How can developing countries access HIV/AIDS drugs?

It is estimated that only seven percent of those with HIV/AIDS in developing countries receive any anti-retroviral (ARV) therapy. Guaranteed long-term access to affordable medicines, along with investment in public health infrastructure, is essential to tackle the pandemic. How can developing countries overcome the barriers to accessing HIV/AIDS drugs?

Developing countries are currently stuck in a‘price-infrastructure trap’: high prices for HIV/AIDS drugs reducethe possibility of extending treatment programmes and decrease government motivationto invest in much-needed public health infrastructure for HIV/AIDS. Thegenerally limited response of these countries to the HIV/AIDS pandemicis largely due to the problem of stability of access to affordable medications.

Although the international community has now recognised the need to support treatment, and not justprevention, mechanisms to provide ongoing stable access to affordable drugs areinadequate. A paper from the London School of Economics considers ways to helpdeveloping countries access discounted drugs, and analyses how globalregulations on intellectual property rights (IPRs) can limit developingcountries’ ability to obtain ARV and other drugs.

The author looks at four ways of achieving stablesupplies of affordable drugs:

• local production of brand-name drugs: not a viableoption because in most developing countries the HIV/AIDS drugs arenot patented or, if they are, the patent-holding transnational corporation doesnot have local manufacturing facilities
• local production of generic drugs (copies ofbrand-name drugs): no more than fifteen developing countries have the abilityto produce such drugs
• importing brand-name drugs: although there are many discountschemes for such drugs, they are restricted to specific drugs with conditionsdetermined by the supplier, and the drugs can be withdrawn at the discretion ofthe supplier
• importing genericdrugs: perhaps the most feasible option, though threatened by changes in theglobal IPR system. This would also allow developing countries to bargain forprice reductions on brand-name drugs.

The November 2001 Doha Declaration on the TRIPSAgreement (Trade-Related Aspects of Intellectual Property Rights) and PublicHealth confirms developing countries’ rights to use the patent system to securestable access to affordable ARV drugs, as Brazil has successfully done. TheDoha Declaration will not, however, assist the majority of HIV/AIDS-affecteddeveloping countries, which lack domestic production capacity. They will haveto import ARV drugs from those countries with the technical and legal capacityto produce and export generic medicines. In 2005, the transition period onpharmaceutical patents under the TRIPS Agreement comes to an end, requiring allbut the least-developed countries to establish pharmaceutical patent systems.Imports of generic HIV/AIDS drugswill then be made difficult by patents in exporting countries.

Policy-makers need to realise that:

• Importing brand-name drugs depends so heavily on thevoluntary actions of patent-owning pharmaceutical firms that it is unlikely to providesufficient stability, predictability and reliability of supply.
• Competition in production of generic drugs iscritical for obtaining price reductions from brand-name pharmaceutical firms.
• Developing country governments are wary of makingmassive investments for the treatment of HIV/AIDS without first knowing thatdrugs are available and future versions will remain available.
• The high costs of launching an effective response tothe epidemic, combined with the lack of political power of people with HIV/AIDS and theirfamilies, can encourage governments to deny the severity of the problem.

Ultimately, even if discounted drugs are madeavailable, increased international financing will be needed for the treatment(and prevention) of HIV/AIDS indeveloping countries.