Lower drug costs key to disease help

By LILLIAN NG*

On his just-concluded visit to Africa, President George W. Bush captured headlines by pledging US$15 billion to help to fight the continent's Aids epidemic.

But the United States appears to be giving with one hand and taking with the other, because it is also blocking the right of poor countries to get access to inexpensive medicines that would allow them to import drugs to treat illnesses such as HIV/Aids.

The US protects its pharmaceutical industry from competing generic manufacturers by imposing strict drug-patent rules that threaten the ability of poor countries to provide affordable medicines. It is petitioning the World Health Organisation to "promote innovation in the field of public health by encouraging respect for strong intellectual property rights".

Poor countries rely on imported medicines because they cannot manufacture them, and drug patents keep them from accessing cheap generic drugs.

Central to the patent issue is the Trade and Intellectual Property Rights Agreement (Trips), allowing intellectual property laws on drug patents.

For developing a drug, pharmaceutical companies get 20 years of patent protection, enabling them to make a substantial profit. Drug patents may encourage research and the development of new and innovative drugs for modern diseases in the Western World, but they do not provide any incentive to develop essential medicines for people in developing countries.

Drug companies developed 1400 new products between 1975 and 1999, but only 13 were for tropical diseases and three for tuberculosis.

Ninety per cent of the 14 million global deaths from infectious diseases occur in developing countries, but 90 per cent of global pharmaceutical sales are to wealthy countries.

Trade ministers at the World Trade Organisation conference in Doha in 2001 negotiated the right of developing countries to have the same access to cheap generic medicines as rich countries.

Part of the Trips agreement aimed to set up a system of exemption from drug patents that would allow developing countries to override drug patents and buy generic drugs from elsewhere if they did not have the capacity to manufacture these themselves.

At the time, Doha was hailed as a public health triumph, putting people before commercial interests.

Since then, there has been a change of heart by rich countries, which have attempted to restrict the export of affordable generic medicines for a limited range of diseases.

The most visible example of the effect of competition from generic companies is anti-retroviral drugs for Aids. The drug company GlaxoSmithKline this year halved the annual cost of treatment for the anti-Aids drug Combivir.

The generic copy of Combivir, produced by Ranbaxy in India, is even cheaper - about 20 per cent less than GlaxoSmithKline's version after its price cut.

Sustained price cuts of essential medicines will come about only through competition with licensed manufacturers of generic drugs.

But more could be done.

"If GlaxoSmithKline truly wishes to contribute to the global struggle against Aids, it should provide voluntary licences for the production of patented Aids drugs in poor countries," wrote the British director of Action for Southern Africa, Euan Wilmshurst, in May.

Non-governmental organisations have criticised the US and other rich-country governments for reneging on their promises and seeking to water down potential solutions to the Trips agreement.

Organisations such as Oxfam and Medicins Sans Frontieres have described the American action as "based on an almost blind belief in the intellectual property system, without regard for the reality for patients in desperate need for newer, more effective health technologies and access to existing essential medicines".

The real therapeutic challenge to the pharmaceutical industry is to reinvigorate its efforts to treat the world's major diseases, especially in developing countries.

New public health problems with international impact, such as the emergence of Severe Acute Respiratory Syndrome (Sars), mean that access to new medicines should be universally available without discrimination.

President Bush's aid to Africa should be followed by his Administration's re-examination of the intellectual property laws on drug patents that prevent poor countries from accessing cheap generic medicines for global diseases such as Aids.

* Lillian Ng is a general practitioner in Auckland.