New York Times Magazine Highlights Brazil’s Success in Fighting AIDS Epidemic
In yesterday's New York Times Magazine cover story, Tina Rosenberg depicts Brazil as a case study of how a country can mobilize an effective response to the HIV/AIDS crisis, and writes that several factors, most notably the efforts of pharmaceutical companies to block developing nations' access to generic drugs, have prevented other countries from following Brazil's lead. Rosenberg, an editorial writer for the Times, outlines her thesis as follows: "Brazil is showing that no one who dies of AIDS dies of natural causes. Those who die have been failed -- by feckless leaders who see weapons as more alluring purchases than medicines, by wealthy countries (notably the United States) that have threatened the livelihood of poor nations who seek to manufacture cheap medicine and by the multinational drug companies who have kept the price of antiretroviral drugs needlessly out of reach of the vast majority of the world's population."
The Brazilian Model
In 1998, Brazil "def[ied]" the pharmaceutical industry and began producing its own generic versions of antiretroviral drugs, resulting in a 79% price decrease. This decision followed the enactment of a law that "guaranteed every AIDS patient [in Brazil] state-of-the-art treatment." This program has cut the national AIDS death rate by 50%, and while the World Bank predicted in 1994 that the country would have 1.2 million HIV-positive individuals in 2000, the actual number was around 600,000. Rosenberg also writes that the treatment program has "very likely saved the Health Ministry money" and has "improved the treatment of other diseases." Brazil passed a law "recognizing patents on medicine" in 1996, but the legislation specified that "anything commercialized anywhere in the world by May 14, 1997, would forever remain unpatented in Brazil," thus allowing the country to produce generics for all the "first-generation antiretrovirals."
Why Not Others?
Rosenberg writes that no "legal reason" exists for other countries not to produce their own generic drugs, as a World Trade Organization "loophole" allows countries that do respect medical patents to get a compulsory license that allows them "to make copies of patented items [or import them] in certain situations, including that of a national emergency." There are several reasons why this has not occurred in other nations, Rosenberg writes. One, countries such as Kenya and South Africa have "indifferent, or even hostile, leadership" which precludes an effective response to the pandemic. Second, many countries are not aware that there are "legal ways" to obtain "cheap medicine." Third, pharmaceutical companies "fear" compulsory licensing, "since it represents the most direct assault on control of their patents." The industry has been supported by U.S. trade officials, who "have put the full weight of American trade pressures to work on [drug companies'] behalf." Rosenberg criticizes the industry's efforts to introduce AIDS drugs into developing nations through "limited, negotiated price cuts" as "slow, grudging and piecemeal." Stating that compulsory licensing is "very necessary" for poor countries, Rosenberg concludes, "This is the larger lesson of Brazil: AIDS can become a manageable disease in the third world, but it takes power, in addition to other things. The ability to pull the price of AIDS drugs within reach of those who need them may someday come from the backing of some international organization, or the pharmaceutical industry might find religion. But at the moment, it arises only from the threat to make or buy generic drugs. AIDS is turning the third world's human landscape into a parched wasteland. Brazil has shown that, armed with the power of competition, a government can do more than sit and watch the desert encroach" (Rosenberg, New York Times Magazine, 1/28).