Patients before profits

Srikumar Bondyopadhyay, Upasana Pande, Rajkumar Leishemba & Prachi Raturi.

If earlier people were dying with AIDS, now they are living with HIV infection. The prices of drugs have come down. The accessibility has increased. This year’s World AIDS Day on December 1 was in fact positively different from the days in earlier years.

Says Dr Bitra George, a consultant with Sharan, an NGO: “As far as the availability of drugs for HIV infected and AIDS patients is concerned, there has been an encouraging change of late.”

Explains Dr Nalin Nag, a senior consultant in internal medicine, Indraprastha Apollo Hospital: “With the cheaper availability of anti-retrovirals (ARVs) therapy, management of AIDS has become a very active one.”

Dr Ashutoh Biswas, assistant professor, All India Institute of Medical Sciences, agrees with him. He adds: “At present, with six months of affordable treatment, we are able to suppress the virus to the extent that it becomes undetectable in blood.”

Of course, patients are the happiest lot. Naresh Bhatia (name changed), who recently tested HIV positive, is appreciative of the efforts of pharmaceutical companies like Cipla in lowering the prices. Says he: “Two years back the same medicines were beyond reach. But now they have become accessible to some, if not all.”

Another patient Rajesh Dube (name changed) too, is relieved that the prices have been reduced. He was diagnosed with HIV positive when he went for blood donation. Mr Dube has been prescribed a combination of two drugs (which cost him about Rs 1,560 per month) and a test (which costs Rs 8,000) after six months. He wishes: “The prices should be reduced further as these medicines are to be taken for life.” They may well be in due course as the pharmaceutical industry assumes more responsible role in a competitive market. Says R Gopalakrishnan of Cipla: “We have reduced the prices in the past and will continue to do so in the future.”

It all started in February this year when Indian pharmaceutical company Cipla offered its cocktail of ARVs—copycat generics of patented ARVs—to the developing world, and an international doctors’ voluntary organisation, Medecins Sans Frontieres (MSF), at cheaper than market rates. Cipla has reduced the price for its ARVs in the domestic market, too. Says Mr Gopalakrishnan: “Currently Cipla’s domestic and international prices are the same.” Imunus Aurobindo and Ranbaxy too, followed suit.

Of course, it did not happen without hiccups. Earlier this year, 39 pharmaceutical multinational companies—the patent holders of anti-AIDS generic drugs—took the South African government to court over the latter’s move to import cheaper copies of their anti-AIDS drugs.

Subsequently they withdrew the case in April and agreed to supply cocktail drugs to less developed countries (LDCs) at much cheaper rates than the price they sell at in developed countries provided the recipient LDC governments distribute the drugs among patients free of cost. The anti-AIDS drugs, which cost between $10,000 and $15,000 per person per annum in the developed countries, are now available to LDC governments at a price as low as $347 per person per annum.

A shot in the arm for the public welfare system also came when the Doha ministerial summit under the aegis of WTO (World Trade Organization) put health before patent and profit, and authenticated parallel imports and compulsory licensing. The inclusion of HIV/AIDS in the definition of public health crisis in the WTO Doha declaration should go a long way in helping the pharmaceutical industry in the fight against the disease. Adds Mr Gopalakrishnan: “The declaration will have to be enacted by the Indian government in the form of amendments to the Indian Patents Act.”

While the Doha ministerial declaration also allows for using every flexibility in TRIPS (Trade Related Intellectual Property Rights), India and Brazil have already successfully used the time lag before they come under international product patent regime. For India the time limit is 2005. The Doha summit also witnessed another significant development in terms of TRIPS—the authentication of parallel imports.

However, says Krishna Sarma, an attorney-at-law (patent and trade mark): “The actual benefit of the compulsory licensing and parallel imports will be felt after the product patent regime is in place after 2005. During the interim period, we only have a process patent in place. So the scope of re-engineering is always there.” However, she allays the fear that the drug prices offered by the generic patent holders will shoot up steeply once the international product patent regime is in place. “After all, the pharmaceutical MNCs will also have to sell their products and in doing that they will have to keep in mind the affordability of patients,” she argues.

Bibek Debroy, research director, Rajiv Gandhi Institute of Contemporary Studies and an expert on WTO related issues, also echoes a similar view. “If I have to put it in a single line, I’ll say the fears are exaggerated.” He adds: “Whether, in the interim period, Indian customers can avail of cheaper clones of the patented costly generic drugs will, however, depend on the use of compulsory licensing. Since 1970, we have used it only once.” While the macro issues are being debated, the base of stakeholders is increasing. It’s not only pharmaceutical industry that is at the centrestage, even other industries are getting drawn in. For example, the Confederation of Indian Industries (CII) has set up a business trust with 17 founder trustees, which includes the likes of C K Birla, N R Narayanamurthy and Arun Bharatram. In fact, the CII plans to start a separate cell to cope with HIV and AIDS related issues before April next year.

This is not a one-off initiative. The CII embarked on an advocacy programme to tackle HIV/ AIDS amongst workforce way back with 70 companies in 1996. Today, more than 2,000 companies are involved in these programmes, says Dr Sandhya Bhalla, a consultant with
CII, who is in-charge of the AIDS/ HIV programme.

The CII has also tied up with Sahara, an NGO, whereby the outfit provides employment and training facilities to people affected with HIV/AIDS. Phenyl making, detergent making, and chalk making are taught to these people. Besides conducting training programme for employees, their partners and children are also targeted by awareness campaigns. A special attention, points out Dr Bhalla, is paid to adolescents.

Irrespective of who takes the initiatives, the emphasis is more on prevention. “And this can be better done by imparting strong moral values and the teaching of abstinence to pre-teen children,” says Dr Farzin Davachi, professor of peadiatric cardiology, New York Medical College. Dr Davachi. He is also a medical advisor and consultant to the United Nations’ Development Programme (UNDP), World Health Organization (WHO), and The World Bank.

The message is already being driven home. The awareness and change is coming in. It is slow and it will be slow though, notes Dr K Sudarshan, a senior health specialist at The World Bank. Says he: “One cannot expect things to happen over a few months or a year. It’s about awareness. So it will take a while. The problem areas are being looked at. The awareness campaigns are going on.”

Adds Mr Shaleen Rakesh, a project coordinator with NAZ Foundation, an NGO working on sexual health: “For something like this, which is still a hidden issue, people coming up and discussing their problems is a significant change. At least people are more willing to discuss, and to become proactive. A door seems to be opening up. So there definitely is a shift in people’s awareness about the disease. It’s a small shift alright, but definitely a very encouraging one.” The foundationhas already set up a care-house for 14 people. Agrees Dr Bhalla: “People are becoming more interactive, more aware and more willing to communicate. And this awareness is showing in the improvement of problem areas.’’ These may be small changes, but they seem to be in the right direction.