Africa & AIDS Drug Access
By John S. James
The U.S. government's use of its economic power to block almost all access to modern medicines in developing countries--stopping those governments from licensing cheaper copies of patented pharmaceuticals even when allowed by international treaties, just to maintain the sanctity of pharmaceutical patents, even when the drugs are not marketed in those countries anyway so no profit would be lost--has moved into public awareness with amazing speed.
Key events have been recent high-profile demonstrations at Vice President Gore's presidential campaign appearances, release of a State Department document detailing Gore's role in U.S. policy, and a Geneva, Switzerland meeting March 25-27, 1999, on compulsory licensing (see AIDS Treatment News #317 on the State Department document, and #314 and #317 on the Geneva meeting).
Due largely to the demonstrations against Gore, this issue is now being discussed by members of Congress and researched by journalists around the world.
Similar problems can be expected in other diseases where medical progress is rapid enough that new drugs offer major advantages. But for four years we could not find anyone who knew enough about the problem to get us started in researching it.
That changed last August, with a visit from Bob Lederer and John Riley of ACT UP/New York, who came to interest us, not knowing we were already interested; inspired by New York AIDS doctor Alan Berkman, they were helping organize the group which later became the Health GAP Coalition.
They referred us to the Web site of the Consumer Project on Technology, www.cptech.org , where we found the technical background needed for our first article, "GATT and the Gap: How to Save Lives," AIDS Treatment News #307, November 20, 1998.]
Small signs show the depth of the change. A month ago, an email list of organizers started by the Health GAP Coalition quickly grew to over 100. Yesterday, to help a friend get up to speed on the issue, we forwarded two days worth of emails- -more than 15 on this subject important enough to forward, not including some of the major email lists which we receive at a different address.
While forwarding those messages, two more arrived that needed to be sent as well--and these did not yet include any reports from the Philadelphia demonstration at Gore's campaign stop on that day (June 28; 400 people showed up on five days' notice, according to ACT Up/Philadelphia). A year ago, we had never received a single email, phone call, or letter on this subject.
Here are two statements to give our readers a sense of the issue--one regarding compassion, the other providing technical background.
Statement of Sean Strub, Founder of POZ Magazine
The following is from a talk by Sean Strub at the National Association of People with AIDS awards luncheon, hosted by Congresswoman Donna Christian-Christiansen, June 21, 1999:
On behalf of POZ Magazine, POZ En Espanol, and our staff, interns and readers, I thank NAPWA for this award.
Part of the reason we are here today is to launch National HIV Testing Day, which is next Sunday, in the hopes that it will help encourage people to become aware of their HIV status.
But for those of us most intimately involved in AIDS activism--and AIDS policy--there is another test facing us. A test of humanity, compassion and justice.
The eminent Doug Ireland wrote it succinctly in his Public Eye column in the most recent POZ, which focused on AIDS in Africa:
The Clinton-Gore "international AIDS policy is politically smart-bombing Third World countries to save profits, not people with AIDS. The administration, in cahoots with the pharmaceutical industry, is using economic pressure and political blackmail to stop developing countries from making inexpensive copies of patented AIDS drugs."
The architect of this tragic campaign is our own Vice President Al Gore, a man who professes great compassion in public but is in fact promoting murderous policies in private.
This is sadly familiar--one more person who raised the hopes of PWAs by vowing that he would do better, be more sincere, work harder to save lives but who has turned out to be, at best, I pray, only temporarily misguided.
According to Gore and other proponents of the administration's policy, it is a simple question of protecting the profits of drug companies so their financial incentive to invest further in research isn't "compromised".
I haven't yet heard them address the needs of the hundreds of thousands of people with AIDS--mostly Africans--who are being profoundly compromised by grueling AIDS deaths of the kind we, fortunately, see less often here in the states these days.
But because we see them less often in this protease era, doesn't mean we should forget what it was like to watch loved ones wither and die before our eyes. Die in pain. Emaciated. Hollow-cheeked. Without control of one's bodily functions. In shame and agony.
Those deaths are horrible memories for most of us, but daily realities for people in Africa. When I was at the Matabele AIDS Clinic in Bulawayo, Zimbabwe, last December I met people with AIDS who were determined to make sure they died on a Monday or Tuesday.
Why? Because Wednesday was funeral day in Zimbabwe. Stay-aways from work are scheduled for Wednesdays; families plan on getting together on Wednesdays; funerals are bunched together to save money. On Wednesdays.
For people who died on a Thursday or Friday or Saturday, it was more difficult--and costly--for their families to preserve the body for a Wednesday funeral.
Profits vs. people. An old battle. But the truth--and the potential solution--is more complicated. I am alive today because of a profit-driven pharmaceutical research system. I know that.
But I also know that if South Africa were to produce generic drugs--and didn't pay a penny in royalty to the developers of those drugs, which is NOT their proposal by the way--the profits of Roche, Glaxo, Bristol Myers Squibb and the others would not suffer one bit.
The cost of drugs--especially new drugs--bears virtually no relationship to the actual cost of manufacturing those drugs. Other costs--including overhead, research and marketing (including advertising in POZ) and profit margins that are the envy of the Fortune 500--all of this helps drive the costs to as high as the market will bear in the developed world. As high as the market will bear. The market for survival.
