Dr. Bernard Fabre-Teste, a World Health Organization adviser, said the lack of low-cost AIDS drugs was “a key problem” for many developing countries and that countries facing severe HIV and AIDS epidemics should consider using domestic or international trade rules to circumvent patent laws on anti-retroviral drug therapies. Basically, he is referring to a World Trade Organization agreement reached in 2003 that allows countries facing a public health emergency to issue “compulsory licenses” to manufacture generic versions of patented drugs. It also allows those countries to export generic drugs to other countries that have no domestic pharmaceuticals industry.

Although no country has yet to use the WTO provision, earlier this year the Brazilian government threatened to use the WTO provision to break the patent on the AIDS drug Kaletra unless Abbott Laboratories significantly reduced the price of the medication. Kaletra, also known as Lopinavir/Ritonavir, is a protease inhibitor and is expected to bring in $1 billion in sales this year.

In July, Brazil’s health ministry and Abbott said they had reached an agreement for Abbott to keep the government’s annual expenses on Kaletra at current levels for the next six years and that Brazil would not break Abbott’s patent to produce a generic equivalent of the drug. However, less than a week after the agreement was announced, incoming Brazilian Health Minister Jose Saraiva Felipe dismissed the agreement and said the country would continue to negotiate for a lower price and now Abbott says it submitted a revised pricing proposal last week. Officials from Argentina, Brazil and nine other Latin American countries earlier this month reached an agreement with 26 pharmaceutical companies to secure discounts of as much as 66% on antiretroviral drugs. The other countries participating in the agreement include Chile, Bolivia, Ecuador, Peru, Venezuela, Colombia, Mexico, Paraguay and Uruguay. Abbott, GlaxoSmithKline, Merck, Bristol-Myers Squibb, Roche and Bayer were among the companies involved in the agreement, and discounts range from 15% to 66%, depending on the medicine.

Abbott feels that Brazil, with the world’s ninth-largest economy, can afford the “fair price” Abbott is demanding. And it argues that without strong profits from Kaletra and other successful drugs, Abbott would be unable to fund the research that produces such breakthroughs. But Brazilian says Kaletra itself eats up a third of the country’s AIDS spending. Anti-HIV medicines account for a quarter of the Health Ministry’s budget.

Fabre-Teste also said governments should consider taking unilateral steps to allow generic AIDS drugs to be imported from countries that produce them. In 2004, the Malaysian government enacted a law allowing it to import generic versions of AIDS drugs for “noncommercial” or non-profit distribution. Since then, the price of delivering AIDS drugs has dropped by 90 percent and the number of patients receiving treatment increased from 1,500 in 2003 to 3,000 in 2004.

Also, Saraiva Felipe has signed a memorandum of understanding with the Clinton Foundation that will allow the country to obtain generic antiretroviral drugs at lower prices. Under the agreement, the foundation will provide technical support to help the Brazilian government obtain the raw materials necessary to produce generic antiretrovirals. The agreement also will help Brazil purchase diagnostic tests and monitor the spread of HIV.

Finally, Argentina and Brazil have pledged to join forces in producing generic AIDS drugs to cut costs and expand care for people infected with HIV. The nations will begin by sharing information and technology and by bringing experts together. Left unsaid is whether the two countries plan to break international patents.

As we’ve discussed before, nothing in life is free. Drug companies won’t develop drugs unless they can charge for the drugs. This isn’t about a greedy drug company withholding life-saving drugs from the public. They’re available. This is a case of greedy governments not wanting to pay the cost of healthcare for their own citizens. And who wouldn’t want to pay less for any item? I’d like a big discount on every patented item I purchase.

I’m all for furthering discussions on how to share the burden of medical care costs but saying that the burden should fall solely on the patent holder is short-sighted and unfair. Perhaps countries with greater wealth should share more of the burden but breaking patents is not the route to go on this. Let’s get this discussion on the right track.

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