- The international financial crisis and
growing world inequality dominated much of the roundtable discussion at
the 1999 Annual World Health Assembly (WHA 1999). The World Health Organization
(WHO) held its fifty-second annual meeting in May in Geneva, Switzerland.
The AIDS roundtable included discussion by health ministers concerning
the exorbitant cost of drug cocktails for AIDS patients in poor countries.
"WHO should lobby for medicines. If technology is available, no one
should be denied it, said J. Kalweo, Minister of Health from Kenya.
- Outbreaks of tuberculosis, malaria, sleeping
sickness and meningitis, as well as the deepening AIDS crisis, have raised
serious alarms from WHO. The AIDS crisis has put increasing health inequalities
in the forefront of the major international health conferences.
- The severe effects of the world economic
crisis on AIDS treatment in one country were clear in the recent WHO report
entitled "Funding Priorities for the HIV/AIDS Crisis in Thailand."
The report compiled data first presented by the Thai Ministry of Public
Health last year. According to the report, the 1998 national AIDS program
budget was cut 33 percent in real terms and staggering reductions in prevention
and care of AIDS patients were imposed. The budget for vertical transmission
(from mother to newborn) was reduced by 76.4 percent. Out of 18,000 AIDS
pregnancies expected, only 2,500 of the women could be treated in an attempt
to keep their babies from being born with the disease. The budget for universal
AIDS precautions was reduced by 72 percent.
- The Thai doctors reported that in 1997
of 60,000 AIDS patients, one-third had opportunistic infections (infections
taking advantage of the body's debilitated immune system). Treatment for
these infections would require 920 million baht, but only 166 million was
available. They also reported that the cost of four common drugs for opportunistic
infections used at Ramathibodi Teaching Hospital in Bangkok increased an
average of 10 percent from 1997 to 1998.
- Inequality in medical care in the US
as well as between the developed and underdeveloped countries was the focus
of a speech by Eric Sawyer of ACT UP/NY at the 1996 XI International Conference
on AIDS. "The headlines that PWAS [People With Aids] want you to write
from this conference would read: 'Human Rights Violations and Genocide
continue to kill millions of impoverished people with AIDS.' ... Drug companies
are killing people by charging excessive prices. This limits access to
treatments. The greed of AIDS profiteers is killing impoverished people
- Many who attended the 1998 World AIDS
Conference echoed these sentiments. The XIII AIDS Conference, scheduled
for South Africa in 2000, will be even more explosive, as it is taking
place in the area of the world where there are staggering numbers of people
infected with HIV.
- WHA 1999 pledged special efforts would
be made to allow countries to monitor world drug price levels, to provide
resources related to drug quality, and to disseminate knowledge developed
by member countries for promoting efficient use of drugs. The World Health
Organization (WHO) has urged countries to use the Internet to advance health
cost efficiency, especially in the area of essential drug policy.
- WHA 1999 also passed a resolution concerning
the World Trade Organization (WTO) law on drug costs. The debate on the
resolution has raged for more than a year. In a statement to WHA 1999,
Consumers International pointed out that "Enforcement of the WTO regulations
will remove a source of innovative quality drugs on which the poorer countries
depend. Patent protection for 20 years will increase the access gap between
the North and the South. Another organization providing testimony related
to new trade laws and intellectual property was Health Action International
- In late March an international conference
of 120 delegates from 30 countries met in Geneva under the auspices of
HAI, Médecins Sans Frontières and US Consumer Advocate Ralph
Nader's Consumer Project on Technology to discuss the campaign surrounding
Trade-Related Aspects of Intellectual Property (TRIPS.) Thai conference
participants said that Thailand was forced to drop its plan to manufacture
DdI, to be used as part of a double therapy AZT/DdI, after the US threatened
trade sanctions on some of Thailand's key exports. DdI is exclusively marketed
by Bristol-Myers Squibb.
- Trade sanctions have also been threatened
against South Africa if a proposed South African Medicine Act passes. The
act would take advantage of parallel importing and compulsory licensing,
which are legal under World Trade Organization regulations. Nader contends
that such processes can lower drug prices 75 percent or more.
- Compulsory licensing enables countries
to instruct a patent holder to license the right to use its patent to another
party. The drug is manufactured by the country granted the license, at
a substantially lower price. The monopoly on sales by the patent holder
is thus broken, although royalties are usually mandated in the process.
Parallel importing or "gray market" importing takes advantage
of substantial price differences from country to country by importing a
product to one country and reselling it to another without authorization
by the original seller.
- The Clinton administration is meeting
all threats to the pharmaceutical companies' monopolies and profits with
severe action. Nader has charged Vice President Al Gore, the chair of the
United States/South Africa Binational Commission, with using "bullying
tactics" to prevent South Africa from implementing legal policies
designed to expand access to HIV/AIDS drugs.
- Nader referred to a State Department
report to Congress which said Gore was leading an "assiduous, concerted
campaign" by US government agencies"including the Department
of State, the Department of Commerce, the US Patent Trademark Office, the
Office of United States Trade Representative and National Security Council"to
undercut South Africa's policies. Nader called the State Department and
administration attack on the South African law an "affront to the
sovereignty of Third World Nations."
