Dollar diplomacy

Police during the 2003 World Aids Day celebrations in Nairobi, Kenya in front of a billboard featuring Mwai Kibaki, President of Kenya, calling for a joint effort in the fight against HIV/AIDS.

Sven Torfinn / Panos /

IN May 2003, the World Health Organization (WHO) announced that it would provide the technical and organizational support to provide three million people in poor countries with antiretroviral treatment by the year 2005. A meeting convened by the US only weeks ago in Africa has attempted to undermine this proposal.

The WHO’s ‘3-by-5 initiative’ would provide treatment to only about five per cent of those in need. But it would be a major step forward, particularly because the WHO proposed a novel manner of delivering the anti-HIV medicines: combining the drugs into a ‘fixed-dose regimen’ – a combination pill containing three drugs in one capsule allowing an infected person to take only one pill twice per day for a complete HIV-treatment regimen.

Taking two fixed-dose combination pills a day for a year will cost $140 per patient, compared to about $600 per year for the normal regimen of six pills per day. So given that the reduced cost and greater ease of use will provide far more accessible HIV treatment, why hasn’t a combination pill (such as this one that the WHO proposes) been designed before?

Because HIV treatment requires a number of different types of medications, and these types are patented by different companies in the US and UK. Ideal combination pills could not be produced when one company owned the patent to a necessary chemical and another company owned the patent to a secondary component. The patents are argued as necessary to give inventors a fixed monopoly time in a marketplace to recoup costs on research and development (R&D).

But the R&D claim ignores the fact that most AIDS drugs were produced through public financing (even through the clinical trials stages), and 85 per cent of the basic and applied research for the top five selling drugs on the market were produced through taxpayer funding. According to the industry’s own tax records (obtained from the Securities and Exchange Commission), the industry overall spent 27 per cent on marketing and 11 per cent on R&D.

Meanwhile, all of sub-Saharan Africa constitutes only 1.3 per cent of the pharmaceutical market. As one former pharmaceutical executive put it, allowing generics to enter this market would result in a profit loss to the patent-based industry equivalent to ‘about three days’ fluctuation in exchange rates’.

Nevertheless, the new US AIDS ‘Czar’, Randall Tobias – the former CEO of Eli Lilly who was appointed as the first US global AIDS co-ordinator last year – has almost totally undermined the WHO plan. He and the White House initially pledged to support the initiative but no monies have flowed to date. While President Bush claimed to pledge $15 billion to global AIDS efforts during the State of the Union Address last year, it now appears that the US will only pay if US patent-based pharmaceutical manufacturers are given the money – an effective subsidy of an already heavily subsidized industry that is taxed at only one third of the rate of other equivalent industries.

On 29 March, the US Department of Health and Human Sciences convened a meeting in Botswana that questioned the WHO approval process by drawing in ‘experts’ from the patent-based industry to claim that this process – which every major academic public health expert in the field has supported – is inadequate and unsafe.

AIDS activists have responded with an open letter endorsed by 381 organizations to Ambassador Tobias condemning the meeting because it needlessly cast doubt upon the clinically proven quality of generic AIDS medicines, and the internationally recognized WHO Drug Prequalification Programme. ‘The meeting is intended to justify the use of expensive, more complex branded treatment regimens,’ says the letter, ‘and will be used by the US as the minimum basis to justify its efforts to use bilateral assistance programs to lock generics out of developing countries.’

A version of this article appeared in Pambazuka News (, a free electronic newsletter for social justice in Africa.

New Internationalist issue 376 magazine cover This article is from the March 2005 issue of New Internationalist.
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