Pressure mounts for cheaper anti-AIDS drugs

by Gumisai Mutume

Washington, 9 Feb 2001 (IPS) -- A new international AIDS lobby group intends to set up shop on the day the South African government is hauled into court by the pharmaceutical industry which is demanding the country amend laws favouring generic drugs.

Plans are at an advanced stage to launch the Global AIDS Alliance (GAA) on 5 March in Washington, in solidarity with groups fighting for access to cheap anti-AIDS drugs, especially in South Africa. The alliance is a metamorphosis of part of the highly successful international anti-debt campaign Jubilee 2000.

In Pretoria on that very day, 40 pharmaceutical companies will sue the South African government over the Medicines Amendment Act of 1997, which permits the importation of cheap generic anti-AIDS drugs into South Africa, a country where one in five adults is believed to be HIV-positive.

The Act also calls for the creation of a committee to monitor drug prices and compel pharmaceutical companies to justify their prices. It proposes that doctors prescribe generic versions in place of brand-name drugs whose patents in South Africa have expired.

“Generic drugs are key” to an effective response against AIDS, says Paul Zeits, a public health doctor who is part of GAA. “The response to AIDS so far has been inadequate. This is the year for political momentum.”

GAA intends to raise at least $4 billion annually for HIV/AIDS programmes in sub-Saharan Africa in much the same way Jubilee 2000 campaigned for debt reduction. GAA intends to raise part of this from the US Congress, lobbying for the appropriation of $2 billion to be channelled through agencies such as the US Agency for International Development and the World Bank.

Access to cheap drugs for the millions of poor people in developing countries with HIV/AIDS is fast emerging as a hotly debated issue, with activists likening major drug companies to business hawks, sitting on and safeguarding their profits while millions die.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 36 million people are HIV-positive worldwide and 25 million of them are in sub-Saharan Africa.

While there is a provision in the World Trade Organisation’s (WTO) intellectual property rights agreement to allow the importation of cheap drugs or the manufacture of generic versions in the event of a national emergency, pharmaceutical firms are not pleased with the local production through compulsory licensing of their drugs.

South Africa is one of the thorns in the side of the international drug industry because of its insistence that it be permitted to use all means necessary to obtain cheap drugs, even if international patents are disregarded.

The lawsuit against South Africa presents an interesting test case as it may hold the key to whether African countries will in future be permitted to import cheap generic drugs. If South Africa loses, it may face costs amounting to millions of dollars from the companies which have been opposing the act since 1998.

In a statement this week, South Africa’s health minister Manto Tshabalala-Msimang said that cutting the prices of anti-retroviral drugs is not a panacea to the country’s AIDS crisis, but is an important aspect of a broader AIDS programme.

“Provision of care for HIV/AIDS-related conditions must consider other critical elements such as health infrastructure, laboratory support and other requirements for close monitoring of patients that would ensure the drugs are safely and effectively administered,” she said.

One of the main demands of emerging trade agreements is the protection of intellectual property rights, strongly pushed and enforced by western countries such as the USA and UK. The WTO’s TRIPS agreement, for instance, requires signatories to grant patent protection on drugs for 20 years.

But the drugs are expensive for many poor Africans whose per capita incomes average 500 dollars. The cost of annual treatment with the triple-therapy cocktails, which have proven effective in inhibiting the development of HIV into AIDS, is between $10,000-15,000 per person in the United States.

Last year, five major pharmaceutical companies, Glaxo Wellcome, Merck, Boehringer Ingelheim, F. Hoffmann-La Roche and Bristol Myers Squibb, began offering discounted prices to African nations through agreements negotiated secretly and whose terms highly limit the reach of the drugs.

The companies have refused to disclose the details of the arrangements, but some of the conditions include rigorous monitoring of patients taking the drugs, which writes off poor rural areas that do not have monitoring facilities.

So far, only Rwanda, Senegal and Uganda have signed on to the programme, known as the “Accelerating Access” initiative. Senegal is paying between $1,000 and $1,800 per treatment for each person annually under the programme, notes Doctors Without Borders - more than three times the price of the generics, but much lower than the US cost.

Dr Mohammed Abdullah, chair of Kenya’s AIDS control council, has however discounted the offer from the drug companies as “cynical” and “hypocritical” because they only reduce prices to European levels, which the majority of Kenyans cannot afford.

The stakes were raised this week when an Indian company, Cipla, offered to sell generic versions of a triple-therapy drug cocktail for $350 per annual treatment to 20 programmes in Africa run by Doctors Without Borders (known by its French acronym as MSF). Cipla said it would be willing to sell the drugs to African governments for $600 per person.

The $350 price is a discount of 96.6% off the price of the same combination in the United States, which is about $10,400, noted MSF in a statement in which it accepted Cipla’s offer.

On World AIDS Day last year, MSF challenged the five companies to lower their US prices by at least 95 percent. MSF is now urging the five pharmaceutical companies involved in the Accelerating Access initiative to match Cipla’s offer.

Mark Grayson, spokesman for the Pharmaceutical Research and Manufacturers of America (PhRMA) in Washington DC, however, says the Cipla deal will not alter the current market situation and the pharmaceutical companies have already gone a long way towards accommodating Africa’s needs through the Accelerating Access initiative.

While Africa only accounts for about 1% of the five major drug companies’ global market, the firms fear that cheap generic anti-AIDS drugs in the developing world may leak back onto high-price markets in Europe and North America. They also fear the move may push up latent demand for cheap generic drugs in the industrialised countries.

Less than 1% of the 25 million people infected with HIV/AIDS in Africa are currently receiving anti-retroviral drugs, yet these medicines have been proven effective in prolonging lives in western countries.

Independent economist Ed Deak blames the current dominant economic ideology, which places heavy emphasis on market forces. He says:

“People will have to understand once and for all that the main purpose of this commercial version of globalisation is the protection of corporate profits and the speculative value of certain currencies on the money markets. The majority of the profits of major multinationals now comes from the money markets. It is no use talking about community help until the question of the blackmail and stranglehold of these agreements, supported and enforced by the WTO, World Bank and International Monetary Fund, is broken.”