E-DRUG: Time Magazine on AIDS drugs in Africa
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[Another big USA newspaper on the access problem. Time thinks that the
balance of power is slowly shifting towards developing countries.
http://www.time.com/time/2001/aidsinafrica/drugs.html
Crossposted from Pharm-Policy with thanks. Copied as fair use. NN]
Paying for AIDS Cocktails
Who should pick up the tab for the Third World?
By Johanna McGeary
Let's say the countries in southern Africa finally mobilize the
political will to take on AIDS. If they are able to use only their own
money, these countries will be forced to write off those who are already
infected. The best they can do is try to slow new cases through
preventive education and encouraging condom use, maybe reduce
transmission from mothers to babies. Hardly enough to save a continent.
So figuring out how to save the millions who are infected remains an
agonizing challenge.
Life-extending drugs are out there. Wealthy countries use
multidrug-cocktail therapies that transform AIDS from certain killer to
chronic illness and reduce its spread by making the infected less
contagious. The people you just read about could stop dying if they too
had access to the drugs.
Despite years of evidence of AIDS' genocidal toll on poor countries, no
one has brought these drugs within reach of ordinary Africans. In fact,
the people who make the drugs � American- and European-owned
multinational pharmaceutical corporations � and their home governments,
notably Washington, have worked hard to keep prices up by limiting
exports to the Third World and vigorously enforcing patent rights. They
argue that drug firms legitimately need the profits to finance research
on new wonder drugs. They say it's not wise to offer cheap AIDS drugs
without a proper medical infrastructure � that deadly, drug-resistant
strains would emerge. But at what point does the human benefit to
desperate, destitute countries outweigh strict adherence to patents and
profits?
During the tug of war so far, the pharmaceuticals and Western
governments have prevailed. But increasingly, poor countries and AIDS
advocates are finding ways to shift the balance. India and Brazil have
vigorously exploited a time lag until international patent rules apply
to them, manufacturing copies of AIDS drugs and selling them at deeply
discounted prices. The practice opens the door for other countries to
follow suit by taking advantage of a legal loophole in global-trade
rules called compulsory licensing. In effect, it lets countries breach
patents during national emergencies to manufacture generic versions of
AIDS drugs. So a virtually identical version of the antiretroviral
combination cocktail that sells for $10,000 to $15,000 a year in the
U.S. costs $3,000 in Brazil and less than $1,000 in India. And when
Brazil decided to provide the generic drugs free to all its AIDS
victims, it disproved the argument that poor countries couldn't master
the complex regime of AIDS pills. The government set up effective
clinics, and reports indicate that Brazilian patients take their
medicine as meticulously as American AIDS sufferers do.
The pharmaceutical firms see local manufacture and so-called parallel
imports � where other countries buy the copycat generics instead of the
brand name � as a threat they are battling to wipe out. They feel that
they alone should not have to pick up the tab for Africa. They want to
stanch drug pirates who might make worthless fakes or flood drugs onto
the black market. And they fear that making AIDS therapies cheaper for
Africans will prompt lucrative Western markets to demand lower prices as
well.
But the increasing activism to lower AIDS-drug prices has forced some
grudging changes in boardrooms and government offices. Last May the U.S.
reversed course when President Clinton, over fierce resistance from the
Republican Congress, issued an Executive Order promising that the U.S.
would not challenge laws in African countries that seek to improve
access to AIDS drugs. For five years, unAIDS (the Joint United Nations
program on HIV/AIDS) jawboned the companies to set lower prices for
developing countries. Finally, just before the international AIDS
conference held last July in Durban, South Africa, five major
pharmaceuticals joined an "Accelerated Access" program to negotiate 60%
to 80% reductions in AIDS-drug prices for poor nations. To stave off a
wave of compulsory licensing around the globe, one company has said it
will match generic prices where it can't block copycat production.
On-the-ground impact from these moves in Africa is hard to find. Each
country must negotiate the price of each AIDS-cocktail component with
each company, and the tough bargaining has barely begun. While Senegal,
for instance, might haggle prices down 75% or 80%, the therapy is still
too costly at $1,200 a year for people who earn $510 a year, Senegal's
per capita income. And to start, the company will provide sufficient
drugs for only 800 patients over five years. Kim Nichols, policy
director at the New York City�based African Services, calls it "too
little, too late."
Now all eyes are on the Bush Administration. Will it stick with
Clinton's order to stop blocking Africa's efforts to get cheaper drugs?
Or will it give way if Republicans and drug companies apply pressure to
rescind the order? So far, says a trade official, "no one has said,
�Hold your horses.'"
While access to antiretrovirals would bring a medical miracle to Africa,
it would still provide no more than a holding action. Only a vaccine
that could actually stamp out the virus would provide a lasting cure �
and that remains tragically elusive.
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