‘Patents versus patients’ still part of the problem
pharmafile | July 26, 2004 | News story | |Â Â Â
The head of the UN AIDS programme has said there must be an end to divisive "institutional agendas" and greater action at the local level if the world is to halt the progress of the deadly epidemic.
UNAIDS and its collaborators have a mountain to climb in helping the 38 million people living with HIV and in halting its rapid progress around the globe – a further three million people becoming newly infected in sub-Saharan Africa alone last year.
Peter Piot, head of UNAIDS closed the recent Bangkok International Aids Conference by saying: "To prevail we must rewrite the rules. An exceptional threat demands exceptional actions, be it on financing, development, trade rules, activist strategies, public service delivery, or fiscal ceilings."
Asking all stakeholders to break out of their established positions without exception, Piot underlined the massive and unprecedented collaborative effort required to tackle AIDS – something only sporadically achieved.
A sharp fall in the average price of antiretrovirals, since the last conference of its kind two years ago, means the pharma industry is no longer the pariah of the international community, but most activists maintained their hardline opposition, vandalising stands and heckling speaker Hank McKinnell, Pfizer's chief executive.
The indiscriminate fingerpointing practised by some activists – including those who attacked the Gilead conference stand, despite the company rarely even registering patents in developing countries – underlines the fact that NGOs can be as entrenched as any other stakeholder.
The industry bogeyman status has been maintained largely through its closeness with the Bush administration, which despite committing $15 billion over five years to tackling the disease has been unwilling to compromise on drug patents.
Then in May, President Bush's special AIDS envoy and former Lilly chief executive Randy Tobias announced a U-turn in its policies, signalling that patent issues should not stand in the way of poorer countries purchasing generic drugs, a move hailed as "a real change in policy" by Piot.
Fixed dose combination (FDC) formulation of antiretroviral drugs are now seen as the answer to quickly distributing medicines and guaranteeing their efficacy, the standard three tablet regimen combined in one pill, but patent holders have been slow to collaborate to produce these combinations.
The world's first ever FDC, manufactured by Indian generics company Cipla has been shown to be effective in an aid agency-funded clinical trial, and will now be used even more extensively across the developing world.
Despite often being cast as the 'good guys' the generic manufacturers are not immune from the profit making instinct, a fact demonstrated in the irony of Cipla filing a patent on the combination, brand name Triomune.
Global spending on AIDS has increased 15-fold since 1996, standing at $5 billion in 2003, but this figure is less than half of what UNAIDS says will be needed by 2005 for prevention and care in developing countries.
One of the organisation's core aims is its by '3 by 5' programme to have three million people in the developing world on antiretrovirals by 2005 – a target many believe is overly optimistic, and which has already fallen behind in its progress.
Even with this target achieved, Piot says: "Let's be honest with ourselves: treatment access today has consequences for the future. It means that increasing numbers of people will be on treatment for life, and that the more expensive second generation therapies will need to be made accessible globally."
While the industry has been slow to respond to the crisis, addressing the conference McKinnell said it has been quick to discover and develop new medicines, something it could only continue to do if intellectual property was respected.
"The issue of IP is loaded with emotion because it has become a proxy to rationalize reasons for health disparities and economic inequalities," he said. "In a world where most AIDS patients die out of sight of even a paved road, patent protection alone is too simplistic an answer.
"While IP must not be a barrier to treatment, it is a vital resource to help us find new treatments and cures," McKinnell stated. "People living with HIV are going to need a steady stream of new therapies as the virus mutates and currently available treatments fail patients," he added.
The industry has little to lose in the poorest countries, but is intent on wrangling over patents with richer Asian nations such as Thailand and China – future growth markets but currently struggling to stem the spread of AIDS with healthcare systems ill-prepared to take on an epidemic of this scale.
China's recent revoking of Pfizer's Viagra patent will do little to foster good relations – or indeed tackle the country's AIDS crisis – but pharma will still be held to account over how it weights patents against access to medicines which could mean life or death for millions.
