AIDS drugs offered free in Brazil

Government says AIDS is not the threat it once was, in part because cheaper drugs curb the problem.

Isabel Almeida was watching television one night when she saw a report about the Brazilian government's plan to distribute medicine free to people with HIV, the virus identified as leading to AIDS.

Ms. Almeida, a Brazilian housewife diagnosed as HIV-positive, could not believe what she was hearing. The next morning she called her doctor, looking for more information. When he called four months later to tell her that the program had finally been approved, she says a wave of relief swept over her.

"I thought, I am going to live forever," says Almeida. "It gave me a safety net."

Administering a mix of antiretroviral drugs to HIV-positive patients has so far shown to delay the onset of AIDS in some patients. But purchasing the drugs, at a cost of about $12,000 annually, can be prohibitively expensive.

In Brazil, the government found a way to cut the cost by authorizing state laboratories to make generic copies of all but four of the 12 drugs, lowering the cost of production to about $4,500 per patient per year. Now, the Brazilian government distributes them free of charge to some 90,000 people.

"The simplistic argument that treating AIDS is expensive is no longer convincing," says Pedro Chequer, who coordinates UNAIDS programs in South America's Southern Cone. "Offering treatment is a question of morals and ethics, but we have to emphasize the economic side of things and change the focus. In Brazil, the cost of the investment is economically positive."

Brazil's controversial scheme, which is similar to generic drugmaking practices in India and Thailand, got under way in 1997. All pharmaceutical patents registered before a drug patent law was introduced at that time became public property. Four of the 12 AIDS drugs, patented after the new law, are manufactured privately.

The Pharmaceutical Research and Manufacturers of America says that Brazil is effectively stealing the patents on these drugs and the profits rightfully due their inventors, as well as violating international property rights. Such practices put future investment in Brazil at risk and could slow development of new drugs, the group says.

But Brazil and other developing nations argue that saving lives now is more important than protecting profits. Brazilian authorities are warning pharmaceutical firms that unless they lower the cost of the remaining four drugs, the government will invoke a rarely used constitutional provision and produce all the drugs. "We are negotiating [over drugs No.] nine, 10, 11 and 12, and if prices don't fall, then we'll break their patent licenses," says Paulo Teixeira, the national coordinator of Brazil's National AIDS program.

Similar attempts to convince pharmaceutical companies to lower the costs of AIDS-related drugs have met with mixed success elsewhere. Five major international drugmakers have offered to slash prices in Africa, but so far Senegal is the only country with a pricing pact.

Critics say the firms are still making big profits and have a moral duty to provide poorer countries with drugs they can't afford. The companies counter that they are required by their shareholders to recoup the huge sums invested in drug research.

A local manufacturer of Ritonivir, one of the four privately made drugs in the usual mix, says they stand to lose huge sums if the government starts producing the drug. "In terms of losing market, I am worried," says Irapuan Oliveira at Abbott Laboratories of Brazil, the company that developed Ritonivir. Mr. Oliveira says he worries that the quality of the government-made product may be inferior, doing "more harm than good" for the patient.

Supporters of the patent-busting solution say that it has been a success for Brazil, both in terms of lives and money saved. In the first two years of the program, administering the drug cocktail kept 146,000 people out of the hospital and saved the nation $472 million, officials say. The amount the government spends on domestically produced pharmaceuticals has fallen 72 percent during the same period, compared with a 9 percent fall in the price of the privately manufactured drugs, Mr. Teixeira says.

In 1995, the World Bank estimated that the number of AIDS cases in Brazil would reach 1.2 million within five years, but the actual number is currently closer to 540,000, Teixeira says. The disease that was once the leading killer of women and the second leading killer of men is no longer a principal cause of death for either sex, he adds.

That is heartening news for people like Almeida. Taking a drug cocktail has prevented her from contracting any serious illnesses, she says, even though it has meant she has had to forgo her once active social life. She now devotes her time to her two children, neither of whom have the virus. The former domestic servant and child-care provider says she began looking after other children again last month, the first time she has worked in years.

Such successes have brought the Brazilian program to the attention of other countries keen to replicate the scheme in their own nations. But international agencies are not showing interest in sharing the Brazil prescription.

Teixeira says Brazil tried to organize a system under which nations could together lobby drug companies to sell cheaper drugs. As a first step, Teixeira asked the World Health Organization, the Pan American Health Organization, and AIDS experts meeting at the annual UNAIDS conference to sponsor a Web site that would show how much each country was paying for each drug.

None of the organizations would help.

"Their argument is that they don't have the structure or the competence. As far as we are concerned they didn't want to get involved," Teixeira says.

Instead, Brazil plans to put the information on its own Web site this month. Brazil also announced that if any other nation wants to produce its own generic drugs and distribute them gratis, then Brazil will give them the technology free. Already, India and China have expressed interest. Brazilian officials say that talks may take place in Rio later this month at a meeting of world health ministers.

(c) Copyright 2000. The Christian Science Publishing Society

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