Washington Post Series on AIDS, Drug Access in Africa Shows ‘Unequal Calculus’ of Life and Death in Developing Nations

Millions of people in developing nations have died of AIDS-related illnesses over the last decade as world health organizations and pharmaceutical companies debated drug access, the Washington Post reports in the first of a three-part series on "AIDS, Drugs and Africa." In Africa, where more than 25 million people are infected with HIV, fewer than 25,000 -- one-tenth of 1% -- receive drug therapies that could extend their lives. The Post reports that despite 10 years of wrangling, "nothing fundamental" has changed in determining who obtains access to treatment. The high price tag for AIDS therapies is cited by most as the main reason for the disparity in treatment access. The drugs, with a $10,000 to $18,000 a year market value, are simply unaffordable for many developing nations. In addition, the Post reports, the medical infrastructure needed to properly deliver and administer the drugs is not in place in most developing nations, citing cases in Zimbabwe where "huge quantities" of medications have had to be destroyed because they had expired.

Decade-Old Discussions
The "first and pivotal" meetings concerning drug access began at WHO headquarters in Geneva, Switzerland, in 1991 and lasted for two years. The discussions, which the Post describes as "doomed" from the beginning, were based on a "concise six-page framework" drafted by WHO that stated that HIV/AIDS medications, although "technically available" to developing nations, were not accessible because of their cost. The paper called on the drug companies to use a "certain flexibility" when selling AIDS drugs to the developing world. Although in private talks pharmaceutical executives had shown an inclination to offer a "preferential price to developing countries for AIDS therapeutics," at the meeting, John Petricciani, a senior Washington lobbyist for the drug companies, "closed the door on AIDS drug discounts," saying that the "broader responsibility for ensuring such products are delivered to those they could benefit should be borne by society, particularly governments." Petricciani instead suggested that the drug industry "lobby governments and donors ... to buy more AIDS drugs at market prices." And so, as the talks continued until their end in 1993, pharmaceutical companies continued to claim that price was not the problem, but that other social, political and medical system barriers hindered access to drugs in Africa.

WTO 'TRIPS' Up Developing Countries' Plans
As pharmaceutical companies pursued research, developing a new class of drugs called protease inhibitors throughout the mid-1990s, the World Trade Organization was formed. The rules of the new "legal entity" included the Trade Related Aspects of Intellectual Property Rights, or TRIPS, agreement, which states that countries that wish to take part in the global trade economy must respect the "exclusive marketing rights of patent holders." This meant that countries could not make or buy generic versions of AIDS drugs, even protease inhibitors that could reduce the virus to undetectable levels in the bloodstream when used with two of the older types of medications in a "triple therapy."

Glaxo Makes a Move
In 1994, Glaxo Wellcome's antiretroviral AZT, which had a "traum[atic]" debut in the United States due to "hostile" congressional hearings and "outrageous" protests, was shown to reduce the rate of vertical transmission of HIV by two-thirds when administered to the woman during pregnancy and labor and later to the newborn. The company, fearing more backlash over the drug, approved "flexible pricing" in January 1997, agreeing to leave pricing decisions to the managers of the drugmaker's regional operating companies, but setting limits on how low the prices could drop. Initially, discounts were not enacted because managers, who were held accountable for profit growth, did not believe that they could increase sales enough to make up for the price cuts. However, in a March 1998 press release, Glaxo Wellcome "forced the hands of its operating companies" when it announced it would sell AIDS drugs in developing nations at prices "substantially below Western market levels." The announcement came in response to mounting pressure from the World Health Assembly, the top governing body of the WHO, and the United Nations, which issued a paper declaring drug patents to be "in conflict with the human right to equal health care." The announcement prompted the British Department for International Development, in an internal memo, to label vertical transmission the "ethical lightening (rod) of international discussion on drug access." The memo "predicted" that "greater access" to AIDS drugs for HIV-positive pregnant women would lead to more demands for treatment in other populations (Gellman, Washington Post, 12/27).