HIV/AIDS Drugs for USD 1/day

[Guest guest]

Dear Forum members,

The following is a news item appeared on the front page of the

NewYork times news paper yesterday. This is significant for people

living with HIV/AIDS, AIDS NGOs and AIDS policy makers in India.

[Moderator]

Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa.

NewYork Times, February 7, 2001. By DONALD G. McNEIL Jr.

In a move that could force big drug multinationals to cut the prices

of their AIDS drugs in poor countries, an Indian company offered

today to supply triple-therapy drug " cocktails " for $350 a year per

patient to a doctors' group working in Africa.

The Indian company, Cipla Ltd. of Bombay, a major manufacturer of

generic drugs, made the offer to Doctors Without Borders, which won

the Nobel Peace Prize in 1999 for its work in war-torn and

impoverished areas. In Africa the group sets up small pilot programs

to develop models for broader approaches to combat AIDS, and would

distribute the Cipla drugs free.

As part of its program, Cipla would also sell the drugs to larger

government programs for $600 a year per patient, about $400 below the

price offered by the companies that hold the patents. " This is the

way to break the stranglehold of the multinationals, " said Dr. Yusuf

K. Hamied, chairman of Cipla, who will meet with the doctors' group

on Feb. 15 to discuss strategy.

For two years, Doctors Without Borders has led an aggressive campaign

to force multinationals to cut prices on life-saving drugs for the

world's poorest patients.

Other parties in the campaign are the Philadelphia and Paris chapters

of the AIDS Coalition to Unleash Power, and the Consumer Project on

Technology, a Washington group started by Ralph Nader.

The normal cost of the AIDS cocktail in the West is $10,000 to

$15,000 a year. Last May five multinationals, backed by the World

Health Organization and other United Nations agencies, offered to

sell their components to poor nations at sharply reduced prices.

But Cipla and other makers of generic drugs in Brazil, Thailand and

other countries have not been part of the talks with W.H.O., a

situation that Cipla hopes to change with its aggressive entry onto

the scene.

The country-by-country negotiations about how the multinationals

distribute the drugs have gone slowly, and so far only Uganda,

Senegal and Rwanda have agreements. The companies refuse to

release figures, but the cost of a typical cocktail in Senegal is

$1,000 a year, according to Doctors Without Borders.

Dr. Bernard Pecoul, director of the Access to Essential Medicines

project for Doctors WithoutBorders, said the Cipla offer, which he

learned of only today, " will let us start up our pilot projects on a

larger scale. "

The doctors' group has 40 AIDS projects around the world, about half

in Africa, where the infection rate reaches as high as 36 percent.

Only five of these pilot programs are giving out antiretroviral

cocktails. With the Cipla offer, or matching ones from other

companies, up to 20 could be distributing the drugs by the end of

year.

Cipla is offering to sell the agency as many doses as it is wants at

$350 a year. Dr. Hamied said that his company would lose money at

that price, but that he would supply " 10,000 doses or 20,000 or

30,000, however many they want. "

The $600 price to governments is near Cipla's break-even point, he

said, but costs could drop with greater production. If that happens,

he would cut prices further.

In India he sells the same cocktail for about $1,100 a year. But he

denied that he was trying to grab market share in Africa. " What do I

want with market share? " he asked. " I don't have a monopoly, and the

only way to make real money in drugs is with a monopoly. In this

disaster, there is room for everybody. "

Wide distribution of the drugs in Africa is not without critics,

given the attendant need for careful monitoring. Some experts argue

that it would be better to spend the money on providing clean water,

controlling malaria and increasing the use of condoms. But Doctors

Without Borders says that the dangers and side effects of the drugs

pale beside the immensity of the epidemic itself, and that Western

testing standards are overcautious.

The typical AIDS cocktail is a combination of any three of about nine

protease inhibitors or reverse transcriptase inhibitors. The

chemicals suppress the human immunodeficiency virus but, as with any

chemical therapy, they are toxic and can damage the liver. In the

West, doctors carefully monitor the levels of the drug in the blood,

test for organ damage and check the levels of the virus in the

bloodstream. If the virus mutates to resist the therapy, the

combinations are changed. Carefulmonitoring may not be possible in

many African settings.

But with 25 million Africans infected with the AIDS virus, Doctors

Without Borders and other agencies argue, imperfect treatment is

better than none.

Dr. Pecoul pointed out that large numbers of infected Africans live

in urban areas where, " with a quite simple clinic, you can deal with

anti retrovirals. "

He is also " not convinced " that the batteries of tests routinely

ordered for Western patients are really necessary. " Some people

suggest that H.I.V. testing and clinical followup can be enough, " he

added.

The Cipla drug combination is two tablets of 40 milligrams of

stavudine, two tablets of 150 milligrams of lamivudine and two

tablets of 200 milligrams of nevirapine.

In the United States and many other countries, the Bristol-Myers

Squibb Company holds the patent on stavudine, also known as Zerit or

d4T; Glaxo-Wellcome of Britain holds the patent on lamivudine, also

known as Heptovir or 3TC, and Boerhinger Ingelheim G.m.b.H. of

Germany holds the patent on nevirapine, or Viramune.

Western drug companies have shown themselves determined to defend

their patent rights to be sole distributors throughout the world, and

Dr. Wecker, head of Boerhinger Ingelheim's efforts to negotiate

cheaper prices in Africa, said he did not yet know what his company

would do if Cipla undercut its prices. " We offer a standard quality

from the original manufacturer and can meet any demand that exists

out there that can be delivered with safe procedures, " he said.

He refused repeatedly to say at what price Boerhinger Ingelheim sells

nevirapine to Senegal or Uganda, saying, " Affordability is an issue,

but not the major issue. " Representatives from Glaxo-Wellcome and

Bristol-Myers did not return phone calls, but the three companies

can be expected to wage a hard fight against the distribution of

generic versions of their drugs.

Late last year, Glaxo-Wellcome threatened to sue Cipla when it tried

to sell Duovir, its generic version of Glaxo's Combivir, a

lamivudine/zidovudine combination, in Ghana.

Cipla offered the drug for $1.74 a day; Glaxo had cut its price to

$2, from $16. But even though the African regional patent authority

said Glaxo's patents were not valid in Ghana, Cipla backed down and

stopped selling Duovir.

Asked what he would do if the three drug companies sued to stop him,

Dr. Hamied said: " We won't fight it. I don't look at it as a fight.

There's room for everybody.

This is a holocaust in Africa. It's like the earthquake in India

right now ¯ everybody is helping out. I'm not looking to pick

anybody's business; there's room for the multinationals at their

price and room for us at our price, a partnership. "

________________________________

Copyright 2001 The New York Times Company

http://www.nytimes.com/2001/02/07/health/07AIDS.html?printpage=yes

Copied as fair use.]