Copyright 1999 The Chronicle Publishing Co.
The San
Francisco Chronicle
View Related Topics
MAY 24, 1999, MONDAY, FINAL EDITION
SECTION: NEWS; Pg. A1
LENGTH: 2140 words
HEADLINE:
New Crusade To Lower AIDS Drug Costs;
Africa's needs at odds with firms' profit motive
BYLINE: Sabin Russell, Chronicle Staff Writer
BODY:
In the 18 years since he first showed
symptoms of AIDS, Eric Sawyer has been a fighter, battling his
own disease while agitating on the streets and in the halls of Congress for more
research and better drugs.
The payoff is an array of costly new pills
that since 1996 have helped slash the American AIDS death rate
in half, and restored vigor and good health to Sawyer and tens of thousands like
him.
Now a new cause is tapping the fresh energy and political instincts
of American AIDS veterans, whose work succeeded in changing
U.S. drug approval policy. They are helping in an international movement to let
Third World nations make cut-rate copies of the life-saving drugs.
"When
you are no longer burying your friends, you have the luxury of time to try to
save people in more remote areas," said Sawyer, a co-founder of ACT UP/New York.
"There is a tremendous sense of survivor guilt, which gives us inspiration to
fight harder."
The problem is this: At Western market prices of
$1,000 a month, the multidrug therapies are hopelessly out of
reach in the very countries hit hardest by the epidemic -- in African and other
developing nations where 90 percent of AIDS cases occur.
Activists such as Sawyer, director of a new group called the
HIV/AIDS and Human Rights Project, think they have found a
solution:
By declaring health emergencies, impoverished countries could
sidestep patent laws and produce or import these drugs at a fraction of the
cost, making them available to millions of destitute AIDS
victims -- a market that big drug companies would never touch.
But the
quest to flood Africa with cheap AIDS drugs
has run headlong into conflict with American trade policy. High level Clinton
administration officials are blocking attempts to tamper with
AIDS drug patents, saying that they undermine the entire system
of intellectual property protection that encourages businesses to find new
drugs.
One of the best examples of this new front in the battle over
AIDS drugs is South Africa, where a recently
enacted law would override pharmaceutical company patents and allow "gray
market" imports of cheap drugs from other countries.
Prescription drug
prices vary dramatically from country to country, based on deals cut by the
manufacturer. The antibiotic Amoxicillin, for example, costs 50 cents a pill in
Johannesburg, 4 cents in Zimbabwe. The South African law would let the country
pursue the lowest cost drugs on the world market.
But court challenges
have delayed the law's being put into effect. Also, U.S. officials are
threatening trade sanctions. One State Department memo to Congress boasted of a
"full court press" involving the Vice President Al Gore, Commerce Secretary
William Daley and four U.S. agencies to change the "offending" law.
"The
U.S. government has . . . made it clear that it will defend the legitimate
interests and rights of U.S. pharmaceutical firms," wrote State Department
assistant secretary Barbara Larkin in her letter to Congress.
Veteran
AIDS activists are angry. The Clinton administration, they
charge, seems content to let multinational drug companies set American trade
policy -- which is threatening access to life-saving medicines, not only in
South Africa, but also in Thailand, India and poor countries
around the world.
"Pharmacy companies are making U.S. government policy
with essentially no other voices. That has to change," said John James, editor
of the respected San Francisco newsletter AIDS Treatment News.
Drug companies have all but ignored markets in Africa.
Less than 1 percent of AIDS drugs are sold in African nations
south of the Sahara Desert, where 70 percent of new HIV infections and 90
percent of all AIDS deaths occur. Some 11.5 million people in
sub-Saharan Africa have died of AIDS since the
epidemic began.
Dr. Ian Roberts, special adviser to the South African
Health Ministry, said the United States is showing little understanding of his
country's public health catastrophe. "Medicines to treat
HIV/AIDS are far too highly priced for the mass of our people,"
he said. "With up to 16 percent of our people already HIV positive, this can be
seen as a national disaster."
