25,000 people from around the world gathered this week in Mexico City for the 17th International AIDS Conference. Thomson Ayodele’s column in yesterday’s New York Post focuses on the main challenges facing patients in developing countries: lack of healthcare infrastructure and access to safe medicines.
( August 4, 2008 ) This week, 25,000 people from around the world have gathered in Mexico City for the 17th International AIDS Conference.
Many discussions will focus on how best to deal with AIDS in the developing world. Looking to the West – where scientific advances have allowed those with HIV/AIDS to live long, comfortable lives – many attendees will argue that pharmaceutical patents are the main barrier to getting medicines to the poor. That argument misses the true obstacle – local policies.
Consider tariffs. In some African countries, duties and taxes on medicines drive the costs through the roof.
In my home country of Nigeria, there’s a 5 percent tariff on Imported Pharmaceutical Ingredients (APIs). And all generic medicines imported into Kenya, Uganda and Tanzania are subject to a 10 percent tariff. The rate is 34 percent in Nigeria, 40 percent in Sierra Leone and a whopping 50 percent in Kenya.
Government regulations also add to the price of drugs. It takes the South African government more than three years to grant regulatory approval for medicines already available in developed countries. This not only delays access, it closes off a market – and so drives up drug prices all over the world.
On top of that, drug companies already sell their drugs to poor countries at prices well below cost. Often, they’re free. Just this year, GlaxoSmithKline, Merck and Pfizer donated $450 million worth of drugs to Burkina Faso.
Then there’s the lack of investment in infrastructure. In 2000, numerous African leaders signed the Abuja Declaration, a pact to combat malaria. The agreement called for 15 percent of every country’s budget to be directed toward improving health care – yet most countries that signed it spend less than 10 percent.
That means low wages and low morale for health-care workers – and, ultimately, a loss of medical personnel. Recently, the National Association of Nigeria Nurses and Midwifes said over 300,000 nurses are needed to fill positions in the nation’s hospitals and clinics.
Add to that the lack of roads and electricity in many poor countries, and you start to see why focusing on drug patents misses the point. Many developing countries don’t have the roads to transport drugs to patients, nor the electricity to keep temperature-sensitive AIDS medications refrigerated.
Kevin De Cock, director of the World Health Organization’s Department of HIV/AIDS, recently noted that the main barrier to essential medicines “is not the current price of drugs. The real obstacle is the fragility of the health systems. You have health infrastructure that is dilapidated and supply chains that do not exist.”
Despite understanding these fundamental problems, the WHO has backed a global treaty aimed at weakening pharmaceutical patents and putting drug research under government control. The treaty, known as the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), lets developing nations issue “compulsory licenses” to legally override pharmaceutical patents.
This practice of compulsory licensing isn’t just a distraction from the real issues: It also threatens the safety of many AIDS patients.
Just look at India. As a result of poor-quality knock-offs that don’t have to pass the same safety tests as their brand-name counterparts, drug resistance is on the rise. As a New Delhi-based pharmacist recently remarked, “We lack quality infrastructure to test the quality and purity of drugs.”
This problem extends far beyond AIDS drugs. In May, the science journal PloS One published a study showing that 35 percent of all malaria drugs in Africa are of substandard quality. Such low-grade drugs provide no medical benefit to patients and pose a serious health risk.
If this week’s conference is to have an impact on the growing AIDS pandemic, the participants need to get their priorities straight. Improving medical infrastructure and lowering tariffs should be their chief concern – not weakening drug patents.
Thompson Ayodele is the executive director of Initiative for Public Policy Analysis, a public-policy think tank based in Lagos, Nigeria (ippanigeria.org).