Medicines avec frontières

An old story from the Southeast Asia Globe that seems timely right now.

Southeast Asia Globe, October 2011

Opportunity or threat? Negotiations for a Pacific Rim free trade agreement are raising hopes and fears amongst observers. At its best, the agreement may boost trade; at its worst, intellectual property provisions may restrict access to crucial medicines, particularly those required by HIV and Aids sufferers.

Since 2000, Indian generic drug manufacturing companies have lowered the price of life-saving and life-extending Aids treatment from a whopping $10,000 per person per year to $70 in developing countries such as Cambodia – saving millions of lives.

However, the European Union and the United States are pursuing aggressive trade policies that they say will encourage economic expansion, but which alarmed patient advocacy groups say will threaten the ability countries have to manufacture and import generic anti-retrovirals.

As part of this push for economic growth, the EU is in negotiations with India, Thailand, Indonesia and the Philippines to step up levels of intellecutual property protection. In a similar vein, the US is currently in the final rounds of talks with eight countries for a Trans-Pacific Partnership Agreement that it hopes will be expanded to include all 21 members of the Asian-Pacific Economic Cooperation (Apec) – which collectively accounts for 54% of world economic growth and 44% of world trade.

Advocacy bodies say such attempts to reverse current trade laws will only serve to expand monopolies of multinational pharmaceutical companies and increase the cost of essential new and forthcoming Aids medicines.

Vietnam and Malaysia could be required to create legal provisions that will, among other things, enable patent holders to roll over their monopoly rights in perpetuity. The agreement may also require and ‘data exclusivity’ terms that mean third parties cannot access clinical trial data submitted to pharmaceutical licencing authorities. This data is the lifeblood of manufacturers of generic medicines, and the people whose lives depend on them.

“More than 80% of those on Aids treatment in poor countries are taking generic medicines,” says Shiba Phurailatpam, from the Asia Pacific Network of Positive People. “Yet the United States is pushing even greater legal barriers to generic treatment.”

The vast majority of these drugs are produced in India, which has so far resisted intense pressure from the US and the EU to drastically upscale its patents regime, which would cripple its generic pharmaceuticals industry and end its role as the ‘pharmacy of the world’.

“More than 85% of the drugs we use in Cambodia are Indian generics,” said Heng Phin, M&E manager for the Cambodian People living with HIV/Aids Network. “If prices go up, we will have to cut people out of the programme.”

Tony Lisle, the country coordinator for UNAIDS in Cambodia, fears restricting access to generic medicines will set Cambodia’s fight back by a decade.

“It is precisely because of generics that the Cambodian Ministry of Health has been able to scale up treatment to such an unprecedented extent,” he said. “Cutting off that access will send us back to 2001, when we were treating 71 people from one centre. Today, we’re treating 42,000 people from centres all over the country.”

The US and EU’s controversial moves came hot on the heels of a high-level UN meeting in June that concluded intellectual property provisions in trade agreements had the potential to undermine public health goals, especially relating to Aids treatment. Aids donor groups have since pledged a further $150m to  efforts to reduce mother to child HIV transmission.

The trade negotiations have come at a time when the fight against HIV/Aids seems finally to be on the front foot. Trials of a new microbicide have produced positive results. The early use of anti-retrovirals by infected persons has been shown to reduce the risk of transmission  to their sexual partners to less than 4%. In an apparent medical breakthrough, an American man has reportedly been functionally ‘cured’ of Aids following a stem-cell transplant. Further, only one month after the UN meeting, bio-pharmaceutical company Gilead Sciences announced it would licence manufacture of four Aids and hepatitis B drugs to the newly formed Medicines Patent Pool, a groundbreaking initiative that seeks to improve access to HIV medicines through voluntary licencing of intellectual property rights. Countries such as Cambodia, Laos, Vietnam, Myanmar and India will benefit from the licences, though middle-income countries, such as Thailand, China, the Philippines, Malaysia, Indonesia and Brunei, are excluded.

The Trans-Pacific Partnership Agreement includes terms they haven’t seen in previous trade deals, says Peter Maybarduk, a lawyer and the Global Access to Medicines programme director for Public Citizen, a Washington-based citizens’ rights advocacy organisation. He believes the US is attempting to isolate India so it will finally be forced to put an end to generic production.

“This is solely for the benefit of big pharmaceutical companies that are dictating trade policy to governments,” Maybarduk said.

While campaigning for the presidency, Barack Obama committed to “break the stranglehold that a few big drug and insurance companies have on these life-saving drugs”. Whether that commitment still stands will be seen in the terms of the agreement he announces later this year.


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