We need a different model in the less developed world, one which is based on a very different economic and political reality than that which we find in the US....
South Africa: Open Letter to Vice President Gore
Over 250 people, mostly health experts and leaders of AIDS organizations, signed the following letter to U.S. Vice President Gore; 16 of them are from South Africa. The deadline for signatures was June 30.
1. The South Africa government has indicated it wants to use compulsory licensing of medical patents to produce cheaper copies of HIV drugs and other essential medicines. This is of course legal under the WTO/TRIPS agreement, subject to Article 31 safeguards.
2. The South Africa government wants to authorize "parallel imports" of pharmaceuticals, so that it can buy drugs in the United States, Europe or elsewhere, in order to get the best world price. As you know, parallel importing of pharmaceuticals is legal under Article 6 of the WTO/TRIPS agreement, and is a common practice in Europe.
3. The South African government has approved generic versions of Taxol, a U.S. government invention for treating cancer.
As co-chairman of the U.S./South Africa Binational Commission (BNC) you have authorized a wide range of trade pressures against South Africa, much of which is documented in a February 5, 1999 report to the Congress by the U.S. Department of State.
Despite increasing criticism of the U.S. bilateral pressures on South Africa, here and internationally, your office has authorized new trade pressures against South Africa on April 30, 1999.
The April 30, 1999 announcement of a Special 301 out-of-cycle review of trade pressures against South Africa ignored every shred of information that has been provided to your office by public health groups.
Indeed, this most recent announcement is basically a recycled version of the February 16, 1999 submissions by the Pharmaceutical Research and Manufactures Association (PhRMA), the trade association that represents giant drug companies like Bristol-Myers Squibb, Glaxo, Pfizer, and Johnson and Johnson that are trying to stop South Africa from implementing policies to cut costs for pharmaceuticals in South Africa.
It is shocking that the U.S. government is adapting such an aggressive trade policy on behalf of U.S. pharmaceutical companies, when all of sub-Saharan Africa is confronted with a public health crisis of historical dimensions.
The U.S.Surgeon General, Dr. David Satcher, recently wrote in the Journal of the America Medical Association that "HIV/AIDS can be likened to the plague that decimated the population of Europe in the 14th century."
Dr. Satcher says that "in many southern African countries, HIV/AIDS has become an unprecedented emergency, with 20% to 26% of people between the ages of 15 and 49 infected." This is a here-and-now emergency. It is not a hypothetical or potential emergency. These people will die without access to pharmaceutical drugs.
Your response to this emergency should be to find ways to save lives. But look what you are doing:
You are aggressively seeking the repeal of legislation in South Africa that would permit that country to do what nations in Europe do, use parallel imports to buy drugs at the best world price.
South Africa wants to use market forces to cut drug costs. You are pushing to protect pharmaceutical companies from global competition, thereby forcing the South Africa people to pay premiums to buy drugs.
You are punishing South Africa for even speaking out in favor of compulsory licensing of HIV/AIDS and other essential medicines. The April 30, 1999 report on South Africa complains that:
During the past year, South African representatives have led a faction of nations in the World Health Organization (WHO) in calling for a reduction in the level of protection provided for pharmaceuticals in TRIPS.
In fact, everything South Africa is seeking to do is legal under the WTO/TRIPS agreement, so this and countless other statements by U.S. government officials are bald lies.
But regardless, the exercise of free speech in international forums is an astonishing basis for trade sanctions. As an elected official, indeed, as a human, how would you act if 20 percent of all sexually active young people in the United States were infected with a fatal disease, and a foreign country was trying to prevent you from purchasing drugs on the global market to save money, and was preventing you from licensing firms to manufacture life saving medicines?
Would you simply show up at the World Health Assembly and docilely applaud the actions of that country? Even if that foreign country was engaged in a relentless public relations campaign to label every legal action as a form of piracy or lawlessness?
At what point would you have the guts to tell the world the truth, and to speak out on behalf of millions of infected young men and women?
You are punishing South Africa for giving approval to generic versions of Taxol, a cancer drug that was invented by the U.S. government. There are aspects of the U.S. government complaint about Taxol that are absurd, on technical grounds, such as the insistence that South Africa extend longer periods of data exclusivity than are required in the United States. But the larger issue is more basic.
Why on earth should Vice President Al Gore or any other U.S. government employee seek to prevent global competition for Taxol, a life saving cancer drug that was invented and developed by the U.S. National Institutes of Health?
Taxol was in NIH sponsored Phase III trials before the Bush Administration gave BMS [Bristol-Myers Squibb] exclusive rights to use NIH research for drug approvals. What is the moral basis for extending the BMS monopoly on Taxol in a country that is so poor?
As the Vice President of the United States you are in a position to do much good or much harm in the world. U.S. voters will soon be asked to determine if you should be the next President of the United States. Please explain why they should choose you.
Note: As this issue goes to press, there are signs of potential movement in U.S. policy--although the outcome remains unclear.
For More Information
To help the effort to change government and industry policies on these issues, or for more information, contact the Health GAP Coalition, c/o AIDS Treatment & Data Network, 800-734- 7104, or email@example.com. The Health GAP Coalition has a Web site at: www.healthgap.org
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Copyright 1999 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.