18th July 2000

AIDS Conference Calls for Access to Generic AIDS Drugs

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Researchers, activists, representatives of pharmaceutical companies, health care providers, health ministers and heads of state gathered in Durban, South Africa last week for the 13th International AIDS conference. One of the major topics of discussion was access to essential medicines and how the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs) affects developing countries’ abilities to gain access to those medicines.

According to Mark Heywood, the director of the AIDS Law Project in Johannesburg, “This conference is unique for its focus on treatment and barriers to treatment for people living with HIV in Africa and the rest of the developing world. We’ve always expected the worst from the [pharmaceutical companies], and now we’re just getting our act together in figuring out how to challenge their pricing policies, which put drugs out of reach for so many poor people.” Activists at the conference announced their plans to protest, lobby and sue both drug companies and governments to provide the poor with access to antiviral drugs.

On 9 July, the first day of the conference, the group Médecins Sans Frontières presented a paper entitled “Setting objectives: is there a political will?” which dealt specifically with the pricing of HIV/AIDS medicines. The paper looked at factors that influence the prices of HIV/AIDS medications, including monopoly rights, the presence or absence of generic production, internationally coordinated programs, and price/cost disconnect. The group then addressed the mechanisms that would reduce the cost of HIV/AIDS treatment, in particular the role of generic drugs and intellectual property rights, including the WTO TRIPs agreement.

According to the MSF paper, countries such as Brazil and Thailand have succeeded in pushing the prices of HIV/AIDS medicines down not by securing markdowns from pharmaceutical companies, but by producing cheap generic equivalents of patented anti-retroviral drugs locally. Daniel Berman, an MSF representative, called upon countries to allow a generic form of essential drugs to be manufactured in their country, or to impose compulsory licensing. The AIDS activist group ACT UP confirmed this, saying “there is no other solution [to the access problem] except the production of generics by local industries and the importation of those drugs in countries without production capacities.”

In closed-door meetings, officials from more than a dozen African countries hardest hit by the AIDS pandemic met with representatives from generic-drug producers from Brazil and India. However, according to Paulo Roberto Teixeira, the director of Brazil’s National AIDS program, Brazilian companies “have only a limited capacity to produce generic drugs for export.” Dr. Teixeira did say that Brazil could provide expertise if countries elect to build generic drug manufacturers.

One of the overarching concerns for both developing and developed countries is whether the importation and production of generic drugs violates WTO rules regarding patents. UNAIDS — the convener of the conference — believes that importing generic drugs into many African countries would not constitute a violation because pharmaceutical companies do not have patent protection in those countries. South Africa is an exception; many of the drugs sold there do have patent protection, but South Africa is seeking to annul the patents as a result of the health crisis (see BRIDGES Weekly Trade News Digest Vol. 4, No. 26, 4 July 2000, /html/weekly/story4.04-07-00.htm ).

According to documentation from the WTO, there are exceptions to the TRIPs rules on patentable subject matter. From a public health perspective, the important exceptions (contained in Article 27.2) are those for inventions whose exemption from patentability are “necessary to protect public order or morality, including to protect human, animal or plant life or health”. The other two exceptions are for diagnostic, therapeutic and surgical methods for the treatment of humans or animals, and for certain plant and animal inventions. Discussions at the WTO on these matters are currently gridlocked (see BRIDGES Weekly Trade News Digest Vol. 4, No. 26, 4 July 2000, /html/weekly/story3.04-07-00.htm ).

At the conference, Canada announced its support of the temporary suspension of international patent agreements to improve accessibility to AIDS drugs for poor, hard-hit countries. Canada has also backed calls for pharmaceutical companies to lower prices for developing countries, indicating that if prices come down enough, it may be willing to provide subsidies to make treatments available free of charge.

“MSF urges poor countries to continue to bring AIDS prices down,” AGENCE FRANCE-PRESS, 9 July 2000; “RIGHTS-THAILAND: Struggling to HIV Drugs Cheaper,” INTER PRESS SERVICE, 26 June 2000; “African Nations Studying Generic AIDS Drugs,” DOW JONES AND COMPANY, INC., 13 July, 2000; “Canada supports AIDS drug changes,” THE GLOBE AND MAIL, 12 July 2000; “AIDS Meeting Evokes New Sense of Urgency,” THE WASHINGTON POST, 15 July 2000; “Setting objectives: is there a political will,” ACCESS TO ESSENTIAL MEDICINES PROJECT, Medecines Sans Frontieres, 9 July 2000; ICTSD internal files.