their
rights under trade agreements and send experts to point out the
loopholes and escape clauses that allow them to import or make cheap
drugs. And it must defend developing countries against US aggression
- and if necessary, shame the businessmen and politicians who put
profits before human life.
[Many issues are raised by this article:
1. Can someone confirm this Thailand story? Is the cheaper
fluconazole at 7% of the price no longer available? What companies
were producing them? Were the Thai companies using process patents to
produce the cheaper fluconazole?
2. The article is probably not 100% correct as compulsory licencing
is allowed under art 31 of TRIPS (under certain conditions), even
after Thailand will have become TRIPS-compliant.
3. TRIPS does only force countries to respect NEW patents from the
day that TRIPS becomes effective. So if the fluconazole was produced
legally under the old Thai patent regime, then they should not be
illegal under TRIPS, as they were already on the market before
Thailand became TRIPS compliant.
4. What is WHO or UNAIDS going to do to make more affordable
fluconazole, AZT and other HIVrelated drugs accessible?
5. There were suggestions that USA laws allow WHO to obtain
("compulsory") licences from the USA government for drugs developed
with US taxpayer money. Any progress on this?
6. Has any country already tried the art 31 compulsory licencing for
a patented medicine since TRIPS became operational in developed
countries (1996)?
The debate on access to essential drugs is open!
WB]
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