Brazil Scores Victory Against U.S. Medicine Industry
"Local manufacturing of many drugs used in the anti-AIDS cocktail permits Brazil to continue to control the spread of AIDS. The drug industry sees this as an act of war. We see it as an act of life." - From a Brazilian advertising campaign in U.S. newspapers
SAO PAULO, Brazil - On a day when world attention was focused on a historic United Nations special session on AIDS, health workers in one of the globe's largest cities went about their business trying to prove that a developing country can head off catastrophe through an aggressive program of testing and treatment.
And while observers hailed the 16-page declaration that emerged from the three-day U.N. General Assembly, a little-publicized settlement of a trade dispute between Brazil and the United States may yet prove to be the week's most significant development.
The U.S. decision to withdraw a patent complaint against Brazil gives the Latin American democracy the freedom to continue manufacturing some generic anti-retroviral drugs - and provides the country with leverage to negotiate lower prices for other anti-AIDS drugs manufactured by U.S. pharmaceutical firms.
Brazilian health officials say the annual cost of the therapy is about $1,000 per person and dropping, a figure they say compares favorably to a $2,500 or higher annual cost in the United States.
For Greta Silveira, the strict daily regimen of seven medicines - provided free by the government - has meant continued good health despite being diagnosed two years ago with HIV, the virus that causes AIDS.
"I'm fine!" says Silveira, a 45-year-old transsexual and nightclub actress in this city of 17 million people.
She stops in every two months at the Reference and Treatment Center for testing and to pick up her supply of medicines, which must be taken twice a day following careful instructions.
While the rate of new HIV infections - and AIDS deaths - seems to be spiraling ever upward in other developing countries, Brazil has sharply cut its rate of infection and mortality.
Government officials estimate about 600,000 Brazilians have HIV - but are proud to note that is less than half the number expected to be infected by this time in estimates made a few years ago by the World Bank.
The mortality rate fell from 12.2 deaths per 100,000 people in 1995 to 6.3 deaths per 100,000 people in 1999. In all, about 100,000 Brazilians have died from AIDS.
About 100,000 Brazilians are receiving free treatment for AIDS, an increase from about 60,000 just two years ago. The availability of free testing and drugs has led more people to seek treatment - but government costs have stabilized due to the dropping cost of medicine.
Brazil began providing free anti-AIDS drugs in the early 1990s, but expanded the program following passage of a law in 1996.
At the same time, the country's patent laws were changed to provide that foreign companies lose patent protection in Brazil if they don't either make a drug in Brazil or provide a local company with a license to make the drug within three years of securing a patent. For drugs predating the 1996 law, Brazil allows for copying and production by government-run laboratories without regard to international patents. Seven anti-retroviral drugs are made in Brazilian labs - but still about 44 percent of the drugs used last year were purchased from foreign firms.
Naturally, the Brazilian approach doesn't sit well with the United States and its pharmaceutical firms.
In April 2000, the Clinton administration asked the World Trade Organization to establish a dispute resolution panel to review Brazil's local manufacturing requirement - and to rule in favor of drug companies who wanted protection for their patents. The United States maintained it was fighting for the general principle of protecting intellectual property.
Nonsense, said Brazil. This is not about copying music CDs or movies for the black market. "Health is different," said Rosemeire Munhoz, chief adviser for international cooperation for Brazil's Ministry of Health.
In advance of the U.N. special session on AIDS, Brazil stepped up the pressure with a series of advertisements in the Wall Street Journal and East Coast newspapers. Munhoz acknowledged the move was aimed at shaming the drug companies and the U.S. government on the issue of drug prices.
Brazil has already used its laws to negotiate with Merck for price cuts of nearly 60 percent on some drugs, Munhoz said. And her boss, Health Minister Jose Serra, added that price is the only issue as far as he is concerned. Brazil does not really want to manufacture every drug - it just wants foreign companies to charge reasonable prices, he said.
The Bush administration decision to withdraw the WTO patent complaint allows the two countries to resolve the dispute through negotiations, a move U.S. officials described as a step forward "for the common fight against HIV/AIDS."
Observers hailed the decision as a victory for developing countries - and a signal that the drug companies can no longer hide behind patent laws in denying drugs to poor victims of AIDS.
But while satisfied in victory, Brazilian officials are quick to say their program will not be easily duplicated elsewhere. In some African countries where AIDS has reached epidemic proportions, health agencies are simply not equipped to provide the screening, training and monitoring to be sure the anti-retroviral medicines are taken properly.
Still, if they can build on the blueprint coming out of the U.N. AIDS summit, the developing world can take comfort in knowing that at least in Brazil, the promise of free, life-prolonging treatment seems to have encouraged more people to come forward to be tested.
Once in the door, those people learn more about prevention and how to avoid spreading the disease. That in turn provides hope for the next generation that AIDS can someday be stopped.
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