Philadelphia Inquirer Series Examines World Dispute Over AIDS Drugs
"As much as the dispute in South Africa [over the Medicines and Related Substances Act] is about health care, it is chiefly a titanic ideological struggle between the apostles of globalization, represented by the drug companies and the advocates of equal access to health care. The two ideologies collide when international trade rules hamper efforts to create cheap medicines," the Philadelphia Inquirer reports in a three-part series on the "global war" between drug companies and AIDS activists over drug prices and patent protection. The "public debate on AIDS" has taken "especially bizarre twists" in South Africa, where 39 drug companies have sued the government to block the 1997 Medicines Act, which would allow the government to override patent protections and produce and import cheaper generic versions of AIDS medications (Maykuth, Philadelphia Inquirer, 3/4).
The lawsuit is only the latest in a series of international occurrences that may affect how HIV/AIDS is treated around the world. AIDS activists, led by the "umbrella" group HealthGAP Coalition, have launched an "ambitious new movement in international AIDS activism" aimed at "pushing for free-market competition" between brand-name drugs and their generic equivalents, the Inquirer reports. They have branded drug prices a "moral issue," and their efforts are "vigorously opposed" by the pharmaceutical industry, which "fears that knockoff versions of AIDS medicines will undermine industry patent rights needed to generate the revenues that help finance the discovery of new drugs." Despite the industry's opposition, the Inquirer continues, activists have made "significant gains over the last year." They successfully pressured UNAIDS to "broaden" its efforts to include treatment as well as prevention and persuaded the Clinton administration to issue an executive order stating that it would not pursue trade sanctions against South Africa if it imported or manufactured generic drugs to treat AIDS. Their efforts also caused five major drug firms to announce last May the creation of a program to offer "greatly discounted" AIDS drugs in Africa, and they are continuing to lobby the Bush administration to uphold the Clinton order. The coalition -- which began when Dr. Alan Berkman assembled a group of 30 AIDS activists in New York in January 1999 -- and other AIDS activist groups are focused on the international epidemic, a "sharp departure" from the AIDS movement's "decidedly domestic agenda" over the last 15 years. At the 1999 meeting, Berkman outlined his plan, titled "A People's Call to Action Against AIDS," which stated that "all people with HIV, no matter where or how poor, were entitled to four basic things: AIDS medicines, nutritional supplements, clean water and HIV tests." Berkman turned to James Love, an expert on international trade and patent law with the Consumer Project on Technology, to help develop a plan for making affordable medications. Love "asserted" that under World Trade Organization rules, developing countries could "override" patent rights and make or import generic versions of the AIDS drugs. Asia Russell of ACT UP/Philadelphia said that because of Love's findings, "For the first time, it became clear what the U.S. government role was." By supporting patent protections, the government wasn't just being "indifferent," she said, "It was taking actions that accelerated needless suffering and death." The coalition began to increase its efforts, resulting in the Clinton executive order. But as the current lawsuit in South Africa demonstrates, activists still face "significant challenges," especially in the form of a recent trade complaint lodged by U.S. representatives with the WTO against Brazil, which manufactures its own generic AIDS drugs. "We are at the beginning of a campaign. Industry is very powerful. We haven't really seen how strong it can fight," Love said.
The Industry View
The drug industry argues that even if they "cut their prices even further -- to the level of generic AIDS medicines," the price would still be out of reach for most Africans. Company officials say they are "as troubled as the activists" about the spread of HIV and the toll the disease is taking on Africa and have discounted their prices up to 90% in some countries (Collins, Philadelphia Inquirer, 3/5). But other factors complicate the issue. Manufacturers are worried that discounted prices in developing nations may affect prices in U.S. and European markets, the "lifeblood" of the industry. They point out that South Africa, where half of the medicine in government warehouses is stolen, is "notorious as a source of black-market drugs." They also assert that in the South African case, there has been an air of "distrust and antagonism" between the government and the drug companies, which claim that the government "never attempted to negotiate discounts," but instead drafted the "adversarial" Medicines Act. The government declined offers of AZT, discounted up to 90% from its U.S. price, saying the offers were "ploys to expand market share." The government first balked at proposals to treat HIV-positive pregnant women and questioned the toxicity of nevirapine, the drug used to reduce the risk of vertical HIV transmission, but eventually decided to launch an 18-hospital pilot project in January. "The South African government has shown no indication in wanting to treat HIV/AIDS. They started out saying the problem was cost. Then we offered to discount drugs and they said they were toxic. Then they questioned the link between HIV and AIDS," Mirryena Deeb, CEO of the South African Pharmaceutical Manufacturers Association, which is the leading plaintiff in the suit, said (Philadelphia Inquirer, 3/4). Pharmaceutical makers also worry that the drugs would not be properly administered, leaving the virus free to develop drug-resistant strains. "If a willy-nilly approach produces a bunch of generic AIDS drugs in a manner that is not scientifically sound, we will have new strains of HIV, and God help us all if that happens," Henry Bale, director-general of the International Federation of Pharmaceutical Manufacturers, said.
Even if pharmaceutical companies lower prices to generic levels, as Harvard economist Jeffrey Sachs believes they will do, the question remains as to how the drugs will be financed. Sachs estimates that to treat about five million AIDS patients a year and provide preventive efforts for 500 million people would cost between $5 billion and $10 billion annually. The estimated U.S. share would be about $3 billion, or $10 per year per U.S. citizen. Sachs, who also chairs the World Health Organization's Macroeconomics and Health Committee, called on the world's wealthy nations to "pick up the tab." Pharmaceutical company officials also would like to see a cooperative effort among the companies, governments and aid agencies. "All together we have a real shot," GlaxoSmithKline CEO Jean-Pierre Garnier said (Warner, Philadelphia Inquirer, 3/6).