A leading charity figure has claimed that some of the world’s leading pharmaceutical companies have worked to prevent developing countries from reducing the price of high-cost medicines. “In some case, ‘big pharma’ has put profits before lives,” said Andrew Hewett, executive director of Oxfam Australia, speaking at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, held this month in Sydney, Australia.

The Australian government is committed to spending A$600 million over four years to treat and prevent HIV/AIDS in the region, but it has said little recently about the drug majors’ impact on developing countries, said Mr Hewett. “If Australia fails to act to prevent the harmful actions of some pharmaceutical companies, taxpayer dollars will continue to be spent subsidising the high prices demanded” by multinational drug makers for antiretroviral (ARV) drugs, he said.

However, Mr Hewitt’s comments were dismissed by Alan Moran, director of deregulation at the Institute of Public Affairs (IPA), an Australian free-market think-tank, who pointed out that a recent study by the Institute reveals that undermining patents can in fact have detrimental effect on developing HIV/AIDS medicines for the world’s poor. In Thailand – which, says Mr Moran, is not “a particularly poor country,” the military government has already forced drugmakers to dramatically cut the price of anti-AIDS medicines. The IPA study found that the company licensed by the Thai government is making “unconscionable” profits, and that other governments in developing countries exploit their citizens by taxing the drugs.

In the IPA report, entitled HIV/AIDS Medicines for All?, author Tim Wilson concludes: “India provides compelling evidence that undermining patents doesn’t yield improved access to affordable medicines.” He also believes that Thailand and Brazil’s recent issuance of compulsory licenses for HIV/AIDS and heart disease medicines will “do little” to promote access to affordable medicines. In contrast, he says, enforcement of patent protections has many benefits for patents, not least in that it combats the development and use of counterfeit drugs.

Meantime, the nongovernmental organisation Medecins Sans Frontieres (MSF) reported at the conference that it had found dramatic price reductions for second-line ARVs over the last year, largely, it says, stimulated by the Thai compulsory license. However, MSF says it has also found that using the newer, less-toxic first-line combination now recommended by the World Health Organization (WHO), which are based on combinations including GlaxoSmithKline’s Ziagen (abacavir) and Gilead’s Viread (tenofovir disoproxil fumarate), the cost for patients goes up nearly 500%, from $99 to $487.

MSF worries over access to first-line treatments

“It’s encouraging to see the price of second-line regimens finally starting to come down,” said Karen Day, pharmacist with MSF's Campaign for Access to Essential Medicines. "But we are worried that the lack of competition and dramatically higher prices for the newly-recommended WHO first-line regimens could mean that people in developing countries may not be able to benefit from improved treatment that has been widely available in wealthy countries for years."

MSF also claims that the compulsory licenses issued by Thailand and Brazil have been far more effective in bringing prices down than negotiating price reductions with manufacturers or relying on companies' differential pricing schemes.

“Just one year ago, treating a patient with a second-line regimen containing lopinavir/ritonavir [Abbott’s Kaletra] in Thailand cost $2,800 per year,” said MSF spokesman Kannikar Kijtiwatchakul. “Thanks to competition since the compulsory license, treating that same patient with a second-line regimen will now cost $695 - four times less. But this is still far too expensive for the majority of people in Thailand, where the average annual salary is $1,600,” he added.

The group adds that significant delays persist between when newer treatments become available in wealthy countries, and when they become available in the developing world.

“I work in Sydney and also have been treating patients with AIDS in countries like Malawi and Mozambique and the gaps I have witnessed are alarming,” said Alexandra Calmy, HIV/AIDS Advisor for MSF’s Campaign for Access to Essential Medicines. “At this conference in Sydney, we're seeing presentations on several promising drugs. These drugs should be available in Africa, Asia and Latin America at the same time as they are marketed in rich countries, not only after years of fighting for access to them. This means including the needs of people living in developing countries into the R&D plans from the beginning,” said Dr Calmy. By Lynne Taylor