Despite South Africa's
gold and diamond mines, most of its people remain poor, with an average annual
income of $2,600. "Clearly, we cannot afford retrovirals at a
cost of $1,000 per month," said Roberts.
South
Africa has emerged from the shadow of apartheid only to become
a major center of the AIDS epidemic. An estimated 3.2 million
South Africans are infected by the virus, including 45 percent of the nation's
military personnel. Most of those infected are poor and black.
Consumer
advocate Ralph Nader, who was drawn to the issue because of his long-standing
interest in pharmaceutical regulation, called the Clinton position on South
Africa "an affront to the sovereignty of Third World nations."
In a sharply worded letter to Gore, who chairs a commission on South
African trade, Nader accused the United States of abusing its superpower status:
"You have engaged in an astonishing array of bullying tactics to prevent South
Africa from implementing policies . . . designed to expand
access to HIV/AIDS drugs."
Nader's Consumer Project on
Technology advocates two steps -- both of them legal under international law --
by which poor countries can slash the cost of AIDS drugs. The
first is for poor countries to issue "compulsory licenses," granting rights to
make copies of patented drugs without the approval of the patent holder.
Compulsory licenses are permitted in health emergencies under international
trade agreements.
The second step is to allow countries to shop around
on the international market for AIDS drugs and import the
cheapest available. Forbidden in the United States, such "parallel market" or
"gray market" purchases are routinely permitted in Europe.
"Compulsory licensing will have huge effects on price,
leading to decreases of 50 to 90 percent," said James Love, director of the
Consumer Project on Technology.
But the pharmaceutical industry and the
Clinton administration take the view that compulsory licenses and gray markets
pose a threat to the entire system of intellectual property protection. Access
to AIDS drugs, they say, can be solved without destroying the
patent system.
"Patents are the lifeblood of our industry," said David
Warr, associate director of tax and trade policy at Bristol-Myers Squibb, the
New York-based maker of an array of drugs to treat AIDS and
AIDS-related infections. "Compulsory licensing and
parallel imports expropriate our patent rights."
The only beneficiary of
an erosion of patent rights, said Warr, is the generic drug industry, which does
not subsidize through its sales the costly process of research -- research that
makes new top-of-the-line therapies available. "There is a need not to fight the
firefighters," he said.
Drug makers stress that even if
AIDS medications were magically made cheaper for the African
market, the lack of an infrastructure to distribute the drugs and monitor
patients means that few would benefit.
Tom Bombelles, a spokesman for
the Pharmaceutical Research and Manufacturers Association, said patents are not
the problem. Access to AIDS drugs remains a desperate problem
in India, which does not recognize international drug patents and where
manufacturers make low-cost generic versions of AIDS drugs.
Experts in the international AIDS crisis agree that
merely lowering the price of AIDS drugs will not solve the
problem, and potentially could make the epidemic worse.
"If you spread
anti-HIV drugs in a population, but not in sufficient quantities, you are
establishing a recipe for disaster. You could make people sicker, rather than
better, and increase the possibility for development of drug-resistant HIV
strains," said Tom Coates, executive director of the University of California at
San Francisco AIDS Research Institute.
Coates said the
limited money available to fight AIDS in
Africa would save the most lives if it were directed at
prevention first. Most African nations do not even have funds to pay for testing
of the blood supply, and in 1997, only $650 million was spent
on all African AIDS programs. "If, as UNAIDS (the Joint United
Nations Programme on HIV/AIDS) has suggested, we raised
spending to $2.5 billion, we could prevent half the HIV
infections from occurring," Coates said.
By raising the patent issue,
however, activists believe they are already nudging the international
pharmaceutical industry to pay more attention to Africa. This
month, Bristol-Myers Squibb announced a five-year, $100 million
project to test AIDS drugs and improve physician training in
five African nations, including South Africa.
