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AIDS, Africa, and Antiretroviral Drugs
Why don’t Africans
have access to antiretroviral drugs?
Until an HIV/AIDS vaccine is developed, antiretroviral drug treatments
(ARVs) remain the most effective tool for fighting HIV/AIDS.
For many patients in developed countries, HIV/AIDS drug cocktails
have turned an HIV/AIDS diagnosis from being an automatic death
sentence into a manageable long-term disease. By contrast, however,
in the developing world, the situation is not at all the same.
Accordingly, the need for antiretroviral drug treatments is greatest
in sub-Saharan Africa. ARV drug treatments, however, cost anywhere
from $12,000 to $15,000 annually per patient. This is far beyond
the reach of governments whose national health budgets may be
as low as $10 per year, per patient.
Several options exist for providing ARVs to people in sub-Saharan
Africa, and other developing countries:
- Pharmaceutical companies can agree to lower the cost of
drugs being distributed in countries that do not have the
financial means to afford them.
- Countries can amend the legislation governing medical patents
so that parallel importing can be permitted, thereby allowing
the drugs to be purchased from the cheapest source, instead
of from the manufacturer.
- Countries can amend their medicine patent legislation to
permit compulsory licensing, whereby a non-research based
drug company produces a generic version of a patented drug
and pays a royalty to the pharmaceutical company that holds
the patent.
Problems with providing cheaper drugs to developing countries include
the following:
- Even at substantially reduced costs, many countries will
remain unable to afford ARVs.
- Many developing countries do not have the infrastructure
in place to monitor patients and ensure the drugs are administered
properly or that proper dosages are taken.
Providing cheaper drugs involves a substantial cost to pharmaceutical
companies in terms of lost profits. Losing profits means these
companies will
- be less willing to pay for research into developing new,
more effective drugs.
Besides reducing profits, compulsory licensing and parallel importing
could potentially threaten intellectual copyright laws.
In 1997, South Africa introduced legislation that would allow drug
companies to produce cheaper generic versions of HIV/AIDS drugs.
The Medicines and Related Substances Bill was designed to “provide
for measures for the supply of more affordable medicines in certain
circumstances.” Section 15 of the legislation permitted
both parallel imports and compulsory licensing. Accordingly,
41 large pharmaceutical companies, including Bristol Meyers Squibb,
Merck, and the Pharmaceutical Manufacturers’ Association
of South Africa, filed a lawsuit against the government. Additionally,
the US exerted enormous pressure on the Government of South Africa
to withdraw its legislation, threatening sanctions if it did
not do so. Due to a wave of negative publicity, the United States
was finally forced to back down and the pharmaceutical companies
withdrew from the lawsuit. However, former South African President
Nelson Mandela, who has been criticized for not doing enough
to fight AIDS, withdrew the legislation.
To learn more about generic drug legislation in South Africa, see “The
South African Medicines and Related Substances Control
Bill and TRIPS.”
Since 2000, pharmaceutical drug manufacturers, globally, have reached
agreements to provide antiretroviral drug treatments to several
African countries at substantially reduced rates. In this context,
Senegal, Rwanda, Uganda, Cameroon, and Mali all agreed to improve
the health care infrastructure in their respective countries,
in order to receive the discounted drugs. As these improvements
take time and money, however, the number of people that are actually
receiving ARVs in these countries is still relatively low.
Unfortunately, the reality is that many African countries simply
cannot afford the high costs associated with antiretroviral drugs – even
if the drugs are discounted by as much as 90 percent, bringing
the annual per patient cost down to $2,000 to $3,000 dollars
per year. Further compounding the problem is the fact that many
countries don’t have the necessary medical personnel available
to administer the drugs.
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