Government officials, humanitarians and business executives have batted this question around for years, but last week Yusuf Hamied came up with an unequivocal answer. The chairman of Bombay pharmaceutical firm Cipla announced that the company would provide AIDS cocktails to be distributed through Medecins sans Frontieres, the nonprofit health organization, for a mere $350 a year for each patient. Cipla stipulates only that MSF administer the drugs free of charge. “We want to provide these drugs at an economical and affordable price to the very needy,” says Hamied. “I am confident that Cipla will be able to supply any amount of drugs that [MSF] may need.”
Hamied’s surprise announcement may provide a fillip to an ad hoc and rather haphazard campaign to get drugs more cheaply to AIDS patients in defiance of the leading drug companies. Brazil got things going in 1997 when it passed legislation protecting patent holders but reserving the right to break patents in a health emergency. In January, U.S. trade officials complained to the World Trade Organization. The law, they worry, may set a precedent that erodes patent protections in other countries as well. “This is an unfair trade practice,” says a U.S. official. The WTO convened a special panel to consider the issue. Brazil’s health minister, Jose Serra, replied last week by threatening to usurp patents of two important AIDS drugs unless the prices come down fast. He named no names, but the two costliest cocktail ingredients imported into Brazil are Nelfinavir, made by Roche, and Merck’s Efavirenz.
It’s easy to see why the Brazilians are up in arms. Steeper drug prices might threaten the health service’s ability to maintain its care and treatment of 100,000 AIDS patients free of charge. The program was started in 1994; in the last five years, AIDS deaths have halved, and Brazil has become a model for other countries around the world. But the program is expensive, with imported drugs taking a big bite. Of the $305 million it costs to administer 12 different drugs, more than half goes toward four costly imports. And that’s accounting for price reductions that Brazil has already won from drug companies, which have driven AIDS treatment costs to $4,500 a year per patient.
Elsewhere, however, progress has been markedly slower. Five big pharmaceutical companies began working with United Nations agencies last May to get drugs cheaply to poor countries. Merck, for instance, supplies Senegal with AIDS drugs at a cost of $1,000 to $1,800 a year for each patient. A lack of money and distribution problems have limited the program to only 120 patients since October. “We may have 1,000 patients in a couple of years,” says a Merck spokesman. With about 80,000 Senegalese carrying HIV, that would amount to a drop in the bucket.
Back in July, Brazilian health officials met privately with ministers from Nigeria, South Africa, India and China about exporting generics and even the know-how to make the drugs. Nothing concrete appears to have come of the talks, at least not yet, but this is just the kind of defiance the big drug companies fear.
