AIDS – the strange war being fought out in the favellas…

[7 May 2007 - 10h48]
[mis à jour le 9 May 2007 à 11h55]

Is it really any surprise that the Brazilian government should decide to invoke “a health emergency” – as provided for under the terms of WHO agreements – in order to acquire the essential antiretroviral drug efavirenz from generic producers in India? Or that Brazil should do so in spite of the fact that the drug is still protected by patent?

Who would find it surprising? Not the Bush administration which, in October 2001 while smoke was still seeping from ruins of the Twin Towers, challenged the Bayer laboratories’ intellectual property rights in ciprofloxacin – the only effective treatment against the anthrax bacteria from which the United States believed it was under threat.

And it wasn’t so much a question of importing drugs manufactured elsewhere but quite simply of manufacturing them on site, in accordance with the TRIPS agreements. Which, it should be said in passing, prohibited such easy access to essential drugs to any country unable to produce them – which is to say …. developing countries. It was the US again who in December 2002, alone against 143 unanimous WTO member states, used their veto to annihilate the good intentions demonstrated the previous year during the Doha negotiations.

So how can developing countries get access to treatments against AIDS? How can they achieve the objectives of the WHO’s Three by Five strategy?

By relying on the efforts of UNAIDS and the NGOs acknowledged in the Three by Five declaration which has been taken up in France by the organisation Act-Up. There is also the US President’s Emergency Plan for AIDS relief (PEPFAR), launched in 2003 by George W. Bush. However, although generously funded – 15 thousand million dollars over 5 years, which is 6 more than the Global Fund has available – it raises questions at the most fundamental level. In fact it advocates prevention rather than treatment, and appears to reserve the aid it offers to those who agree to preach abstinence. In Africa this type of approach is rapidly displaying its limitations. And it is quite possible that this is also the case in Brazil.

Of course there are still the companies…. Those which deal with all aspects of the prevention and treatment of the disease. And also the pharmaceutical laboratories that produce the antiretrovirals and sell them at heavily reduced prices to the countries concerned. Unless they grant licensing contracts to generic producers. And this is what has happened with the American firm Merck – now implicated in the Brazilian coup de force – which granted just such a licence for efavirenz to a South African generic producer. However, this licence is valid only in southern Africa and the Indian Ocean region. It can’t be used to export to Brazil, for example.

In a press release in response to the decision of the Brazilian president Lula Da Silva, Merck states that it “regrets” this decision. Nor are the company’s directors slow to underline how “chilling is the signal being sent out to industries engaged in extremely costly research … They make the point that the prices of these essential drugs “must be adjusted to the level of economic development and to the burden that HIV represents for the countries concerned”. They therefore believe that they do not need to grant a “rich” country like Brazil – which ranks 12th in terms of global economic power – the same terms as more disadvantaged countries. The pharmaceutical manufacturer, which for 20 years has fully funded more than 250 million treatments against onchocercosis (river blindness) may indeed have a legitimate point to make!

One thing is certain. In health matters, once bridges need mending it is always the patient who picks up the tab. The good news is that the Brazilian authorities and the manufacturer of efavirenz say that they are “open to resuming dialogue”. It just needs someone to start the ball rolling…

Source : WTO, UNAIDS, Act-Up, PEPFAR, Merck and C°

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