The dangers of cheap, low quality medicines

The close of the International Aids Society Conference in Sydney ended the publicity train of posturing activists and non-government organisations. In the conference’s wake, it is time to refocus on ensuring access to HIV-AIDS medicines for the world’s poor through real solutions, not political catchphrases.

Two NGOs particularly active this week have provided poignant examples of how discussion about serious science and public policy can be outshined by ideological PR campaigns.

Oxfam Australia lays the blame on the increasing prevalence of HIV and AIDS in the developing world on the patent system and intellectual property for drugs. The Executive Director, Andrew Hewett, argued in On Line Opinion last week that Thailand provides a “model” for dealing with treatment of HIV-AIDS.

What exactly is that model? The military junta which seized control of Thailand earlier this year has nationalised the patents of a series of vital drugs. It has gone on to manufacture cheap, but extremely low-quality drugs which have contributed towards a growing resistance to the medicine among the poorest Thais.

The danger of these medicines has become so apparent that the World Health Organisation recommended they not be sold outside of Thailand. Now many Thai HIV-AIDS patients are unnecessarily reliant on second-line therapies that cost more and require more substantial health infrastructure to administer.

Indeed, the Thai government’s approach to health care has little to recommend it. Since the beginning of the year, it has cut health spending by US$12 million a year, increased the salaries of military leaders by US$9 million and defence spending by more than US$1 billion.

If Thailand provides a model for managing an HIV-AIDS crisis, it is one to avoid, not emulate. But Oxfam praises the Thai government because the military junta has stood up to “Big Pharma”.

Médecins Sans Frontières (Doctors without Borders) released a report citing the high cost of second-line medicines as a barrier to effective treatment. Their report also blames Big Pharma and their drug patents. But were it not for the Thai “model,” many Thai HIV-AIDS patients would not need these second-line therapies.

Oxfam and Médecins Sans Frontières are far too quick to blame the HIV-AIDS crisis in the developing world on patents and intellectual property regimes. But their concern does not match the facts - patents are not the major barriers preventing access to vital medicines.

For instance, one recent scholarly survey found that of 18 single-dose AIDS medicines available in developing countries, 14 patent-protected drugs were in a similar price range or cheaper than their generic counterparts.

The real barriers to access are unfortunately familiar. Many developing countries impose high tariffs that can double the cost of medicine to patients. Such trade barriers are illegal for developed countries like Australia and the United States, but not so for developing countries - another sad result of the anti-trade mentality pushed in international forums by some misguided NGOs.

Other major barriers are also not surprising. Poor medical infrastructure limits the effectiveness of drug regimens - particularly where ineffective, or even counterfeit drugs are common. Widespread government corruption raises the cost of medicine by necessitating bribery, and often prevents the medicines from reaching the patients at all.

Yet in their haste to blame drug companies, Oxfam and Médecins Sans Frontières have ignored these factors. While extolling the virtues of nationalisation programs like the one in Thailand, they wrongly dismiss the negative consequences of such radical measures.

The real tragedy is that the sufferers of HIV-AIDS in Thailand are being used as political fodder in a campaign that ignores the real challenges of the disease. Some NGOs may need to decide how serious they are about fixing this problem, and perhaps consider a reconciliation with private enterprise.