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Hanging in the balance

Peru: $20

*Nations should have the power to establish and defend intellectual property rules that protect the interests of their citizens. Trade agreements must guarantee access to essential drugs, prohibit the erosion of traditional cultures and protect indigenous knowledge and biodiversity.*

You’d never know that Jesus Culis has spent eight years living with HIV. The energetic young man appears fit and healthy and works long hours as president of PROSA, a Peruvian non-profit agency supporting HIV patients. But Jesus’ condition hasn’t always been so stable – three months ago his immune system was dangling by a thread, leaving him susceptible to a host of deadly illnesses. He began taking anti-retroviral (ARV) drugs, often called ‘the AIDS cocktail’. The results were dramatic.

Jesus Culis of PROSA, a Peruvian agency working with HIV patients. New trade treaties may block access to cheap generic AIDS drugs. Photos: Malu Cabellos

However, the medication has nasty side effects, including nausea and rashes. ‘And I can’t eat chocolate – ever,’ says Jesus wistfully. But, he adds, ‘it is the only medication that works for me. And I’ve tried everything out there.’ Antiretrovirals in the US and Canada have reduced deaths for people with HIV by about 70 per cent and improved the quality and length of life. Now a new Peruvian government programme is distributing free antiretrovirals to Jesus and other HIV patients. The initiative works because of cheap generic drugs from India and support from the Global Fund – a UN foundation which provides money to fight AIDS, malaria and tuberculosis. But Jesus worries that a free trade agreement between the US and Andean nations will cut off Peru’s supply of generics. This could be a life-or-death issue for the 76,000 Peruvians battling HIV/AIDS. Once patients begin taking antiretrovirals they must continue the regimen. Missing just one day could send Jesus’ immune system into crisis. Earlier this year, Jesus and fellow activists won an impressive victory, convincing the Government to pass a law mandating free antiretrovirals for all people infected with HIV. The programme is still desperately short of funds and understaffed. But Jesus says it is an important start. He points to the success of Brazil’s National AIDS Programme which has provided treatment to HIV patients for nearly a decade. With the help of affordable generic drugs the country averted 90,000 AIDS-related deaths from 1996 to 2002 and avoided 358,000 AIDS-related hospitalizations. This added up to a saving of more than $2 billion – proving that universal AIDS care is not just a humanitarian issue, it also makes economic sense. ‘Unfortunately, the new law won’t make any difference if the Government is unable to purchase medication after the free trade treaty is signed,’ says Jesus. Currently, generic antiretrovirals in Peru cost about $408 a year per person, compared to $4,300 for brand name drugs. That means the Government can treat 10 times as many HIV patients by purchasing generic medication. The benefits also extend to other diseases such as malaria, Chagas and tuberculosis, all of which can be treated with generics. In a country like Peru, where over 50 per cent of the population lives below the poverty line, generic medication is a lifesaver. But the transnational drug companies don’t have much patience for poverty. Big Pharma has declared war on generics and its allies in the US Government are bullying developing nations to sign trade treaties that further their interests at the expense of the world’s poor. The onslaught by Big Pharma began a decade ago when good friends at the World Trade Organ-ization handed unprecedented rights to patent holders under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The treaty blocked signatories from purchasing affordable generic medications. But in 2001 developing nations scored a counter-victory when the WTO signed the Doha Declaration, which provides loopholes to safeguard public health. Doha states that, under the TRIPS agreement, protection of public health is more important than protection of private property rights. Developing countries are allowed to override patents on essential medicines to treat epidemics and public health emergencies. If the price of a patented drug is too high and the medication is deemed ‘essential’, a government can issue a compulsory license so that other companies can make the same product at a lower cost. Thanks to Doha, the doors were opened to generic drugs for AIDS and other life-threatening illnesses. Thousands of Peruvians were able to receive treatment that was previously unaffordable. Now the US is trying to strangle Doha’s advances by negotiating bilateral and regional trade treaties with some of the world’s poorest countries. The new provisions have been nicknamed ‘TRIPS-plus’ because they are even more stringent than the original agreement. The Central America Free Trade Agreement, signed in May 2004, blocks access to generics for hundreds of thousands of Central Americans. Many of the same public health restrictions are also included in free trade agreements with Singapore, Chile and Morocco. Even more worrisome is the planned Free Trade Area of the Americas – FTAA negotiations are scheduled for completion in 2005 to cover a $13-trillion market of 800 million people. Some countries, however, are jumping the gun and negotiating individual agreements with the US. Peru has partnered with its neighbours – Colombia, Ecuador and Bolivia – to form one of Latin America’s poorest regional blocks. These Andean nations are now negotiating a free trade deal with the US. But without support from economic heavyweights like Argentina, Brazil and Chile, the Andean nations are like a flea trying to bargain with a disgruntled Texas longhorn. One of the dangerous proposals includes something called ‘patent policing’. Normally Peruvian drug authorities are concerned only with the safety and efficacy of new medications. But ‘patent policing’ would make them responsible for _enforcing_ patent rules. This takes the pressure off drug companies and puts it on the already cash-strapped Peruvian Government. Another proposal would lengthen patent terms beyond the 20 years stipulated in TRIPS. That means if better drugs – or even cures – are developed for HIV and other diseases the world’s poor will have to wait more than 20 years for affordable generic versions.

