IRIN Focus on drug debate

Delegates meeting at the 13th International AIDS Conference in Durban this week were on Monday locked in heated debates about making HIV/AIDS drugs available to the developing world, where the majority of HIV/AIDS patients live.

According to recent estimates from the UN agency UNAIDS, there are an estimated 34.3 million people globally living with HIV/AIDS. An estimated 24.5 million of them are from the world's poorest region - sub-Saharan Africa. Despite this fact, the drugs that are available to help prolong and improve the quality of life are for the most part limited to patients in the richer nations of the world.

The average price for an annual course of anti-AIDS triple therapy drugs costs US $15,000. That price tag is beyond the reach of most Africans or their governments on a continent where the overwhelming majority of people earn less than US $1 per day. Lack of access to affordable treatment is reflected in Africa's grim statistics: According to UNAIDS, the AIDS pandemic claimed 2.2 million lives in sub-Saharan Africa in 1999.

In his opening address to the Durban conference on Monday, South African High Court Judge Edwin Cameron - who last year openely declared that he was HIV positive - slammed international pharmaceutical companies as "greedy" and driven by the need to make more money. "I am one of the lucky few in this country, I am able to afford the expenive drugs that keep me alive, that allows me to experience joy on a daily basis. But the sad truth is that I have to pay to stay alive. I have to pay to experience joy," he said.

The debate

Throughout the late 1980's and the 1990's, drug companies have been bitter rivals in the market place in their quest to become the drug company of choice for HIV/AIDS patients, analysts said. They have used international intellectual property law to maintain their stranglehold on the development, manufacture, distribution and pricing of AIDS drugs. Their argument has been that allowing the infringement of intellectual property rights in the developing world would set a dangerous precedent and undermine their ability to fund research.

However, according to Medecins Sans Frontieres (MSF), public investment in AIDS drug research has been significant. Five out of six of the antiretroviral drugs MSF studied in a new report on drug pricing received public funding, and the patents for two of them are held by public authorities.

One of the more vigorous voices on drug pricing and availability has been South Africa's. In 1998, the government passed a law to allow for the local production (compulsory licensing) and parallel importation of not only HIV/AIDS drugs, but many other medicines which are simply beyond the reach of the average South African. American drug companies responded by lobbying the US Congress to impose trade sanctions against South Africa.

But in May this year, the US government seemed to have a change of heart. President Bill Clinton announced that Washington would no longer oppose countries trying to find cheaper alternatives to drugs that had been patented in the US. But these countries would still have to work within the framework of the World Trade Organisation (WTO) rules on intellectual property rights.

"When countries are barred from accessing low cost drugs due to the exclusive marketing rights of the patent holder, international organisations should actively support the efforts of developing countries to improve access through parallel imports, and voluntary and compulsory licenses," an MSF statement released on Monday said.

It cited the example of Brazil, where the government has allowed the production of quality generics and the price of AIDS drugs has fallen by 80 percent. MSF claims that through "dramatically expanded generic production and bulk purchasing", the price of antiretroviral treatment could be reduced to "as little as US $200 a year".

"We are using antiretroviral treatment in our programme here in South Africa to reduce the transmission of HIV to newborns, so we know these drugs can be safely and effectively used in a resource-poor setting," said Eric Goemaere, Head of Mission, MSF-South Africa.

"We would like to expand this programme to the treatment of adults, but we are blocked by high drug prices," he said. "We are doubtful that current approaches, including drug donations and vague promises of price reductions, will benefit our patients anytime soon. In contrast, if generics were available in South Africa, we could treat patients tomorrow."

What the drug companies say

With the upsurge in criticism against pharmaceutical companies, they have in recent months made one announcement after another on improving access to drugs. The problem, AIDS activists told IRIN, was that these donations have been made on an ad hoc basis, often for a limited period of time, and for a specific opportunistic disease.

The recent case of a donation by Pfizer to South Africa, said one activist, was a "classic example". "It was for one specific infection for two years and beyond that nothing more. What happens after that?"

On Monday, South African Minister of Health Manto Tshabalala-Msimang said that although the offer was welcome, "it was simpy not enough." She stressed that donations should not only be made to South Africa, but must consider the 80 million people in the southern African region as a whole as well. "South Africa cannot think of itself in isolation, we have to think of ourselves in relation to what is happening around us," she said.

But a senior industry source told IRIN that drug companies needed to be given incentives to bring prices down: "These are people that are largely motivated by profit and not by any sense that this is the right thing to do."

"The bottom line is that, whether we like it or not, we have to answer to our shareholders. Without them we would not be able to fund research, we would not have drugs such as AZT. We have to make money to spend money and if we lower prices we have to convince our shareholders in econmic terms that it make sense. These people could be on another planet when it comes to the AIDS epidemic in Africa. Most of them think Africa is one country," he pointed out.

"The profit margins in the developing world are very low and especially in Africa. Maybe we should start looking at alternative funding such as tax breaks if we lower prices for drugs in Africa, but we need incentives," he insisted.

The way forward?

The new MSF report, 'HIV/AIDS Medicines Pricing', urges that in parallel with the efforts of individual countries to source generic drugs, UNAIDS should develop a system to facilitate the bulk purchasing of AIDS drugs by putting out a tender to multinational pharmaceutical drug companies and local and international generic producers.

The medical aid agency cited the model of a UN vaccine and contraceptive programme. The scheme involves collaboration between international organisations, national governments and the drug industry which has created "dramatic" price differentials between developing and developed countries. For example, oral contraceptives cost US 14-23 cents per month through the United Nations, compared with US $30 in the United States, MSF said.

"Differential pricing should not have a negative effect on research and development of new treatments, especially when you consider that Africa currently only represents one percent of the world-wide drug market," said Daniel Berman, coordinator of MSF's Access to Essential Medicines Campaign. "Companies can survive and prosper if prices are lower in poor countries. More importantly, millions of lives can be saved."

The MSF report 'HIV/AIDS Medicines Pricing' is available at:
http://www.accessmed-msf.org
For the official 13th International AIDS Conference site see:
http://196.33.164.114