Fighting AIDS in Africa A viewpoint

Late last week 39 major drug companies, including such powerhouses as Merck, GlaxoSmithKline and Bristol-Myers Squibb, bowed to immense international pressure and withdrew a lawsuit they had filed against the South African government. The suit sought to block a law allowing generic drug companies to produce and market patented drugs under certain conditions. While any weakening of patent protection was, and is, anathema to the big pharmaceutical companies, they appear to have realized the futility of fighting a losing PR battle. They conceded in the face of withering criticism that they were profiting by charging impossibly high prices for AIDS drugs to desperate patients who could not afford them. What is the genesis of this issue, and how should it be resolved?
AIDS unfortunately began to be recognized as a public health threat in Africa much later than it did in the West. There are a number of reasons for this, the most important ones probably being the relative lack of openness on sexual matters, and the lack of resources and/or vision on the part of public health officials in certain African countries. Now that the problem has become too big to ignore, AIDS is considered the leading public health threat in much of sub-Saharan Africa. According to W.H.O. figures, the adult infection rate ranges from 1-2% in West African countries Mali, Senegal and Niger to 19-20% in such nations as Zambia and Namibia. Botswana and Zimbabwe top the list with an adult infection rate of 25% each. According to the AP, roughly 70 percent of the 36 million people infected with HIV live in sub-Saharan Africa, with the disease claiming 2.4 million victims there in 2000 alone.

Given these staggering numbers, something clearly needs to be done. The only question is what. Substantially all of the affected nations have instituted education and prevention programs, with varying degrees of success. The recent controversy arose over the best way to make drug treatments available to the vast numbers of afflicted Africans. In this debate there have been three distinct players: the Governments, the pharmaceutical companies and AIDS activist organizations, both international and domestic.

African governments, together with activists, have argued for cheaper access to the advanced drug “cocktails” that are used to treat symptoms in the West. The South African government, faced with a 13% rate of adult infection, decided in 1997 that it was critical to make these drugs available and passed the law allowing generics. They had the enthusiastic support of the activists, and were successful in mobilizing world opinion to their side. They made the argument that people were suffering and dying in Africa because the drug companies were unwilling to take a hit in their bottom lines. They cited the willingness of generic drug companies such as Cipla in India to make these drugs cheaply, as evidence of profiteering.

The drugmakers countered with several arguments. Firstly, they argued, they should enjoy the right to make money from their own patents, acquired through years of painstaking and expensive research. They made the reasonable claim that weakening of patent protection would diminish the incentive of companies to invest in other potentially life-saving medical research. They also argued that the kinds of drug cocktails that governments like South Africa wanted to provide were not the most appropriate form of treatment for the situation in Africa. They argued that the focus in Africa should be on more cost-effective solutions such as emphasizing prevention and treating HIV-related infections. They further argued that the provision of free drugs would not be a panacea because it would not address the high costs of associated medical care and, in the absence of co-ordination between companies, would not even necessarily provide all the drugs in the so-called cocktail.
So who is right and who is wrong? While the drug companies’ arguments do sound self-serving, they should not be dismissed out of hand. Some of the companies involved (Merck being a leading example) have shown a willingness to spend large sums of money on public health in Africa that belies most attempts to caricature them as greedy exploiters. We must also remember that these firms are profit-making private entities. They cannot and should not be expected to shoulder the burden of fighting a massive public health problem on their own. They must also in the end be adequately compensated for their research efforts or eventually there will be no more miracle drugs for anyone. Their arguments against the widespread use of drug cocktails in Africa are lent credibility by the South African government’s reluctance to immediately license production of these drugs, to the chagrin of AIDS activists. There are indeed substantial costs to providing these treatments, over and above the cost of the drugs themselves, and these must be taken into account.

But the controversy has had the positive effect of awakening the drug companies to the fact that they must show some leadership. Like any company that reaps profits in an area, they cannot simply refuse to help their erstwhile customers in a time of desperate need. Many grocery stores in the US happily hand out free food or water during natural disasters like floods and hurricanes. The companies involved have operated profitably in Africa for decades and must share the burden in this time of crisis. Additionally some of the arguments against the suitability of using drug cocktails in Africa fail to ring true; the reason these companies can sell these drugs in the West for many times what it costs them to make them is because they are very effective at prolonging life and controlling symptoms in patients with advanced AIDS. Sadly, such an expensive course of treatment is outside the means of most Africans, but that does nothing to diminish its desirability to the AIDS sufferer.

The way forward is not entirely clear. The pharmas are right to say that cheap drugs alone will not solve the problem; only a relentless effort to change behavior and encourage prevention can do that. AIDS is a many-headed beast and governments must be realistic about where they allocate their limited resources. The move towards cooperation by governments, NGOs and private corporations will only help attack this problem in a more effective manner.