HOUSTON A variety of motives are behind several recent drug company announcements of donations of HIV/AIDS drugs to African countries. Certainly, something needs to be done to control existing cases of HIV/AIDS, in addition to the lifestyle changes that would reduce the number of new AIDS cases. By the end of this year, 36.1 million people will be living with HIV or AIDS, according to the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO).
WHO and UNAIDS researchers have concluded that at least $3 billion annually is needed in Africa alone to cover prevention and care, including treatment of opportunistic infections in HIV-infected patients. Anti-retroviral therapy would cost several billion dollars more. Current aid efforts fall far short of this. The US is the biggest bilateral donor of HIV/AIDS aid, investing $1 billion in 75 developing countries in the past decade in prevention, education and treatment efforts. US assistance of $225 million in 2000 accounted for nearly half of the total overseas development funding to fight the disease.
"One in ten South Africans now lives with HIV/AIDS," said South African activist Nomaswazi Mlaba of the National AIDS Convention of South Africa (NACOSA). Proper administration of AIDS drug treatment can greatly reduce the loss of life according to the president of the Pharmaceutical Research and Manufacturers of America (PhRMA), Alan F. Holmer. He noted, "Since combination drug therapy with protease inhibitors was introduced in the mid-1990s, the US death rate from AIDS has dropped about 80%."
Certainly, properly administered drug therapy can reduce the human tragedy in Africa and elsewhere. Altruism, however, is far from the only reason for major pharmaceutical companies to donate HIV/AIDS drugs to African countries or make them available at low cost. Other factors include protection of AIDS drug patent rights and the economic damage caused by HIV/AIDS, which limits economic growth thereby reducing the ability of less developed countries to afford other drugs. Another motivation is the generation of good publicity, especially in the US where the high cost of AIDS drugs is widely criticized.
According to Brian Ager, Director General of the European Federation of Pharmaceutical Industries and Associations (EFPIA), patent infringement is a key concern. Donating patented HIV/AIDS drugs or offering them at greatly reduced prices could blunt competition from cheaper generic versions. This could reduce the influx of these generic drugs into the northern hemisphere as well. For example, Glaxo Wellcome opposes plans by Indian generic drugmaker Cipla to sell discounted versions of Glaxo's patented Combivir AIDS medicine in Ghana. In addition, Cipla is selling nevirapine, a patented Boehringer Ingelheim drug (Viramune) under its own trade name, Nevimune. In India, Cipla is doing nothing illegal. It received clearance from the Drugs Controller General of India to manufacture and market nevirapine for AIDS.
Without inexpensive patented AIDS drugs from western Europe and the US, pharmaceutical industry analyst, Peter Laing (SG Securities, London) believes African countries will turn increasingly to cheaper generic suppliers like Cipla despite the patent issues. Already Cipla AIDS drugs originally patented by other firms, including lamivudine, stavudine and zidovudine, have been granted registration in certain African nations according to Cipla director Amar Lulla. Cipla is able to offer AIDS drugs cheaply in part because of the low R&D costs associated with developing versions of patented drugs about which much manufacturing and clinical trial information has already been disclosed. For example, Cipla spent only around two years developing its brand of nevirapine.
Two years ago, the South African government passed a law allowing cheap, generic versions of patented drugs to be produced locally or imported without the permission of the drug companies that make them. The law never went into effect because many drug companies took South Africa to court. The companies alleged the law would violate patents, cut profits and reduce R&D.
HIV/AIDS can reduce the ability of developing countries to afford other drugs. James Wolfensohn, President of the World Bank, notes AIDS "constitutes a very big challenge for us, not just in terms of the human aspect but it's become a major development challenge if not the most important development challenge confronting us in Africa today." South Africa offers but one example. UN researchers estimate that by the year 2010, the gross domestic product will be 17% lower than it would have been without AIDS and that $22 billion will be lost. Even diamond-rich Botswana is expected to suffer major economic losses. Major pharmaceutical companies could have much more profitable trade in other drugs if the African AIDS epidemic were under control.
Another major drug industry concern is the risk of low-price medicines being re-imported into Western markets rather than being used where the need is greatest. Boehringer Ingelheim spokesperson Judith von Gordon has said her firm is concerned about re-importation of donated AIDS drugs into Europe. The pharmaceutical industry analyst Laing has voiced similar concerns. In the future, such re-importation may not even be illegal in the US. The US Congress is considering legalising drug re-importation of US-made drugs from various other countries to reduce domestic drug costs.
AIDS advocacy groups and some politicians are pressuring major pharmaceutical companies to lower AIDS drug costs in less developed countries. Winnie Madikizela-Mandela, ex-wife of former president Nelson Mandela said, "The war against AIDS begins with the struggle against the drug companies."
The HIV and AIDS Treatment Action Campaign (HATAC) lobbied Pfizer for a year to reduce the price of AIDS drug Diflucan according to HATAC co-ordinator Midi Achmat. Last summer HATAC protesters broke into Pfizer's New York headquarters demanding a meeting with Chairman William Steere but met with a less senior executive. Encouraged by Pfizer's recent decision to donate Diflucan, HATAC is now lobbying other pharmaceutical firms to reduce prices of other HIV and AIDS-related drugs.
US AIDS advocacy groups have complained vociferously about the cost of AIDS drugs in the US as well as in Africa. Donations of AIDS drugs to poor countries could blunt this criticism. Both US presidential candidates have proposed government action to reduce drug prices to senior citizens in the US. Donating AIDS drugs to Africa could reduce the pressure for Congress to move on these proposals.
While these various motivations may seem crass compared to altruism, they probably form the basis of stronger long-term commitments by the drug industry to providing affordable AIDS drugs to African countries than could altruism alone.