24 February 2001
opinion
Nairobi — The offer last week by an Indian company, Cipla, to supply cheap Aids drugs to developing countries, including Kenya, at near rock-bottom prices, has suddenly thrust the issue of access to such drugs into sharp focus.
Just last Wednesday, members of the Kenya Coalition of NGOs on Access to Medicines held an international Press conference, in which it reaffirmed its commitment to lobby Government to allow the importation of cheap generic alternatives.
The excitement generated by the Cipla offer is understandable in a country where at least 14 per cent of the population, or more than 2.2 million people, are infected with HIV.
Aids drugs like Zidovudine (AZT), Zerit (d4T) and Indinavir have been way out of reach for the majority of people with HIV, with the effective three-drug combination costing anything between Sh800,000 to Sh1.6 million a year. In Western countries, this cost has been met by the State, easing access for the sufferers.
But in poor developing countries like Kenya, only the rich have had access. Today, only an estimated 1,000 Kenyans, for example, use the drugs on a regular basis. The rest can't afford them.
Cipla's offer changes the equation of cost and access dramatically, and opens the possibility of thousands more being able to afford the life-saving medications.
The company says it is willing to supply generic versions of the drugs, which are scientifically known as anti-retrovirals, to governments at just Sh48,000 for a year's course. The company is also willing to supply the drugs to the international humanitarian agency, Medicins sans Frontieres, at just Sh28,000, provided the agency uses them to treat the poor for free.
What is most significant about Cipla's offer is that it is far more attractive to poor countries than that made by UNAids and five Western multinationals last May, in which they offered to reduce the prices of anti-retrovirals by 85 per cent.
Critics of the offer by the five companies - Boehringer Ingelheim, Bristol Meyers-Squibb, Glaxo Wellcome (now known as GlaxoSmithkline), Merck and F. Hoffman-La Roche - have dismissed it as a public relations gimmick, pointing out that eight months after the offer, the companies have not moved to effect the reductions.
The possibility of the offer having been a public relations gimmick by the drug companies is not far-fetched. According to the current issue of The EastAfrican, a senior executive of one of the five multinationals last May conceded to the British Secretary of State for International Development, Ms Clare Short, "that little of practical value would emerge from the UN-industry announcement".
In Kenya, the offer by the five has been mostly met with scepticism from doctors and humanitarian agencies. Though the companies are reported to have started negotiations with the Government last month, little is known of just how far these talks have gone, or what has been achieved so far.
Further, only two - Glaxo Wellcome and Boehringer-Ingelheim - have actually moved to reduce drug prices. Glaxo has reduced the prices of AZT, 3TC and Combivir by between 20 and 50 per cent, while Boehringer has reduced the price of nevirapine by 80 per cent.
In their own defence, pharmaceutical multinationals say that though they are, in principle, not opposed to price reductions, they are worried by the spectre of a situation where patent rights as envisaged by the World Trade Organisation (WTO) are not recognised, making it difficult for companies which have invested millions of dollars in research and development to recoup their investments.
The companies are also concerned about the possibility of a domino effect in pricing, in which reductions in drug prices in one region, such as Africa where more than 70 per cent of the globe's HIV cases are found, could lead to agitation for reduction in other regions. The possibility of "reverse leakage", in which lower priced drugs meant for Africa leak back to the West, thus destabilising the market, is real, they say.
Lastly, the companies say, providing anti-retrovirals to countries like Kenya without strengthening delivery and regulatory mechanisms would lead to the emergence of drug resistance.
Amidst the acrimony and rising death toll from Aids, what no side disputes is that something needs to be done to stem the tide of devastation.
Two mechanisms allowed for in the World Trade Organisation's Treaty on Intellectual Property Rights (Trips) offer a window of opportunity to reconcile the positions of Western pharmaceuticals with the need to address the humanitarian crisis now unfolding in developing countries due to Aids.
The first, known as compulsory licensing, enables a government to circumvent patent rights during a medical emergency, enabling licences to be granted to local manufacturers to produce patented medicines for local use. The patent-holder must also be, nominally, compensated.
The second, called parallel licensing, empowers a government facing a medical crisis to shop around for the cheapest drugs, thus ensuring that as much medicine as possible is obtained at the cheapest price possible. This mechanism would, for instance, enable Kenya to take up the offer made by Cipla without any fear of litigation.
Unfortunately, as the Minister for Public Health, Prof Sam Ongeri, conceded last Wednesday, Kenya's legislation does not allow the country to take full advantage of these mechanisms.
Luckily, Kenya is currently re-drafting its intellectual property laws to become compliant with WTO requirements. As this is done, a good starting point in making Aids drugs available at affordable prices to Kenyans infected with HIV would be to enact legislation which allows for the full utilisation of both the parallel licensing and compulsory licensing mechanisms.
Dagi Kimani is the health correspondent for The EastAfrican.
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