But angry
South African officials have dismissed the drug company program as misplaced.
The country does not have doctors to spare for training in the United States,
said Roberts, the adviser to the South African Health Ministry. And critics
consider the offer a public relations ploy. "They are getting billions more than
they should with their monopoly, so they send back a tip," sniffed Nader.
The size of the Bristol-Myers grant has nevertheless upped the ante in
the international response to the AIDS catastrophe in
Africa.
The controversies swirling around U.S. trade
policies indicates that a new front has been opened in the global war on
AIDS. Even as new AIDS medicines save lives in
the United States, they serve to underscore the appalling medical gap between
rich nations and poor.
Daniel Zingale, executive director of the
AIDS Action Council, the nation's largest lobby on HIV issues,
said the trade issues raised by Nader are looming larger. "In my view, on this
issue, Ralph Nader is right," he said. "It's clear to us the pricing of
AIDS drugs is not fair or serving the interests of most people
infected by HIV."
The effect of American trade policy on the
availability of AIDS drugs has already struck a chord on
Capitol Hill. Representative Jesse Jackson Jr., D-Ill., has introduced an
African trade bill that bars U.S. trade sanctions against countries that use
compulsory licensing or parallel imports.
And
Representative Marion Berry, an Arkansas Democrat and the only licensed
pharmacist in Congress -- who has long been a thorn in the side of U.S.
drugmakers -- is winning support with his criticism of the Clinton
administration stand.
Last week, he introduced a bill, with Republican
Jo Ann Emerson of Missouri as co-author, that would allow American wholesalers
to import drugs sold in Mexico or Canada at lower prices than those set by
pharmaceutical companies for the U.S. market.
"We're in favor of these
companies making a profit," Berry said in a recent telephone interview. "We all
want them to make as much money as possibly can. But when they make money at the
expense of someone dying, because they can't afford to buy the medicine -- well,
then it becomes a moral issue."
------------------------
CHART:
THE WORLDWIDE TOLL OF THE AIDS
EPIDEMIC CONTINUES TO RISE
.
Here are the latest U.N. estimates of new cases of infection and disease in 1998, the numbers of people living with the disease or infected by
the AIDS virus, and the cumulative totals since the epidemic
was first detected.
.
Global estimates of HIV/AIDS
Estimates as of end of 1998
.
People newly infected with HIV in 1998 5.8 million
.
Number of people living with HIV/AIDS 33.5 million
AIDS deaths in 1998 2.5 million
Number of AIDS deaths since the beginning
of the epidemic 13.9 million
.
KEY
People living with AIDS (a)
Newly infected with HIV
(infected during 1998) (b)
.
EASTERN EUROPE AND CENTRAL ASIA
270,000 (a)
80,000 (b)
.
EAST ASIA AND PACIFIC
560,000 (a)
200,000 (b)
.
WESTERN EUROPE
500,000 (a)
30,000 (b)
.
NORTH AMERICA
890,000 (a)
44,000 (b)
.
CARIBBEAN
320,000 (a)
45,000 (b)
.
NORTH AFRICA
AND MIDDLE EAST
210,000 (a)
19,000 (b)
.
SOUTH AND
SOUTHEAST ASIA
6.7 Mil. (a)
1.2 Mil. (b)
.
LATIN AMERICA
1.4 Mil. (a)
160,000 (b)
.
SUB-SAHARA AFRICA
22.5 Mil. (a)
4 Mil. (b)
.
AUSTRALIA AND
NEW ZEALAND
12,000 (a)
600 (b)
.
Source: UNAIDS
STEVE KEARSLEY/THE CHRONICLE
GRAPHIC: PHOTO, CHART: SEE END OF TEXT,
John James, publisher of AIDS Treatment News, urged a change in
U.S. policy away from protecting big drug makers and toward making medicines
more available in poor countries., / Liz Hafalia/The Chronicle
LOAD-DATE: May 24, 1999 
