In an article published by The American Enterprise Institute titled "The Real Obstacle to Sound Treatment of AIDS in Poor Countries" the authors, Roger Bate, a Visiting Fellow at the American Enterprise Institute and Richard Tren, Director of Africa Fighting Malaria (more later) do everything they can to paint patented drugs as the angels and third world countries' governments, policies and generic drugs as the devils of AIDS treatments and to suggest that it is the private sector and research institutions that are the best path to program development.
In a kind of twisted effort to show that drug patenting is an advantage and somehow makes drugs cheaper, the authors say that "research into the actual extent of drug patenting of ARV therapy in Africa and of essential drugs in most poor countries shows that drug patents rarely exist....If the "patents block access" thesis were correct, one would expect that in countries that have more drug patents, drug access would be reduced and vice versa. Yet no such relationship exists." They say that of a "total of 795 possible patents, only 172 (or 21.6 per cent) actually exist."
Okay. This boggles my mind. Drug patents rarely exist because there aren't a host of giant pharmaceutical companies inventing drugs they want to patent in these countries. The whole point in these countries is to keep prices down by using generics. Drug access is reduced for poor people when the price is too high, often the case with patented drugs. In countries with lots of patented drugs like the U.S., except for the 43 million uninsured, there is access to the patented drugs through insurance companies who, it should be noted, slash their coverage of patented drugs as soon as generics for specific drugs come on the market.
Non-patented ARVs still cost money to make, and in poor countries even the generics are expensive and delivery of drugs is also expensive and problematic. Thus, while there are still major problems of affordability of treatment, they are considerably less than they would be if only patented medications were available.
The authors rightfully point out the grave problems of infrastructure in poor countries. The response to this problem is to provide sufficient help with the development of the infrastructure. The authors point to Botswana as an example of a government they feel has shown "leadership and foresight" by cooperating with "the drug manufacturer Merck, Harvard University and the Gates Foundation." They go on to say, "Having a government that is serious about tackling disease and bulding partnerships with research institutes and the private sector to ensure that disease control is effective is clearly a crucial prerequisite in poor countries." They do acknowledge that Botswana has one of the smaller populations in Africa, but they ignore a whole lot more:
- The crisis in Botswana is horrifyingly severe. 36.5% of the 1.6 million population is estimated to be positive for AIDS, second highest rate after Swaziland in Africa. Life span, which before AIDS would have been 72 is currently 39. Botswana's President Festus Mogae said to the UN General Assembly in 2001, "we are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude." (HIV and AIDS in Botswana, www.avert.org/aidsbotswana.htm)
- Until 1997, the government response was in fact fairly limited.
- Botswana is one of the richest countries in Africa and one of the most stable and in a better position to make use of resources.
- Botswana's problems threaten to spiral out of control with all its advantages and efforts.
Bate and Tren imply that somehow building partnerships with "research institutes and the private sector" is the main key to success, and that this is done by governments that are "serious." Botswana itself is engaged in projects with many international public as well as private agencies, not just The Bill and Melinda Gates Foundation, The Merck Corporation and Harvard. It is as if Bate and Tren are suggesting you stick with your local church and don't take part in the wider world -- hey, wait a minute, that sounds familiar! Here are just a few of the more prominent organizations active in AIDS work in Africa, and some in Botswana:
- Department for International Development (DFID) -- United Kingdom government department.
- Ausaid
- The World Bank
- Actionaid
- World Health Organization (WHO)
- USAID
- Our very own President's Emergency Plan for AIDS Relief
- The Global Fund
- UNICEF
- The Clinton Foundation (Bill Clinton's)
In their article for The American Enterprise Institute, Bate and Tren manage to suggest that because some African countries add taxes and tariffs to imported drugs, patented drugs from pharmaceutical companies are somehow cheaper. Without going into detail over the specific countries and taxes, a strange list in itself, it is hard to find anyone but drug companies and their henchmen in think tanks and well-endowed Republican politicians who would make this argument. Indeed, Tren and Bate suggest that perhaps the annual price with all the taxes added in for an HIV cocktail would be "well over $300 dollars in all countries" and exceeding "$500 dollars in most" per year. Tren and Bate are challenging the Clinton Foundations's claim that it was possible to provide HIV cocktails for $140.00 a year. Let's, however, compare their prices to some current prices per year for single patented drugs. Recently Merck announced that it was reducing the price of Crixivan, a protease inhibitor, to $600 a year (10% of the U.S. cost). This is the cost for a single drug, not the combined therapy recommended and it is still higher than their worst estimate of generic drug costs.
The world of AIDS drugs is complicated and ever-changing. At present, the generics are not only challenging the patents on price but on drug delivery: they are providing fixed-dose combination pills (that is, more than one drug in a pill) which are seen as a more efficient means for delivering medications in poor countries, a method endorsed by a number of international agencies. Of course, this also is a challenge to the profits of the patented medicine makers.
Tren and Bate conclude by saying, "Ultimately, responsibility for the lack of access to medicines has to lie with poor country governments, and if diseases of poverty are to be tackeled effectively in the future, it is incumbent on them to support the institutions of a free society that can generate wealth and reduce poverty." What supreme arrogance! What supreme ignorance! What supreme dogmatism! What can I say?
Links for this article:
"The Real Obstacle to Sound Treatment of AIDS in Poor Countries," Roger Bate and Richard Ken, American Enterprise Institute. www.aei.org/publications/pubID
HIV and AIDS in Botswana, avert.org. www.avert.org/aidsbotswana.htm.
Associated Press: Experts Debate Generic Anti-AIDS Drugs, 29 March, 2004. www.accessmed-msf.org/prod/publications.asp?scntid=303200416983
"Ban on Generic AIDS Drugs Will Prove to Be Fatal Mistake," by Dr. Marge Cohen and Gordon Schiff, Chicago Sun-Times. www.phrusa.org/campaigns/aids/news050504.html
Funding the Fight Against HIV/AIDS. www.avert.org.aidsmoney.htm
"AIDS Plan Would Cut Drug Costs for Poor," by Shankar Vedantam, Washington Post Staff writer, October 25, 2003. www.washingtonpost.com/ac2/wp-dyn/A14310-2003=Oct24?language=printer