- The March conference took note of the
fact that 26 million of the 33 million people infected worldwide with HIV
live in sub-Saharan Africa, yet Africa accounts for only 1.3 percent of
the global drug market. Currently 3.2 million or 16 percent of South Africans
are HIV positive. While the average annual income is $2,600, the cost of
retrovirals, drugs which can significantly lengthen a patient's life, run
$1,000 per month in South Africa. Other infectious disease epidemics have
resulted in record disease rates, which are causing the de-population of
some parts of the African continent. Treatments for these diseases are
severely curtailed by prohibitively high pharmaceutical prices. Most of
the 100,000 people suffering from multi-drug-resistant strains of TB, for
example, are unable to afford the new standard combination treatment at
$15,000 per course.
- The three organizations sponsoring the
conference have supported the final draft of the WHA 1999 Revised Drug
Strategy Resolution, saying the resolution "will soften the negative
effect of new global trade rules. However, some countries that supported
the resolution nevertheless voiced serious reservations. The Philippines
delegation pointed out that the TRIPS agreement is not sufficient for the
requirements of some WHO Members States, particularly those who are developing
or least developed. They maintained that provisions in the resolution urging
Member States to ensure that public health interests are paramount in pharmaceutical
and health policies must mean "that in the formulation and implementation
of pharmaceutical policies, public health concerns take precedence over
commercial, trade and other economic interests.
- In April, 16 people were arrested in
the US outside a Washington, DC pharmaceutical industry trade office. They
were protesting a bill that would further undermine efforts to use special
WTO provisions to encourage production of cheaper drugs. The Africa Growth
and Opportunity Act, sponsored by Congressman Charles Rangel (Dem.-N.Y)
and Philip Crane (Rep.-Ill.), would set up a Free Trade Zone in 48 sub-Saharan
African countries. The bill is on a fast track in the US Congress, and
is backed by the Pharmaceutical Research and Manufacturers Association
(PhRMA), the American pharmaceutical industry group.
- Protesters said the bill contains language
that gives additional protection to US drug patents and would prop up the
price of disease-fighting drugs on a continent where 70 percent of the
world's new AIDS cases are reported. "We're not going to allow our
president and vice president to bully and harass and kill people in Africa,"
Julie Davids of ACT UP/Philadelphia told the rally.
- There are other health related issues
affected by the use of patents to support high profits. The burgeoning
biotechnology industry is trying to protect investments that anticipated
huge profits by taking advantage of patent law. Attempts are being made
to patent whole genetic sequences. In one example, the Meningitis Research
Foundation warned that Human Genome Sciences, which has applied for the
patent on the sequence for bacterial meningitis, could use their patent
to demand royalties for any vaccine developed by the foundation.
- Recent history shows many examples of
the use of patent law to protect drug companies' profits. In 1993 Bristol-Myers
Squibb was criticized when they announced a wholesale price of $4.87 per
milligram of Taxol, an important cancer drug. Bristol-Myers Squibb acquired
the drug in bulk from a contractor at $.25 per milligram. DdI, the AIDS
drug, was also priced far above Bristol-Myers Squibb costs. The life saving
drug was invented by the US government but was exclusively licensed to
- Mergers between pharmaceutical companies
have also created giant monopolies on health-related products that the
merged partners once competed to produce.
- US domestic drug pricing has also received
a boost from the Clinton administration. In April, 1995 the administration
sided with the pharmaceutical companies by repealing the 1989 law requiring
products developed in part due to research at National Institute of Health
(NIH) laboratories to be reasonably priced. It is estimated that the federal
government funds fully 38 percent of US healthcare research while 10 percent
is funded by other government agencies and nonprofits. The private sector
funds about 52 percent of total healthcare research, but reaps most of
- At an AIDS trade show last year, AIDS
activists demonstrated against Glaxo-Wellcome for "putting greed before
people's lives." Glaxo said it would limit access to the new HIV drug
Abacavir (1592) to 2,500 people worldwide. AIDS drugs currently on the
market are failing more than 10,000 people with AIDS. Although 1592 was
invented in 1989, the protesters say unnecessary deaths are due to Glaxo-Wellcome's
plan to maximize profits on the marketing of AZT until the patent runs
- They also accused the giant pharmaceutical
company of dragging its feet on developing the protease inhibitor 141 W94
that it purchased from Vertex. Glaxo raised the price of AZT and 3TC 3
percent in 1998. AZT has reaped $2.6 billion in sales. ACT UP demanded
lowered standards for viral load and CD4 cell counts to determine that
older drugs have failed, and to determine who will get the new treatment.
They were incensed when the company proposed lotteries to determine who
gets the new drug.
- Recently ACT UP/NY studied several companies'
annual reports and cited figures for profits based on net income/sales.
They were four to five times higher for the drug companies than for non-drug
industries. While AT&T reported a 2 percent profit, Texaco 3 percent
and Chrysler 3 percent; Merck reported 22 percent, Abbott 16 percent and
Roche 18 percent. Glaxo-Wellcome, the maker of AZT, reported a 23 percent
profit. A 1998 Congressional Minority report on pharmaceutical profits
put them even higher, at nearly 29 percent for the US drug manufacturers.