AIDS Fight Boils Down to Dollars Versus Lives

Brazil 2001

By Tom Fiedler

June 09, 2009

BRASILIA -- What if I told you that it is possible to curtail the most murderous disease to hit the world since the Bubonic Plague swept Europe in the Middle Ages; that even developing nations can master the techniques and can be positioned to afford it; that as a result millions of children will not be born with the disease, that millions more won't be left as orphans; that nations will not collapse under population and economic loss; that civilization as it is known in some parts of the globe won't go backward?

All this is true because I have seen proof of it here in Brazil. But what if I told you that all these positive things face a towering obstacle before they may occur and it is this: Us. To be specific, it is all of us acting collectively through the U.S. government. That's a harsh assessment, I know, and perhaps not entirely fair given the efforts that this country has made in myriad ways to bring an end to this plague called AIDS. But when viewed from the eyes of people who live in much of the rest of the world, the U.S. government has deliberately sided against those who have the means to virtually stop the growth of AIDS, which in time will almost certainly lead to a diminution in its effects.

And we are doing so in the name of protecting the huge profits -- some call them obscene profits -- of the major pharmaceutical companies in the United States that make some of the drugs that go into the ``cocktails'' that have proven so effective in allowing people with HIV/AIDS to continue living and participating in society.

All these issues have come to a head here in Brazil, a vast but underdeveloped nation of 170 million that has through sheer commitment become the world's model for dealing with this modern plague. Barely a decade ago the World Bank estimated that by 2000 this country would have 1.2 million people with HIV/AIDS. That statistic terrified the political and civil leadership, which responded by putting into place a program of prevention and treatment that has no rival.

On the prevention side, Brazil, although nominally the world's largest Roman Catholic nation, has few if any hang-ups about openly discussing sex. Children learn about sexually transmitted diseases beginning in schools at age 7; Catholic priests in some parts of the country not only tolerate discussions of prevention, they distribute condoms and conduct classes themselves.

Every year, the government also gives away $200 million worth of condoms through health clinics and programs. But preventing AIDS, though critical, was but half the program. The government also pledged in 1996 that everyone with HIV/AIDS would receive free treatment, including the complex therapies that include taking numerous drugs under rigid conditions.

The complexity of the program has been staggering, and the results no less so. Instead of 1.2 million people suffering with the virus, only 500,000 are estimated now to have it. Of these, 100,000 are in active treatment, the others not yet diagnosed.

In other words, the plague's casualties are below half the best estimates. And in this sort of work, success breeds success because infected people under treatment are much less apt to infect others, slowing the spread.

But here is the catch: Brazil -- and any country that hopes to follow its lead, especially those in Africa being devastated by the plague -- may find further success blocked because they can't afford to pay for new therapies that carry astronomical price tags.

These drugs aren't expensive because of the cost to develop and manufacture them (many were actually invented at public universities using grants from taxpayers). Rather they're expensive because some of the pharmaceutical giants that market them demand huge profits, estimated by Brazil's health minister, Jose Sera, at up to 10 times cost, or 1,000 percent.

And so far they've been able to get away with this because they hold patents on the drugs -- essentially government-granted monopolies that keep others from copying them and selling them for pennies on the dollar. Let's be clear: The drug companies must be allowed to hold these monopolies for a certain period of time to enable them to recover their costs of development and to earn more money to invent other drugs. But the question here is how much is a fair profit? Put starkly, how many people must die without treatment until the companies are willing to lower their prices or to surrender their patents so generic makers can enter the market?

Brazil answered this question in a law it passed in 1996 saying three years of a patent was enough. After that point, Brazil's law said that a local company could copy the formula and make a generic of that drug. Brazil also argued that this was the moral thing to do. In a series of newspaper advertisements aimed at American readers this month, Brazilians argued: ``The drugs industry see this as an act of war. We see it as an act of life.''

Incredibly, though, it isn't the drug companies that are taking on the fight to stop Brazil from making cheap substitutes for the new AIDS drugs: It is the U.S. government. Although started under the Clinton administration, the Bush administration is now asking the World Trade Organization's court to declare Brazil's law a violation of ``intellectual property rights.'' Gov- ernment officials argue, somewhat bashfully, that this isn't about AIDS, but it's about protecting trade agreements.


Bunk. Rather than trying to force Brazil to back down, the Bush administration should be on the other side, pushing the drug makers to agree to minimal profits, perhaps for concessions on other drugs where the stakes are clearly less high. There will be many other opportunities for this country to fight for the principles of private property, and we must. But this is an opportunity to fight for millions of people whose lives are in the balance today. Brazil is on their side. We should join.