Medilinks -The undeclared drugs war

The undeclared drugs war
by John Kiwanuka Ssemakula, 21 March 2001

There is a war being waged against the poor, it is not often in the news and only gets mentioned when people’s moral outrage and consciences are pricked by the suffering of millions of people. The hot topic of the moment is the price of anti-AIDS drugs. The pharmaceutical companies have come under intense and justified criticism for keeping the prices of antiretroviral drugs out of reach of the poor, the people who most need the drugs.

“The Red Cross said it was unacceptable that anti-Aids drugs - and medicines for diseases such as malaria and tuberculosis - should be beyond the reach of people in most poor nations.”

“The international aid group, Oxfam, has accused the global pharmaceutical industry and western governments of waging what it calls an undeclared drugs war against the world's poorest countries.”

Campaigners in developing countries are demanding that government ignore patent laws to be allowed to make cheap copies of drugs to treat diseases such as AIDS, respiratory tract infections and childhood diarrhoea. Pharmaceutical companies have tried to defend their pricing schemes saying they need to recoup the millions they have paid in research and development in order to produce better drugs in the future.

Behind the tortured contortions of the PR departments of the drug companies lies the real truth, the poor do not matter because they are not profitable enough. Quite simply people are dying because it doesn’t pay to keep them alive. In the words of one campaigner “It is the darker side of capitalism” The pharmaceutical companies claims that they need to make back the money so they can produce better drugs does not survive close scrutiny.

A 1999 report by Medecin Sans Frontiers (MSF) found that in the two decades between 1975 and 1997 only 1 percent of the 1,223 new medicines brought to market by multinational pharmaceutical companies were designed specifically to treat tropical diseases plaguing the Third World. That is 13 new medicines, and only four of which were as a result of research designed specifically to combat tropical ailments.

The problem is as much to do with changes in geo-political as with economics. Much of the research into tropical diseases was driven by colonial and military interests in third world countries. For example malaria research conducted by the American military during the second world war and Vietnam war. With the waning of the cold war, and the withdrawal of colonial powers, the incentive for manufacturers to continue research, that often came in the form of lucrative grants and contracts disappeared. Since then the manufacturers have clearly lost interest in conditions that affect poor countries and instead concentrated on more profitable products designed to meet the needs and purchasing power of the developed world.

A powerful example of this loss of interest is the development of a new treatment for African sleeping sickness (trypanosomiasis). In 1985 a more effective medicine was developed to treat second-stage African sleeping sickness. The traditional remedy was a 40-year-old, arsenic-based drug that didn’t always work, had numerous side effects that sometimes resulted in death. The new drug was soon withdrawn from the market because the manufacturers decided it was not commercially viable. There has been an alarming increase in new cases (300,000 a year) that are increasingly resistant to the older treatments. Unfortunately it does not seem any solutions will come from private industry.

Solutions will be sought if for instance a new disease, say HIV/AIDS were to start threatening the lifestyles of the good citizens of western countries. One could expect to see a great deal of research generated into finding drugs that could combat the disease. A cynic might note the drugs created so far are only palliative and do not cure HIV/AIDS, and there is still no vaccine available. Another perennial favorite is the Ebola virus, which undergoes periodic outbreaks, makes headlines and affects a few hundred people at a time in Africa (a recent outbreak in Northern Uganda killed a hundred or so people). How many people died of HIV/AIDS or malaria in Uganda in the same period?

Concurrent with the precipitous decline in research and development of new medicines, is the equally alarming increase in resistance by microorganisms to the drugs that do exist. The majority of the antibiotics available today were developed over 40 years ago. Even in industrialized countries numerous tabloid stories abound of “super bugs” that are resistant to all but one or two reserved very expensive antibiotics. Of course these drugs are not available in Africa.

Another prohibiting factor in the fight for access to cheaper medicines are international patenting and licensing laws, very much in the news because of the HIV/AIDS drugs controversy. The pharmaceutical companies had united to take the South African government to court because they the “Multinational pharmaceutical companies are challenging a proposed new law which would allow South Africa to import medicines from the cheapest source - perhaps India or Brazil - and so give far greater access to drugs.”

As things stand at the moment, the arsenal for healthcare deliverers in Africa and the third world is looking almost bare and we shall soon run out of effective treatments for conditions that are curable. Three in five deaths in Africa in 1999 were due to communicable illnesses and therein lies the real tragedy, it is not that there are no cures, no drugs available to treat commonest causes of death in Africa, it is that they are too expensive.

It is abundantly clear that developing nations cannot rely on the privately owned pharmaceutical companies to look out for their interests. The only motivating factor for the pharmaceutical companies is greed, profit and self-interest. To leave the health of millions in the hands of people motivated solely by profit is to do humanity a great disservice, because if the HIV/AIDS pandemic is anything to go by, diseases know no boundaries, respect no borders and can and will affect anyone.

An urgent rethink in the strategy by the bodies most concerned with providing support for implementing public health policies in the third world is needed. The WHO, UN, World Bank and other allied organizations should stop looking solely to the private sector for solutions, because they just wont do anything. New ways and methods of encouraging and supporting research into new treatments of tropical diseases are needed. Perhaps the creation of local think tanks or research institutions, accompanied by a real commitment to providing support for local researchers, both in terms of finances and logistical support is a way forward. Whatever solutions are found, they must come soon, because we are running out of time.