Brazil has a success story to share with the world. It was the first developing country to provide free antiretroviral (ARV) drugs to its HIV-positive citizens, leading to a dramatic cut in AIDS deaths. By manufacturing its own cheap generic versions of branded medicines, it took on and defeated the big transnational drug companies.
Dr André de Mello e Souza of the Pontifica Universidade Católica do Rio de Janeiro played a pivotal role in developing Brazil’s policy on HIV treatment. Its history of health activism started during the 1980s democratization process and led to healthcare being incorporated into the 1988 Constitution as the right of the citizen and the duty of the state.
‘This was tremendously important,’ he says. ‘It gave the public a legal base to demand their right to treatment. In 1996 another law was passed to give people HIV treatment free of charge.’
Brazil’s stand was controversial at the time. ‘The World Health Organization, the World Bank, the Gates Foundation were all saying “look, you have scarce resources and you have to apply them where they are most cost-effective”. They thought all the resources should be channelled towards prevention.’ But Brazil’s free-drugs policy proved to be surprisingly cost-effective. It made significant savings in hospitalization costs, saw 50 per cent fewer infections than the World Bank had predicted, and death rates from AIDS plummeted.
Brazil came under intense pressure from Big Pharma, who had hoped for huge profits from their drugs. They argued that Brazil was depriving them of income needed to fund further research and development. In reality, according to former UN Special Envoy for AIDS in Africa, Stephen Lewis, these claims were ‘highly inflated’. Such drugs are often developed in the public sector, then simply bought up and patented by pharmaceutical companies for mass manufacture: ‘The drug companies spend far more on marketing than on R&D. Big Pharma’s behaviour has been outrageous and criminally delinquent over the years.’
So why aren’t other developing nations following Brazil’s lead of manufacturing some generic drugs themselves and negotiating with Big Pharma to get fair discounts on others? Stephen Lewis thinks he has the answer: ‘Brazil is almost a superpower, with a good deal of wealth. African countries have a very limited commercial capacity to manufacture the drugs. Even if they had the resources, the US wields an intimidating power, and developing countries could face retaliation around debt or aid or trade. So they are very cautious. Brazil has been able to take a strong, enlightened stance thanks to its economic strength.’
When the US complained to the World Trade Organization that Brazil’s actions violated TRIPS (the Trade-Related Aspects of Intellectual Property Rights agreement), Brazil’s intellectual property experts pointed out that the US had similar articles in its own Patent Act. The US withdrew its complaint, but has come down much harder on other countries attempting to access generics.
Now a new problem is looming for Brazil. Within four to five years, around 15 per cent of those being treated with any HIV drug develop a resistance to it and they then need new ‘second-line’ medication. But since the first generation of ARVs came onto the market, Big Pharma have tightened up their patent protection, preventing these crucial second-generation ARVs from being manufactured generically. This makes them prohibitively expensive. There are 33 million people currently living with HIV and dying of AIDS. Whether or not lifesaving treatment will be available to them will depend on developing countries challenging Big Pharma all over again, with increased international support.