The Thirteenth World AIDS Conference opened today in Durban, South Africa with an intensification of calls for developing countries to be allowed to open up drug production to competition so that prices can be driven down.
Mark Milano of ACT-UP New York, speaking at a satellite meeting organised by UNAIDS, said that a three drug combination could be produced for less than $300 a year if developing countries are allowed to buy drugs in bulk from generic manufacturers in India or Brazil rather than from patent holders. This compares with a cost of $3,000, which has emerged as the most recent offer from negotiations with pharmaceutical patent holders, according to Daniel Tarantola of UNAIDS.
Medecins sans Frontieres and ACT-UP Paris will bring together representatives of African states with generic manufacturers on Wednesday to discuss ways of cutting costs, after Peter Mugyeni of Kampala’s Joint Clinical Research Centre revealed that a two year programme to bulk purchase drugs in Uganda had failed to reduce the cost of patented drugs.
Replying to accusations that UNAIDS should have taken responsibility for organising such a meeting, Daniel Tarantola said that each country has its own rules about tendering for the supply of essential drugs. However, according to Peter Mugyeni, not one African country currently includes antiretroviral drugs on its list of essential drugs.
The TRIPS agreement on patent protection permits governments to grant a compulsory license for non-profit production in national emergencies. Peter Mugyeni urged African heads of states to take the first step towards compulsory licensing by joining Kenya in declaring the AIDS epidemic a national disaster.
“In the case of famine,no country has said `let people starve, we can’t afford the food’”, he declared, at a public meeting organised by South Africa’s Treatment Action Campaign today. He also condemned drug company hints that prices would be reduced as empty rhetoric.
“The companies tell us that there is a need for negotiations before prices can be reduced. Why is there a need for negotiations? If you are not going to reduce the cost, just shut up!”, he said.
However, another conference satellite meeting on access to treatments was warned that dropping drug prices is not the whole answer.
“Our existing infrastructure will be unable to cope if there is a sudden reduction in the cost of ARVs” said Dr Anthony Kebba of Kampala’s Joint Clinical Research Centre. “We also need a reduction in the cost of monitoring, and an extension of access to medical care in rural areas”.
He also warned that in Uganda many people who had been able to afford HAART had nevertheless developed opportunistic infections because they were unable to afford additional drugs for the treatment or prophylaxis of opportunistic infections. These patients generally began antiretroviral treatment with advanced immunosuppression or active OIs, and the degree of immune reconstitution experienced was not enough to protect against common infections.
Dr Mike Youle of London’s Royal Free Hospital also sounded a note of caution.
“In other epidemics, improvements in water and housing have had a greater effect on mortality than drug treatment,and we should not focus solely on drug treatment.”