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The New
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June 25, 2000, Sunday, Late Edition - Final
Correction Appended
SECTION: Section 4; Page
18; Column 1; Week in Review Desk
LENGTH: 1064 words
HEADLINE:
Ideas & Trends;
Do the Poor Have a Right To Cheap Medicine?
BYLINE: By DONALD G. McNEIL Jr.
DATELINE: GENEVA
BODY:
FOR
years now, the Other War on Drugs has been fought from the thatch-roofed
hospitals of rural Africa to the travertine-clad corridors of
the United Nations' Palace of Nations here. It is a war over the sale of
life-saving medicines to developing countries. At issue are not only prices but
also implications for free trade and intellectual property
rights.
Advocates for the world's poor are mounting a powerful moral and
political campaign to make advanced medicines available much more cheaply, even
though it costs billions of dollars to research and develop them. But can
pharmaceutical corporations greatly discount their products for the poor yet
continue to finance research and show a profit? And do the poor have an absolute
moral right to such medicines, even to the point of infringing patents and
pirating drugs?
Thanks to capitalism's victory in the cold war and
pressure from the West for open markets, the world's pharmaceutical giants have
largely had the upper hand in the struggle.
That is no longer true.
The balance has shifted with the forming of an awkward coalition of
public health agencies, governments and drug makers in the third world,
advocates for AIDS patients, consumer groups and demonstrators
who disrupt world trade meetings. The battle line itself was redrawn last month
when the White House changed its position on the way poor countries adopt the
1994 Treaty on Trade-Related Aspects of Intellectual Property
Rights. Written to end piracy of consumer goods, the agreement has an obscure
section permitting patented products to be copied in emergencies. The
AIDS epidemic is such an emergency, said Michael R. Reich, a
professor at the Harvard School of Public Health. Executives can no longer focus
only on profits, he said.
"Big pharma has recognized that it has to
think more positively about access for poor countries," Professor Reich said.
If such a "health exception" to the treaty were recognized, the door
would be open to treat the forgotten epidemics of malaria, sleeping sickness and
elephantiasis as emergencies. This may be possible because of the new forces
that have entered the fray. The new director general of the World Health
Organization, Gro Harlem Brundtland, has reinvigorated an agency previously
known for its sluggishness. Doctors Without Borders, a group already critical of
the drug industry, won the 1999 Nobel Peace Prize, effectively spinning a halo
around its every utterance. Act Up, a protest organization, suddenly took up
Africa's cause and began hounding Vice President Al Gore over
his ties to the industry.
Last month, the White House issued an
executive order: it would not oppose African nations that violated American
patent law to get AIDS drugs. Did that mean the government had
actually switched sides in the debate over protecting the pharmaceutical giants?
"Protecting intellectual property rights is fundamental
to having a dynamic pharmaceutical industry," said Donna E. Shalala, the
secretary of health and human services. "But at the same time, we're recognizing
the need to drag down the costs of drugs." Ms. Shalala called it a "balancing
act."
Two days later, five pharmaceutical giants agreed to discuss
voluntary cuts in the prices of their AIDS drugs to
Africa, even cuts of 80 percent. That would reduce profits but
enable the companies to control their patents.
A week later, a
conference of world health ministers asked the W.H.O. for a database of prices
for all AIDS drugs on sale, even in countries that ignore
American and European patents, and for help in rewriting their own patent laws
so they can buy them legally.
When the 1994 treaty was written, said
Jeffrey D. Sachs, a Harvard economist who studies development in the third
world, the industry didn't have in mind "a titanic struggle for the drug market
in Tanzania -- Tanzania wasn't on the radar screen. They didn't even think about
the implications for the poorest countries, and then they ran into this growing
health disaster."
The five American, British and German companies
offering to talk about price cuts are still vague about exact numbers. The one
exception, Glaxo Wellcome, said it would cut its anti-retroviral cocktail
Combivir from $16 a pill to $2. But it has not shipped the cheaper drug yet, and
the company's representatives in Kenya recently declined to say whether Glaxo
Wellcome wanted any quid pro quo from African countries -- such as dropping
efforts to pass patent-seizure laws, as Kenya is considering. The drug companies
have traditionally put intense pressure on countries contemplating such laws.
A recently released AIDS study for the United Nations
showed that Brazilian companies were ready to sell generic anti-retrovirals at
very low prices. A Combivir equivalent was offered for $1.44, for example, and
ddC for 24 cents a pill, rather than $8.80, its American price. The drug
industry has long warned that copies may be substandard.
If the poor
actually dare to demand free drugs, can the hugely profitable industry really
afford it? The answer seems to be: up to a point.
PFIZER donates
millions of doses of Zithromax to the International Trachoma Initiative, which
treats a form of blindness common in central Africa. The
powerful antibiotic sells for up to $60 a dose in the West, and earns the
company $1 billion a year. Yet Pfizer moves cautiously in
Africa and Asia to make sure that the drug is not smuggled back
to Europe or America, undermining sales. Merck donates Ivermectin for river
blindness; Bayer gives Praziquantel for schistosomiasis, which is caused by
liver flukes. But the quantities are never sufficient, and administrative costs
are high.
If Western industry can't find a solution, it will find the
world turning to what the industry sees as its nemesis, India. There, 26,000
companies replicate everything from antibiotics to AIDS
cocktails to Rogaine and Viagra -- all legally, since Indian law recognizes
patents on processes, not products.
"We don't need to be apologetic
about it," India's secretary of health, Javid A. Chowdhury, said in an
interview. "We are a self-contained developing economy -- we live on little, but
we survive. The per-capita health budget in India is $10 a year."
But
even this generic copying must end. India recently signed the 1994 treaty on
intellectual property rights and must enforce it by 2005.
http://www.nytimes.com
CORRECTION-DATE: July 9, 2000, Sunday
CORRECTION:
An article in the Week in Review on
June 25 about the right of the poor to inexpensive medicine incorrectly
described the disease schistosomiasis. It is caused by a blood trematode, not by
a liver fluke.
GRAPHIC: Photo: Plentiful, cheap
drugs could combat epidemics in poor countries. A Kenyan father with a son ill
with malaria. (Reuters)
LOAD-DATE: June 25, 2000
