Asia Battles AIDS With Cheaper Medicines 
International Herald Tribune
October 27, 1999
Thomas Fuller

Faced with an alarming rate of HIV infections, governments in Asia are battling AIDS in a radically different way than African countries, especially when it comes to providing drugs to treat the disease, experts say.

Several countries in Asia are manufacturing AIDS drugs on their own, ignoring or sidestepping international patents and bringing prices of the treatments to a fraction of what they are in the West.

Companies that hold the exclusive rights to these drugs in Europe and the United States find themselves competing with their own patented formulas in places like India and Thailand, both of which are not yet bound by the intellectual property provisions of the World Trade Organization and thus can produce the drugs legally — and cheaply.

In India, which is now estimated to have more HIV-infected people than any other country, a monthly dosage of locally produced AZT, a drug used to inhibit the reproduction of the HIV virus, costs $47.64 compared with about $250 in the United States.

Other countries are using economic leverage and experience with trade issues to negotiate deals with drug companies. The Thai government imports large quantities of AZT and repackages it. The result: A one month treatment of AZT costs $36

"There is a higher degree of familiarity with trade issues in Asia," said Peter Piot, the head of Unaids, the United Nations agency charged with monitoring and managing efforts to combat the disease. "After all, these are, or used to be, the tigers and dragons of Asia, and they know far better how to handle what is essentially an economic issue."

"Africa doesn't have the know-how to produce the drugs," he added.

Both China and South Korea also have the capacity to produce AZT, according to Joe Thomas, a research fellow at La Trobe University in Australia and an expert on HIV-related treatments.

But the range of generic drugs is still limited, with more recent treatments still exclusively available from the world's big drugmakers.

AIDS specialists stress that overall treatment and prevention of the disease in Asia is still very patchy. The majority of those infected with HIV in the region do not have access to proper medical care, nor do they have enough money to pay for the treatments, even at cut-rate prices.

That problem will only worsen as the number of cases in Asia continues to rise from the current estimated level of 7 million. With a 70 percent jump in the number of people with HIV infections from 1996 to 1998, Asia has the highest rate of infections in the world.

"This is not just a question of making drugs available at a lower price," said Julian Bilous, the director of disease prevention and control at the World Health Organization in Manila. "It's a question of the capacity of the health services to deliver the right type of treatment. Someone has to do the diagnosis."

Nonetheless, AIDS experts say efforts by Asian countries to bring down the prices of these drugs will help the plight of hundreds of thousands of people already infected.

Asian governments have not only found ways to produce the drugs more cheaply than in West, but pressure from Asian leaders may also help convince pharmaceutical companies to lower their prices in the world's less developed countries — where more than 90 percent of HIV infected people live.

"The high cost of the HIV drugs means that most people in developing countries just cannot afford them," Prime Minister Mahathir bin Mohamad of Malaysia said in a speech last weekend. "But this high cost need not be so if developing countries can get together and challenge the pharmaceutical companies to reduce the prices or allow compulsory licensing of lifesaving drugs."

Such statements coupled with the local production of generic AIDS drugs "may put some pressure on companies to lower prices," Mr. Piot said.

Glaxo Wellcome, a leading manufacturer of AIDS drugs, has already declared that it is committed to the principle of "differential pricing" — charging different rates in different countries.

The company has cut the cost of AZT by 75 percent in one program that seeks to prevent the transmission of AIDS from pregnant mothers to their children.

"You recoup your development costs in the industrialized countries," said Benedict Plumley, assistant director of HIV policy at Glaxo Wellcome.

In India and Thailand, Glaxo has brought its prices down for AZT nearly to the levels of the generic versions in those markets.

Other drug companies like Merck & Co. maintain the same pricing for AIDS drugs worldwide.

The dangers of putting too much pressure on drug companies, scientists say, is the risk of hampering future research efforts.

"It is unequivocally true that the engine of productivity in terms of generating new health care products is the profit motive," said John Mills, director of the MacFarlane Burnett Institute in Australia. "These products do not come from countries that have socialized pharmaceutical systems."

But Prime Minister Mahathir counters: "We accept that pharmaceutical companies expend a lot of money on research and need to recoup in order to continue their research, but they should not try to recoup from the sufferings of the poor."

AIDS specialists say the future direction of drug pricing could be decided at a World Trade Organization meeting in Seattle next month and at future negotiations involving the admission of China to the grouping as well as talks determining the timetables for other Asian countries to fully comply with the organization's policies on patents.

"Those who negotiate trade pacts should be sensitized to the affects that they have," Mr. Piot said. "Patents are very important. But I think a degree of morality and justice should be also considered."

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