Paying for AIDS Cocktails

By Johanna McGeary

Let's say the countries in southern Africa finally mobilize the political will to take on AIDS. If they are able to use only their own money, these countries will be forced to write off those who are already infected. The best they can do is try to slow new cases through preventive education and encouraging condom use, maybe reduce transmission from mothers to babies. Hardly enough to save a continent. So figuring out how to save the millions who are infected remains an agonizing challenge.

Life-extending drugs are out there. Wealthy countries use multidrug-cocktail therapies that transform AIDS from certain killer to chronic illness and reduce its spread by making the infected less contagious. The people you just read about could stop dying if they too had access to the drugs.

Despite years of evidence of AIDS' genocidal toll on poor countries, no one has brought these drugs within reach of ordinary Africans. In fact, the people who make the drugs--American- and European-owned multinational pharmaceutical corporations--and their home governments, notably Washington, have worked hard to keep prices up by limiting exports to the Third World and vigorously enforcing patent rights. They argue that drug firms legitimately need the profits to finance research on new wonder drugs. They say it's not wise to offer cheap AIDS drugs without a proper medical infrastructure--that deadly, drug-resistant strains would emerge. But at what point does the human benefit to desperate, destitute countries outweigh strict adherence to patents and profits?

During the tug of war so far, the pharmaceuticals and Western governments have prevailed. But increasingly, poor countries and AIDS advocates are finding ways to shift the balance. India and Brazil have vigorously exploited a time lag until international patent rules apply to them, manufacturing copies of AIDS drugs and selling them at deeply discounted prices. The practice opens the door for other countries to follow suit by taking advantage of a legal loophole in global-trade rules called compulsory licensing. In effect, it lets countries breach patents during national emergencies to manufacture generic versions of AIDS drugs. So a virtually identical version of the antiretroviral combination cocktail that sells for $10,000 to $15,000 a year in the U.S. costs $3,000 in Brazil and less than $1,000 in India. And when Brazil decided to provide the generic drugs free to all its AIDS victims, it disproved the argument that poor countries couldn't master the complex regime of AIDS pills. The government set up effective clinics, and reports indicate that Brazilian patients take their medicine as meticulously as American AIDS sufferers do.

The pharmaceutical firms see local manufacture and so-called parallel imports--where other countries buy the copycat generics instead of the brand name--as a threat they are battling to wipe out. They feel that they alone should not have to pick up the tab for Africa. They want to stanch drug pirates who might make worthless fakes or flood drugs onto the black market. And they fear that making AIDS therapies cheaper for Africans will prompt lucrative Western markets to demand lower prices as well.

But the increasing activism to lower AIDS-drug prices has forced some grudging changes in boardrooms and government offices. Last May the U.S. reversed course when President Clinton, over fierce resistance from the Republican Congress, issued an Executive Order promising that the U.S. would not challenge laws in African countries that seek to improve access to AIDS drugs. For five years, UNAIDS (the Joint United Nations program on HIV/AIDS) jawboned the companies to set lower prices for developing countries. Finally, just before the international AIDS conference held last July in Durban, South Africa, five major pharmaceuticals joined an "Accelerated Access" program to negotiate 60% to 80% reductions in AIDS-drug prices for poor nations. To stave off a wave of compulsory licensing around the globe, one company has said it will match generic prices where it can't block copycat production.

On-the-ground impact from these moves in Africa is hard to find. Each country must negotiate the price of each AIDS-cocktail component with each company, and the tough bargaining has barely begun. While Senegal, for instance, might haggle prices down 75% or 80%, the therapy is still too costly at $1,200 a year for people who earn $510 a year, Senegal's per capita income. And to start, the company will provide sufficient drugs for only 800 patients over five years. Kim Nichols, policy director at the New York City-based African Services, calls it "too little, too late."

Now all eyes are on the Bush Administration. Will it stick with Clinton's order to stop blocking Africa's efforts to get cheaper drugs? Or will it give way if Republicans and drug companies apply pressure to rescind the order? So far, says a trade official, "no one has said, 'Hold your horses.'"

While access to antiretrovirals would bring a medical miracle to Africa, it would still provide no more than a holding action. Only a vaccine that could actually stamp out the virus would provide a lasting cure--and that remains tragically elusive. --Reported by Jay Branegan/Washington, William Dowell and Alice Park/New York

With reporting by Jay Branegan/Washington, William Dowell and Alice Park/New York