TCS Daily


Doctors Without Principles

By Richard Tren - June 13, 2002 12:00 AM

AIDS activists have a new and very curious choice for their new poster boy - President Mugabe of Zimbabwe. The President has become their darling because of his decision to break drug patents and import generic anti-retrovirals for his country's HIV/AIDS programme. That M├ędecins Sans Frontiers (MSF) or "Doctors Without Borders" has aligned itself with the government of Zimbabwe is surely one of their most shameful moves.

If one believes the AIDS activists, then pharmaceutical companies have "blood on their hands", are greedy "profiteers" and are a "party to genocide" as they seek to protect their intellectual property. The reality is somewhat different.

Over a year ago, the South African Pharmaceutical Manufacturers Association and a number of drug companies dropped their controversial legal challenge against the South African Government. At stake were provisions in the Medicines and Related Substances Control Amendment Act which give the Government wide ranging powers to issue compulsory licenses, allow parallel importing and control drug prices.

At the time of the case, Eric Goemaere, the head of MSF in South Africa said "The pharmaceutical companies have already delayed this case for three years. Every day's delay means no affordable medicines and more people dying."

Yet more than a year later, the supposed barriers have been removed and people are still not getting the drugs that they need. Far from admitting that there are other far more important factors blocking drug access than patent protection, the drug activists have continued their anti-property crusade. That they are now supporting one of Africa's most despotic regimes shows an astonishing lack of judgment amongst the MSF policy makers.

Only about half of the available anti-retrovirals are actually patented in Zimbabwe. Those that are patented have been offered to the government at discounts of up to 90% or in some cases even for free. It seems as if the move to import generics was completely unnecessary and motivated only by President Mugabe's crusade against property protection.

In case the good people at MSF have been too busy to read a newspaper recently, here are a few clues as to why ordinary Zimbabweans are not getting access to AIDS drugs (or any other drugs for that matter). First: President Mugabe has been consistently robbing the treasury for the past 20 years, leaving very little for the health budget. Second: President Mugabe has devoted vast sums to fighting his own personal war in The Congo. Third: The Government of Zimbabwe seems to be more interested in arresting and harassing journalists and political opponents than improving health infrastructure. Fourth: Qualified doctors and nurses are leaving Zimbabwe where they are poorly paid and badly treated. Fifth: President Mugabe is an extreme homophobe, blames homosexuals for AIDS and actively encourages violence against gays.

One could go on and on, but one thing is clear; patents and drug company profits are not blocking access to drugs in Zimbabwe, nor indeed in the rest of Africa. Recent research by Amir Attaran and Lee Gillespie-White published in the prestigious Journal of the American Medical Association confirms this and shows that poverty, a lack of infrastructure and insufficient donor funding is behind the lack of drug access, not patents.

India has very weak drug patent protection and a very large and successful generics drug industry, yet only about 10,000 of the 4 million estimated to be HIV positive in that country have access to life-extending anti-retroviral drugs. In Brazil, another country with weak drug patent laws, only 1% of the 2000 brands of drugs are patented, yet according to the United Nations Development Programme, only 40% of the population has access to essential drugs (for all diseases, not just AIDS).

At the WTO Ministerial meeting in Doha in November 2001, the drug activists claimed a major victory with the "Doha Declaration on the Trips Agreement and Public Health". The declaration gives developing countries increased powers to issue compulsory licenses on life-saving drugs, allow parallel importation and essentially put the health needs of their populations ahead of the profits of drug companies. Yet six months later, hardly any countries have used these provisions.

The reason for this may simply lie in a lack of political will or motivation to do anything about the growing HIV/AIDS crisis. Yet many African countries probably recognise that importing generics from India may not necessarily be the best way to increase drug access. With poor health infrastructure, most African countries rely heavily on the logistical support, advice and charitable donations from research-based drug companies. Botswana has one of the world's highest HIV infection rates, at around 36% of the adult population. It has chosen to partner with Merck and the Bill & Melinda Gates Foundation in order to increase drug access. The Merck deal doesn't only mean that the country gets anti-retrovirals for free, it comes with a donation of around $10 million per year for 5 years. No doubt this is a better deal than buying generics from the Indian producer, Cipla.

All of this of course has raised the ire of the AIDS activists. Act Up has claimed that the drug companies are forcing developing countries into onerous deals that preclude the possibility of using generics. They also claim that the drug industry is forcing doctors to 'prescribe bizarre therapeutic combinations.' Despite the lack of evidence for these claims, Act Up ignores the fact that after Doha, any developing country can legally import generics. As for their second claim, one can only assume that Act Up thinks African doctors are entirely ruthless and have no interest in the wellbeing of their patients. Either way, their claims are patronising in the extreme and show how churlish the activist can be when governments don't act as they see fit.

Sensible governments that are committed to fighting HIV/AIDS are far better off coordinating their efforts with research based drug companies, respecting patents, negotiating discounted prices and committing funds to build their health infrastructure.

Developing countries also need to recognise that the best way to build their health infrastructure in the long term is to grow rich. This can only happen with open markets, the rule of law, and the protection of private property. The Doha deal that the activists fought so hard for offers developing countries a non-solution to their healthcare needs and offers very little in terms of open trade and access to the wealthy markets in the North. Since Doha, the US has signed the Farm Bill, giving $190 billion in subsidies over the next 10 years, ensuring that there is even less chance that developing country products will be sold there.

The activists were wrong about the intellectual property rights, wrong about the benefits of Doha and have completely lost their way in supporting Zimbabwe. The AIDS activists have based their campaign on a socialist agenda that is focused on bashing the drugs industry. This is no way to improve drug access in the developing world. Robert Mugabe's prescription for improving the standard of living of his citizens is not a model that any other country should follow.

Richard Tren is a director of the South Africa-based NGO Africa Fighting Malaria.
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