Nairobi, Kenya
September 25, 2003
Allow me to make one point directly on the matter of resources at the outset.
It is worth noting that the industrial world is spending $600 billion a
year on defense, and $350 billion on agricultural subsidies. That is to
say, on those two items alone, the rich world spent almost a trillion
dollars while Africa had slightly less than a billion dollars to spend on
AIDS. That’s a ratio of a thousand to one. For the mathematically-inclined,
it means that the rich world, annually, spends 600 times as much on defense
as Africa has for AIDS, and 350 times as much on subsidies as Africa has
for AIDS.
My use of the phrase “grotesque obscenity” at the conference opening may
sound strong, but it wilts in the face of those numbers.
However, there are many ways to free resources. I want to suggest an
approach that is somewhat unorthodox, but gains significant credibility in
the light of recent events.
At the end of August, the World Trade Organization finally reached a
compromise on generic drugs. After two painful years of dispute and delay,
it was agreed that African countries could import generics if they were
clearly in need, and other countries could export generics to meet that
need. It was also decided that any such import/export activity would not
violate international trading rules, or trade-related intellectual property
rights.
This week, at the UN General Assembly session on Monday in New York, the
World Health Organization announced its determination to achieve the goal
of “3 by 5”, that is, to make sure that three million people are receiving
treatment by the year 2005. In the UNAIDS report that accompanied the
debate, it was said that 50,000 people are in treatment now in Sub-Saharan
Africa, as compared with 4.1 million who are eligible for treatment. In
other words, the numbers receiving treatment represent roughly 1% of those
eligible.
I want to suggest that the two events --- the WTO agreement and the WHO
pledge --- yield a truly interesting possibility which I should like
formally to advance.
It’s time for one of the major industrial countries, in particular, one of
the G7 countries, to announce the manufacture and export of generic drugs
to Africa. I would wish it to be my country, Canada, but it doesn’t really
matter which.
The proposition is simple: if the WHO is going to move from 50,000 now in
treatment in Africa to over two million by 2005 (Africa’s share of the 3
million target), then they will need a fast, reliable, scientifically
sound, continuous flow of generic drugs in order to keep the prices low
enough --- roughly $250 to $300 per person per year --- for the plan to
succeed. There will obviously be some provision from Brazil, Thailand and
India, but much more will be needed. A western country could fill that need
and do it at the highest standards of quality.
All that is required is to issue a compulsory license which lifts the
patent protection from anti-retroviral drugs on the WHO approved list.
Every G7 nation has a robust generic industry with great production
capacity. In Canada, the Generic Pharmaceutical Association has already
asked the government to issue a compulsory license so that they can export
to Africa. The big pharmaceutical industry would suffer not one whit: these
drugs would be for export only, domestic prices would not change, and there
could even be a time limit on production … say, five years, until Africa
develops an indigenous manufacturing capacity of its own. It would be
expected that the generic manufacturers would help build this manufacturing
capacity in Africa by transferring the necessary technology.
If this were done, it would be entirely consistent with the WTO
negotiations completed at the end of August. No rules broken, millions of
lives prolonged and saved. It would be a huge testament of good faith from
the industrial world towards Africa.
I want to emphasize that there is absolutely nothing standing in the way of
such an initiative except a paralysis of political will and the influence
of the big pharmaceutical companies. But the political will can change. And
the drug companies could do the right thing. If the pharmaceutical industry
were to throw up obstacles, they wouldn’t have a leg to stand on: on the
one hand, it’s entirely legal, and on the other, there is no damage
whatsoever to the corporate balance sheet. You’d have to have pretty
twisted motives to oppose a compulsory license. After all, we’re talking
about millions of lives.
When the WTO agreement was reached, the drug companies said they could live
with it. Some of the major NGOs, like MSF and Oxfam and Health Gap, fear
that the big drug companies really agreed to the deal only because it
imposed conditions on the African countries which those countries would
fail to meet. The result, they feel, would be that Africa wouldn’t be able
to import generic drugs, and would have to fall back on non-generics from
the big pharmaceutical companies at higher prices.
So what were those conditions? The importing country would have to go
before the WTO Council to prove the need to import (that is, to show that
there was no local manufacturing capacity); the importing country would
have to go before the WTO Council to show that the drugs were for “health
purposes” and not “commercial purposes”; the importing country would have
to guarantee protection against black market activity; and any third
country could challenge the transaction by issuing a formal complaint
within the WTO.
The NGOs see these conditions as potentially crippling obstacles to the
import of generics. But they want to test the agreement before deciding
that it won’t work.
And that’s a key reason for one of the industrial countries to leap into
the fray. If a G7 country issues a compulsory license so that its generic
industry can provide the drugs, then the G7 country can join the African
importing country when it goes before the WTO Council or responds to some
challenge. The presence at the table of Canada, or the UK, or France would
change everything. It would make the entire process possible. It’s all a
matter of clout and influence.
One final item: It was only ten days ago, in Cancun, that the wealthy
nations of the west took a position on agricultural subsidies so
intransigent and unjustified as to cause a collapse of the talks. In so
doing, they doomed Africa to continuing poverty. It would at least be a
small act of redemption if the same wealthy countries now provided low cost
generic anti-retrovirals to help to diminish the scourge of AIDS.
It might not usher them into the kingdom of heaven, but they’d be further
removed from the inferno.
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