I doubt that singing and dancing is a regular feature of the Pretorian Court in South Africa. But last April, the South African government won a three year battle against 39 large pharmaceutical companies.[2] The companies objected to legislation that sought to lower the cost of drugs to South Africans. Antiretrovirals for AIDS were a high profile component of this. When the lawsuit was dropped, AIDS activists, trade unionists and HIV positive people alike hailed this as a massive victory. The problems of the 4.7 million HIV positive people in South Africa, however, will not disappear overnight. Solving the complex issues will take time, effort and commitment.
AIDS is a big problem. So big that United Nations Secretary General, Kofi Annan wants the United Nations to wage a $7-10bn/year global war against it.[3] Emerging drug resistance will make things even harder. But this is not the biggest obstacle to overcome. Getting the drugs to the people who really need them is the real challenge. 25 million people in Africa are HIV positive, out of a total 36 million worldwide. Yet only a few thousand of them are being treated with antiretroviral drugs. These drugs have turned AIDS into a treatable chronic disease in the West.[2] Drug companies, however, traditionally concentrate their efforts on developing drugs for the developed world. This allows them to recoup the vast research, development and marketing costs they have invested.[1]
The South African government has a different vision. It knows that AIDS has debilitated most of Africa and that health ministers need help. They passed the Medicines and Related Substances Control Amendment three years ago to try and provide this help. It allowed them to bypass patent laws and acquire AIDS drugs from countries cheaper than South Africa. The law also included rules banning practices that allowed drug companies to influence doctors prescribing habits. Furthermore, it permitted generic substitution on prescriptions, and the establishment of a pricing committee.
This worried the pharmaceutical companies, who promptly sued the government. Their real concerns were that intellectual property rights could be stolen without due process or compensation, and that cheaper drugs might leak to other markets, reducing their profits. They claimed that their reduced pricing schemes make the policy unnecessary. Without recouping research and development costs, the companies still insist that drugs research aimed at the developing world will fail to attract the investment it needs.[4]
Pragmatically, if the disease is allowed to retain its stranglehold, some developing countries may cease to be viable as trading nations,4 despite having the biggest potential market in the world. Unfortunately, the shareholders driving corporate strategy are unlikely to buy into such long term planning now. International opinion is mixed. The European Commission has recently endorsed the idea of discounted prices for poor countries.[1] The US government has added South Africa to a ‘watch list’ indicating that it sees it as a threat to trade.4 For further progress to be made, perhaps multinational organisations such as the World Trade Organisation, the International Monetary Fund, and the World Bank should consider the sanctity of life within the political mix.
The recent result will undoubtedly lead other governments to review their patent laws. So capitalist driving forces in society face a moral dilemma. Patents allow drugs to exist. But their very nature prevents the drugs reaching the people who need them most. Sceptics point out that there is not enough money or infrastructure to monitor the effect of the drugs. Spending more on drugs may also mean less spending on prevention.[2] Pharmaceutical companies, however, should not be allowed to hide behind the truth in these sentiments. The African AIDS epidemic is on the brink of catastrophe. Access to affordable drugs to treat HIV infection is only part of the care package, which includes voluntary counselling and testing, home and community based care, and treatment for opportunistic infections. But it will save millions of lives.
