AIDS, Drugs and Africa

The announcement yesterday that Bristol Myers-Squibb has relaxed patents in Africa on two of its AIDS drugs, partially as a result of protests from students at Yale University (Yale holds the patent on one of the drugs) on the surface, appears to be a victory for those seeking to fight the AIDS crisis in Africa. However, even if every pharmaceutical company in the world followed Bristol Myers-Squibb's example, serious questions remain over the short and long-term effectiveness such an approach would have in addressing the AIDS epidemic in Africa.

Actually, Bristol-Myers Squibb is not the first drug company to embark on a strategy designed to make AIDS drugs cheaper for impoverished Africans and their governments to purchase. In just the last week the Ivory Coast announced that it would purchase AIDS drugs from Merck, GlaxoSmithKline and Bristol-Myers Squibb at greatly reduced costs. Some believe the discounts may be as great as 85%.

And the Ivory Coast is not alone; many of the major drug companies have offered drugs, at reduced prices, to numerous African nations.

However, African governments and their citizens maintain that even at these reduced prices they are still unable to afford the drugs.

The numbers do appear to support the African claims. While some drug companies are willing to provide drugs that cost Americans $10,000 a year to Africans at $600 per year, the drugs are still out of the reach of Africans in nations with unemployment rates over 50% and where the purchasing power of low wages are eroded by inflation of as much as 300% a year, in places like the Congo. And this does not mention the excessive tax burden, which confiscate the earnings of people in countries like Zimbabwe, where marginal tax rates are as high as 60%.

Naturally, others have begun to step in where there exists a gap between the prices charged by pharmaceutical companies and what Africans can actually afford.

India's drug manufacturer, Cipla Ltd., which generically "reproduces" high-cost drugs and sells them at reduced prices in India, has offered to do the same in South Africa if it is granted 8 compulsory licenses from the government. Cipla says that it can provide a standard AIDS drug-cocktail for as little as $350 a year in S. Africa.

However, S. Africa, where as many as 1 in 5 adults are HIV positive, is unlikely to grant the licenses due to the pressure it is receiving from pharmaceutical companies whose business is threatened by generic drug companies like Cipla.

39 of the major drug companies are currently suing the South African government in order to keep it from passing a law that would allow "bootleg" generic drugs to be produced in the country.

Advocates of the S. African proposed law believe that the increased competition between generic companies and major pharmaceuticals could bring the cost of AIDS drugs down to $200 a year.

Others are skeptical about that and want the intellectual property rights and patents of the major pharmaceutical companies to be respected in Africa. Harvard Professor Jeffrey Sachs says that the solution may be found in having the United States and the more economically developed world finance the purchase, or part of the purchase, of AIDS drugs at the reduced prices offered by the major pharmaceuticals for Africans. He says that such action can be accomplished with a few billion dollars from several nations and could result in millions of lives being saved.

Some see merit in Sachs' proposal while others believe that he is running interference for the major pharmaceutical companies who fear the growth of the generic drug making industry in the developing world, especially in the few years remaining before World Trade Organization (WTO) regulations effectively put the generic drug industry out of business.

Whether the drugs are offered by generic drug companies or by the major drug companies, African nations have so many basic infrastructure and resource problems that it is doubtful that many of the drugs would ever reach their intended targets or be administered and taken properly.

In addition, the emphasis on costly drug cocktails sold by the pharmaceuticals and "reproduced" by the generics, continues a not-so-subtle war against natural alternatives that have proven to be effective against HIV and AIDS but whose continued clinical trials and sale have been fought tooth and nail by the pharmaceutical establishment and regulatory agencies throughout the developed world and in Africa.

Many recognize that the rush to cut the prices of expensive AIDS drugs in Africa is not just for the sake of appearance, but it is also part of an effort to further undermine the popularity and development of effective alternative treatments and therapies that have begun to spread throughout the world.

And lastly, the question of the role that poverty, in a variety of forms, plays in the spread of AIDS has to be addressed. Education and prevention have to become as high a priority as drug treatment. And the implementation of fiscal and monetary policies that foster economic development and growth is a necessity if Africa is ever to leave behind the environment that provides fertile ground for the spread of AIDS.

While offering AIDS drugs on the cheap may look good on paper and sound good in the world of public relations, if the actions don't result in an end to the scourge of AIDS on the African continent, they haven't accomplished anything.

The war on AIDS has to be measured in terms of the amount of lives, and not dollars, that are saved.

Cedric Muhammad

Thursday, March 15, 2001