Dr. Yusuf Hamied thinks the Indian government should put the country “on a war footing” to tackle the HIV/AIDS epidemic that threatens to decimate his country. As evidence, he cites the three and a half thousand new HIV/AIDS cases registered every day in India – and the forecasts of 35 million HIV-infected Indians by 2003.
But there’s another battle still being fought over the way deal with the pandemic in developing countries like India: the battle over who owns the patents on the anti-retroviral drugs (ARVs) now known to prolong the lives, and minimise the suffering, of HIV sufferers the world over – where they can afford them. As the founder of the Indian drugs company, Cipla, it’s an argument Dr.Hamied is only too familiar with. Cipla produces generic copies of ARVs whose patents officially belong to pharmaceutical giants like Bristol Myers Squibb and GlaxoSmithKline. It was Dr.Hamied who offered to supply these generic drugs to HIV patients in South Africa in 2000 – at a cost of just US$350 per patient per annum, instead of the US$1,500 – US$2,000 the pharmaceutical companies were charging, forcing the companies themselves into a shame-faced retreat over their pricing. But access to ARV drugs isn’t the panacea Hamied wants it to be, argues Dr. Jan Raaijmakers of GlaxoSmithKline in the Netherlands. Without a proper health infrastructure to monitor patients and make sure they take all ARV prescriptions correctly, India faces the real risk of drug-resistant HIV, which will lead to just more deaths and misery. This week’s Life episode, Patents & Patients, explores the arguments.
Already Dr Alka Deshpande, AIDS specialist at the JJ Hospital, Bombay, says they can’t cope with the number of cases. “We don’t have adequate number of nursing staff to look after such a large number of patients. So because the family members are there, then they look after their patients.”
Dr Deshpande says that she is also seeing many young women who are innocent victims. “I’m getting an increasing number of innocent women who are HIV-infected, and the source of infection is their own husband. And they’re passing on this infection to the children.”
But there’s another battle still being fought over the way to deal with the pandemic in developing countries like India: the battle over who owns the patents on the anti-retroviral drugs (ARVs) now known to prolong the lives, and minimise the suffering, of HIV sufferers the world over – where they can afford them.
As Managing Director of the Indian drugs company, Cipla, it’s an argument Dr Hamied is only too familiar with. Cipla produces generic copies of anti-retrovirals (ARVs) and other HIV/AIDS drugs whose patents officially belong to pharmaceutical giants like Bristol Myers Squibb and GlaxoSmithKline. It was Dr Hamied who offered to supply these generic drugs to HIV patients in South Africa in 2001 – at a cost of just US$350 per patient per annum, instead of the US$10,000 – US$15,000 the pharmaceutical companies were charging, forcing the companies themselves into a shame-faced retreat over their pricing. The multinational drug companies threatened to fight the case, in court – but backed down under international pressure. And then they cut the price of their own drugs – by up to 90 per cent.
There’s nothing illegal in making generic versions – Western drugs are too expensive for many Indians. Patent laws are national laws. “There’s no one international patent law which is common for everybody,” says Dr Hamied. This is why the Indian government has allowed Indian drug producers to make generic copies of these drugs – bypassing patents on them – in an effort to ensure a viable health care system. “The multinationals – because of their monopoly, were charging ten thousand to fifteen thousand dollars per patient, per year. Until we came forward, and said ‘no’, we can give it to you at three hundred and fifty dollars. Then, when the damn thing costs two hundred or three hundred dollars, why the hell are you charging fifteen thousand dollars? Am I the thief, or are they the thief? That’s the question I’m asking you…”
Global pharmaceutical companies claim that drug patents are the only way to ensure they’ll be able to go on producing new drugs. Developing new drugs is a long and expensive process. But Dr Hamied says that this argument does not always hold water. “Half the drugs for AIDS that are marketed worldwide have not been developed by the people who are marketing the products. They’ve licensed the products in!” Also, pharmaceutical companies typically spend twice as much marketing their products as developing them. This is where they excel – at marketing new drugs, not necessarily at research and development.
But access to ARV drugs isn’t the panacea Hamied wants it to be, argues Dr Jan Raaijmakers of GlaxoSmithKline in the Netherlands. Without a proper health infrastructure to monitor patients and make sure they take all ARV prescriptions correctly, India faces the real risk of drug-resistant HIV, which will lead to just more deaths and misery.
Dr Deshpande bears this out. “See, we have already burned our fingers with tuberculosis. Now we are facing a big problem with multi-drug-resistant tuberculosis. And that is mainly because these patients – even when the drugs were given free-of-cost – did not continue the therapy for the specified period of time – that is six months to nine months. When we talk about HIV, the therapy has to be continued for years…”
Dr Hamied says that Cipla has educated 200,000 Indian doctors about HIV/AIDS, but as AIDS spreads to all parts of the country, the government health service is not prepared for the consequences. Even a city like Bombay – with 16 million people – has only eight AIDS specialists.
But the bottom line, as even Dr Raaijmakers agrees, is that if developing countries pay less money for essential drugs, then they have more to invest in their health infrastructure.
Visit the website of Dr Hamied’s firm the Indian pharmaceutical company Cipla and their AIDS update pages. YouandAIDS is the HIV/AIDS Portal for South and Northeast Asia. The National Informatics Centre is a useful source of information on Indian government programmes.
WHO’s rationale for the use of essential drugs and their Model List of Essential Drugs can be found on their Geneva website, which also has links to many other documents covering different perspectives of the debate such as differential pricing and Globalization. UNAIDS/WHO have also published a Report on the Patent situation of HIV/AIDS drugs in the developing countries.
In 2000, the Panos Institute published a report on poor countries’ access to HIV/AIDS drugs: ‘Beyond Our Means? The cost of treating HIV/AIDS in the developing world’. An Acrobat version of the complete report can be downloaded from here.
Read the online version of Carlos Correa’s seminal monograph, Integrating Public Health Concerns into Patent Legislation in Developing Countries at the South Centre website
Health Action International (HAI) is a non-profit, global network of health, development, consumer and other public interest groups in more than 70 countries working for a more rational use of medicinal drugs. Read HAI’s pages on Increasing Access to Essential Drugs in a Globalised Economy. The Consumer Project on Technology (created by Ralph Nader) has a programme on Access to HIV/AIDS Medicines. One of the best sources of up-to-date information on HIV/AIDS is the US-based Aegis website.
Some critiques of multi-national drug company practices can be found by reading the Public Citizen’s Rx R&D Myths: The case against the Drug Industry’s Research and Development Scare Card. Other perspectives to the debate can be found on the Pharmaceutical Research and Manufacturers of America, World Trade Organisation and World Intellectual Property Organization websites.