Medical research is a public matter
[ By Christian Wagner ]
For many people suffering from HIV/AIDS, the picture remains bleak. According to the latest figures provided by the World Health Organisation, only one third of HIV-positive people in southern Africa actually get the medicines they desperately need. On the bright side, the WHO reports that the number of AIDS patients receiving such drugs doubled last year, thanks to the plummeting of some medicine prices. Nonetheless, prices for patented drugs still have a prohibitive effect.
The dispute over Kaletra, a patent-protected part of a standard antiretroviral cocktail for the treatment of AIDS, shows how rocky the road towards affordable medicine can be. Last year, Abbott, a pharma corporation, reduced the price for Kaletra for people in the poorest countries to $ 500 per person and year. However, for the government of Thailand that was of little help. As Thailand is ranked as a middle-income country, it would have had to afford $ 2200 per patient and year. Therefore, the Thai government issued a compulsory license for Kaletra in November, lifting patent protection. Pharmaceutical firms in Thailand are thus allowed to produce this medicine inexpensively. Today, the standard HIV cocktail only costs $ 140 dollars in Thailand.
Abbott responded agressively, announcing it would not register any new medicine in Thailand. However, the Thai government had not done anything illegal. The rules of the World Trade Organisation allow national governments to bypass patent protection if they see public health at risk. In the meantime, threats of a worldwide boycott against Abbott have caused the firm to react. In April, its management announced that the Kaletra price would be reduced in middle-income countries from $ 2200 to 1000 dollars. Nonetheless, a dispute over about additional price reductions continues with the Thai government, and so do protests against Abbott.
A firmly established dogma will have to be overcome to prevent such conflicts in the future. Why can medicine not be developed without patents? The Drugs for Neglected Diseases Initiative (DNDi) has shown this approach is viable. In cooperation with pharma giant Sanofi-Aventis, it launched the world’s first new medicine without patent protection in March. A number of research institutes had cooperated to develop this malaria remedy; Sanofi-Aventis is producing it in Morocco. Several governments and the DNDi covered the development costs. Sanofi-Aventis has promised to sell the medicine in 14 African countries at cost price. Because there is no patent, other manufacturers could theoretically also produce the medicine, and possibly even sell it at lower prices.
The new thing about this project is that the drug price is not related to research and development costs. Rather, only production costs matter, and they are generally very low in the pharmaceuticals industry. Thanks to public funding for research, the project gets around the case pharma companies repeatedly make for charging high prices: that they need to make much money as long as their products are patented in order to cover the high costs of developing drugs.
Last year, the World Health Assembly, the WHO’s top decision-making body, worked out a plan of action for research on tropical and poverty-related diseases. The WHA sent out an important signal that it was assuming public responsibility. While no details have been decided upon, one thing is clear: specific commitments to use public funds for pharma research are indispensable. Additional subsidies for pharmaceutical firms may help to create new medicines, but they will not necessarily make these drugs less expensive. However, if research costs are covered with public funds, no patent protection is required, and that does bring prices down drastically. Medical research is indeed a public matter. After all, even the best medicine does no good if people can’t afford it.