TCS Daily

Being Nice Isn't Enough

By Richard Tren - October 9, 2003 12:00 AM

"There is nothing much wrong with Canada," my outspoken grandfather used to say, "except the Canadians." I haven't met enough Canadians to make such a forthright statement, but those that I have met have been perfectly nice. Then again there was always something unnerving about their niceness. It is as if they were a little too polite, overly considerate and, dare I say it, eager to please. Perhaps it is fitting therefore that the Canadian Government, eager to please like its citizens, is set to pass legislation that will allow generic drug manufacturers to export patented drugs to poor countries. While this move is strong on sentiment and may get Canada a pat on the back from some quarters, it is unlikely to make any difference to the sick in poor countries.


Under recently agreed WTO rules that govern intellectual property rights (IPR) and healthcare, poor countries with no drug manufacturing capacity are allowed to import cheap generic versions of expensive patented drugs from other countries to deal with their healthcare needs. The flexibilities within the IPR system with regard to health are important. It is difficult to justify high drug prices on moral grounds when cheap versions are available and could save lives.


There is clearly an urgent need to provide effective drug therapy for diseases like HIV/AIDS in Africa. Up to 4 million people could require anti-retroviral (ARV) treatment, yet according to the UN, fewer than 50, 000 are actually getting it. So if drug patents are the barrier that stops millions of people from accessing drugs, then there is a strong case to ignore the patents and deliver generic medicines. But here is the problem: There are very few drug patents for ARVs in Africa and there is no inverse relationship between the degree of drug patenting and access to ARVs.


Indeed over 95% of the World Health Organization's list of essential drugs are off patent and could be imported perfectly legally from any generics manufacturer anywhere in the world. Yet access to these essential drugs is abysmally low in large parts of Africa. In Malawi for instance, according to the UN Development Programme, only around 40% of the population has access to these essential medicines. The picture is not much better in the rest of Africa as severe poverty, a complete lack of health infrastructure, inadequately trained personnel and (often) disinterested governments mean that people die of entirely preventable and cheaply curable diseases.


The Canadian government should understand that the supply of drugs isn't really the problem. It is the effective demand for those drugs that is absent along with an inability to deliver the drugs. If the generics drugs industry in Canada were to build clinics, deliver diagnostic equipment and train doctors and nurses, then some real progress would be made. But that would cost far more money than even Canadian largesse could stomach.


Despite the gloomy realities, progress is being made in some countries, such as Botswana. This country -- with its stable, open and democratic government -- approached drug company Merck and the Gates Foundation to help it deliver the much needed ARV therapy. As this country has a higher percentage of people living with HIV/AIDS than any other (around 40%), the move was a smart one. The partnership has been building clinics and doing the basic groundwork for successful roll-out of ARV treatment. It seems to have paid off as there are now more people receiving free ARV treatment in Botswana than anywhere else in Africa.


Simply producing cheap generics, whether in Brazil or India or Canada does not guarantee that they will get to those who need them. If there is no way of taking the drugs from the port, distributing to the clinics and hospitals and then ensuring that patients take them properly, they will simply expire in a warehouse somewhere. Indeed this is exactly what happened in Nigeria, when the government, eager to be seen to be doing something about AIDS, imported generic ARVs from India. Even when there is a distribution system through the private sector, the price to the patient of the drugs is often far higher than the rock bottom price quoted by the generics manufacturers. Distributors and retailers need to make a profit which means that the price to the patient can be up to 140% higher, as I recently discovered on a trip to Zambia.


Many Canadians may be feeling rather smug that their government is supposedly being kinder and gentler than their immediate neighbour to the south. The US has been widely criticised for being too unyielding in defending IPR and supporting its research-based drugs industry. Yet it is important to be reminded that it is in the US where most of the ARVs were developed, and continue to be researched. In fact it is in the US where the majority of drug research is being conducted today. It seems to me that this is something to be far more smug about than a gesture by the Canadian government that will make hardly any difference to the sick and dying in poor countries.


Richard Tren is a director of the health advocacy group Africa Fighting Malaria and is based in South Africa.

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