Developing countries account for 80 per cent of the world’s population but only 10 per cent of global drug sales

‘The fact that people will be denied access to new drugs that are being developed that can save lives is ethically almost unbearable,’ says Cedric Martin, head of the _Medicos Sin Fronteras_ (MSF) mission in Peru. In his Lima office Martin sits beneath a large framed poster of an expensive ring, the diamond replaced with a white pill. The poster’s slogan reads: ‘Medicines shouldn’t be a luxury.’ This May MSF launched a public awareness campaign on the threat Peru’s free trade plans pose to healthcare. But Martin says changing the public mindset is difficult – the Government and media have already sold the trade agreement as the new cure to poverty and unemployment. In his yearly speech to Congress last July Peruvian President Alejandro Toledo waved aside concerns over access to medicine, promising to be ‘especially careful’ about health and agriculture. But Martin fears such promises are empty – behind closed doors officials have told him their hands are tied. ‘They say, “we have no choice”. The US has the attitude of “you sign what we want or we’ll pull out of negotiations.”’ The passionate Frenchman is no stranger to bureaucratic struggles. After months of painstaking negotiations MSF recently began a partnership with Government health centres to provide anti-retrovirals to low-income neighbourhoods in Lima. MSF also provides ARVs to prisoners in Lima’s notorious Lurichango prison. Lurichango inmates have a seven times greater risk of contracting HIV than other Peruvians – more than 7,000 men are crowded into a prison built for 1,800. Martin likens Peru’s HIV problem to a time bomb. The prevalence rate is still low for a developing nation but it could explode into an AIDS epidemic if the new programme fails. Unfortunately, all HIV programmes in Peru – MSF’s included – are endangered by the current trade negotiations. If generic antiretrovirals are banned, Martin says it will be impossible for the Government to provide universal treatment and MSF will only be able to treat a 10th of its current patients. On the other side Big Pharma defends its monster prices, saying it needs the money to research and develop new medications.

Ana Teresa Rodríguez: more resources are needed for public health. Photos: Malu Cabellos

Martin shakes his head at such Orwellian doublespeak: ‘The pharmaceutical industry has one of the highest growth rates in the world. When they develop a really successful drug, the recovery of R&D costs is made not in years but in a few months.’ Besides, he adds, major drug firms spend 35 to 40 per cent of their budgets on marketing while research and development account for just 15 per cent. On a global scale, developing countries account for 80 per cent of the world’s population but only 10 per cent of global drug sales. The drug companies follow the profit margins, looking to develop cures for rich world ailments like hair loss, wrinkles and unwanted facial hair. Meanwhile, scourges like Chagas disease (_American trypanosomiasis_) are ignored. Chagas kills an estimated 50,000 mostly poor people in the Americas each year. Nearly 100 million people are at risk of infection and there is no treatment for the chronic stage of the disease. In 2001, only 1 of the top 11 drug companies was developing a drug for Chagas. The solution, say many activists and health professionals, is to bring drug research and development into the public sector so that governments can ensure drugs are accessible to all citizens. ‘Medicine shouldn’t be commercialized,’ says Ana Teresa Rodríguez, a health practitioner from the Dominican Republic working with PROSA in Lima. ‘Governments – not pharmaceutical companies – should decide which medi-cations are available to the population.’ More resources need to be directed towards public health. Until a better system evolves, Ana Teresa and other activists are warning Peru’s Government not to sign away their access to essential medicines. A coalition of Peruvian civil society groups, aided by MSF, has held marches, forums, vigils and protests in an attempt to raise awareness and bring pressure on the Government. They might not have their opponents’ power and wealth, but they are determined to prevent a coup of Peru’s health system by US pharmaceuticals. Their very lives may depend on the outcome.

Stephanie Boyd is a documentary film-maker and frequent _*NI*_ contributor living in Piura, Peru.

Stephanie Boyd

New Internationalist issue 374 magazine cover This article is from the December 2004 issue of New Internationalist.
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