US trade action threatens Brazilian AIDS programme

International health agencies have condemned the US government for threatening the Brazilian policy of providing free drugs to patients infected with HIV.

The US government has initiated legal proceedings against Brazil, through the World Trade Organisation’s dispute settlement body, claiming that Brazil’s production of generic HIV drugs breaks international laws on patent protection. Brazilian laws provide patent protection to foreign drug companies if they manufacture their product in Brazil. These laws have allowed local Brazilian companies to manufacture generic HIV drugs at low cost. The United States has complained to the World Trade Organisation that this requirement for local production discriminates against the US pharmaceutical industry.

Bernard Pécoul, director of the Médecins Sans Frontières’ (MSF) Access to Essential Medicines campaign, said: “The lives of hundreds of thousands of patients depend on this system [in Brazil]. The US action will also intimidate countries which would like to take up Brazil’s offer to help them produce AIDS medicines.”

Brazil’s health ministry estimates that the number of deaths from AIDS has halved since it started distributing free HIV drugs. A ministry spokesperson said, “This policy has resulted in a significant improvement in the quality of life of people living with HIV and AIDS, as well savings to the Brazilian government amounting to $422m (£281m).” Concern is growing among aid agencies that the trade rules administered by the World Trade Organisation are hindering access to essential medicines in the developing world. Although the rules allow poor countries to produce their own generic drugs, these countries’ attempts to do so have often been met by US threats of trade sanctions (BMJ 2000;320:207) or legal challenges by pharmaceutical companies.

In a case that goes to court on 5 March, a coalition of 40 drug companies is suing the South African government with Nelson Mandela named as a defendant for manufacturing generic HIV drugs. “Limiting generic manufacturing capacity is in the interests of the pharmaceutical industry,” said Ellen ‘t Hoen of MSF. “And the US, by its trade threats, is sending out the message, ‘don’t mess with our pharmaceutical companies.’ ”

Oxfam launched its own campaign (Cut the Cost) this week, which calls for a change in the World Trade Organisation’s trade rules to make it easier for poor countries to manufacture low cost drugs. Justin Forsyth, Oxfam’s director of policy, said, “The World Trade Organisation must change the rules that the drug industry is now using to cripple cheap, local competition, which in turn is inflating the cost of new and patented medicines.”

In a move that could start an international price war on HIV drugs, an Indian generic drugs manufacturer, Cipla, has announced that it will sell triple combination HIV therapy to MSF for $350 a year per patient. The cost to governments will be $600 a year per patient. Five major drug companies promised last year to cut the costs of its HIV drugs in the developing world (BMJ 2000;320:1357), but their prices are still three times those offered by Cipla.