Medicines for all, not just the rich.

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March brought bad news for the HIV virus, but good news for HIV/AIDS patients, particularly those in poor countries. In the second week of the month, Merck and Co., a leading US pharmaceutical manufacturer, announced it would slash the prices of two of its antiretroviral drugs, indivar (Crixivan) and efavirenz (Stocrin), by 90% to US$ 600 and US$ 500, respectively, per patient per year. The price cuts would be extended, Merck said, to all developing countries provided they could guarantee that the low-cost drugs wouldn't be re-exported. At about the same time, another drug firm, GlaxoSmithKline, which produces 40% of the world's anti-AIDS drugs, said it would make cut-price AIDS drugs available to any not-for-profit organizations with the capacity to deliver them in developing countries. And the ball kept rolling: yet another US pharmaceutical manufacturer, Pfizer, announced it would distribute the antifungal drug fluconazole (Diflucan) -- used to treat AIDS-related meningitis and fungal infections -- free of charge in South Africa up till December 2002. Then on 15 March came an offer by the New York-based pharmaceutical company Bristol-Myers Squibb to reduce the prices of two of its antiretroviral drugs, stavudine (Zerit) and didianosine (Videx), to a combined price of US $1 per day and to relax its patent protection over Zerit in South Africa. The offer would allow South African-based drug companies to produce and market the: drug at low cost. The surprise announcement followed protests from students at Yale University in the United States where stavudine was developed. The university holds the patent for this drug and allows Bristol-Myers Squibb to produce it on licence. What triggered this price avalanche? Certainly, the curtain was raised on this new scenario by the dramatic February offer of the Indian drug company Cipla to sell governments a cocktail of three antiretroviral drugs for US$ 600 a year -- a fraction of the US$ 10000-15 000 price tag for this triple therapy in the United States and other countries in the west. Certainly, Cipla's offer turned the focus from country-by-country negotiations to across-the-board price reductions aimed at the poorest countries. And for sure, these reductions are part of a broader process which combines pressure from nongovernmental organizations, political will, market forces and close collaboration between the pharmaceutical industry and international organizations to make wider access to AIDS medicines a reality. Meanwhile, another Indian manufacturer of generic drugs is reportedly offering triple antiretroviral therapy for US$ 350 a year. "This is not about profits and patents. It's about poverty and a devastating disease," said Mr John L. McGoldrick, executive vice president, Bristol-Myers Squibb. "We hope: our initiatives can be of some help to African AIDS sufferers and may help energize and accelerate world understanding and action." Cipla's offer catapulted it into the centre of an international squall over the production of low-cost copies of expensive AIDS drugs, since it is far from clear which countries can import and sell generic drugs without breaking existing trade agreements granting exclusive rights to patent-holding companies. The squall is fuelled, among other things, by mounting international concern over the high price of many essential drugs -- but especially antiretroviral drugs for the treatment of HIV/AIDS -- which puts them beyond the reach of the poorest countries where they are needed most. Of the over 36 million people living with HIV/AIDS, less than 10% have access to lifesaving drugs. Of the 25 million Africans living with HIV, only around 10 000 currently receive proper medical care. Under an international trade agreement known as TRIPS -- an acronym for Trade Related Aspects of Intellectual Property Rights -- new drugs can be patented for up to 20 years. This gives manufacturers exclusive marketing rights throughout that period at a price set by them. …