Global HIV Treatment: Prices, Profits and People

Effective treatment for HIV exists, but is out of reach for most people with HIV in the world. There is excitement this year, involving anticipated lowered prices for antiretrovirals in some countries. Direct action by AIDS activists continues to be critical.

Since around 1996, there have been highly effective treatments available for HIV. A handful of pharmaceutical giants own the patents for the drugs that make up highly active antiretroviral therapy (HAART) regimens. In wealthy countries, HIV is no longer a leading cause of death, although state budgets are increasingly feeling the drain of extremely expensive brand name drug spending for HIV. For the vast majority of HIV-infected people in the world, though, death from AIDS continues unabated. Millions of people are dying because they have no possibility of access to life-saving medications.

In the world of HIV science and treatment, we always talk about how quickly our understandings of the virus, the disease, and clinical treatment change. In contrast, many in the field, especially those with a stake in the pharmaceutical business, prefer to leave accepted knowledge about drug pricing and distribution fixed and impenetrable. The accepted knowledge, strongly pro-business and antisocial, has been largely controlled by the Pharmaceutical Manufacturers Association (PMA). Some NGO's and activist groups have made dents, however, in the PMA's rhetoric about drug pricing. For example, Medecins sans Frontieres (Doctors without Borders), Oxfam, HealthGap, and Cptech, among others, have produced excellent critiques and action plans to challenge corporate and political obstacles to global public health.

Three events from last week illustrate some of the forces currently in play. Prices of some brand name antiretroviral drugs, GlaxoSmithKline announced, will be discounted substantially in many countries. The International AIDS Economics Network met in Washington last Thursday and Friday to review economic data on AIDS, including some analyses of antiretroviral pricing. They will make policy recommendations to international organizations like the United Nations AIDS program, the World Health Organization and the Global Fund for AIDS, Tuberculosis and Malaria. And finally, on April 24, activists from the South African Treatment Action Campaign (TAC) led an international day of solidarity, demanding that their government implement a plan for comprehensive HIV treatment and prevention.

GlaxoSmithKline, the most significant producer of antiretrovirals, is of course seeking to maximize profits at all costs. People with HIV want access to treatment. When a person, her family, her children's teachers - entire communities - face unnecessary death and destruction, they sometimes mobilize in extraordinary ways. Such is TAC. They want treatment and they want it now.

TAC earned international attention in 2001 when the Pharmaceutical Manufacturers Association and 40 pharmaceutical companies filed suit against the South African government for planning to produce generic antiretroviral drugs protected by U.S. patents. The South African government won the lawsuit. This was a crucial victory for access to HIV treatment, because brand name HIV drugs typically cost fifty times the price of generic equivalents.

Pressure from TAC and other activists drew attention to the predatory character of drug companies and their U.S. backers in international trade negotiations. Many credit TAC and other South African activists' successful confrontation with the pharmaceutical industry for securing the Doha Declaration on TRIPS and Public Health.

The Doha Declaration was unanimously passed by the World Trade Organization in 2001. Briefly, it reaffirmed the rights of countries to protect public health by producing or importing generic drugs - this type of health measure would not be punished, under Doha, by wealthy countries as an intellectual property rights violation. Unfortunately, Bush Administration trade negotiators have reversed the U.S. position on the Doha Declaration, and are actively attacking it. Meaningful implementation is in peril.

Drug companies are lowering prices for some countries. The threat of more widespread generic drug production appears to have stimulated a rethinking of the "no differential pricing" stance among the pharmaceutical cartel members. It seems clear that they are offering steep discounts in order to maintain control of as many antiretroviral markets as possible. In the short run, this may mean a swell in antiretroviral access among poor people with HIV.

But with continued pressure from the PMA and the U.S. against generic drug production, drug pricing could be very unpredictable and uneven in the future. Short of global social production of essential medicines, generic drug competition appears to be the best way to achieve significantly reduced prices. The World Trade Organization has been blocked by the U.S. negotiators from implementing the Doha Declaration. Public health and TRIPS issues will be taken up again in September by the WTO in Cancún.

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RELEVANT LINKS:
http://www.tac.org.za/
http://www.cptech.org/ip/wto/p6/
http://www.msf.org/
http://www.globalaidsalliance.org/
http://www.healthgap.org/
http://www.iaen.org/