AIDS and Drug Patents
Patients vs. Patents
By Allison Thornton
Copy Right 2004
In the South African version of Sesame Street there is a character that has HIV. A 5-year old Muppet girl named Kani. (UNAIDS, 2003) What is so unusual about this is that there was not the outcry in South Africa that would have occurred if these episodes had aired in the United States. This accepting viewer phenomenon underscores a disturbing reality. In South African and some parts of the world, having HIV is a common occurrence. HIV, the Human Immunodeficiency Virus, and its counterpart, Acquired Immune Deficiency Syndrome, is considered by some to be the plague of the modern age. Currently over 42 million people are infected with the disease, eight thousand people per day are killed by this disease and 13,700 more are infected each day. The epidemic or pandemic has currently reached proportions where it threatens the social, political, and economic fabric of some societies. Major collective action involving governments, corporations, and individuals is necessary to halt the spread of this disease. In order to deepen an understanding of this pervasive social issue, this essay will briefly outline the history of the AIDS epidemic; examine international, national, and pharmaceutical responses to the epidemic in terms of new antiretroviral drugs and economic realities; and it will critically analyze the perpetuation of this social problem from a Marxian perspective.
HIV/AIDS setting the stage for an epidemic
HIV/AIDS has become a major health concern over the last twenty years. It was first described as a distinct entity in 1981, when five cases were reported among homosexual men. Since that time period there has been several changes in public opinion about this disease. The disease first thought to be contained among the homosexual community, soon was found in drug users, blood transfusion patients and hemophiliacs. (Trechler, 1999) HIV weakens the immune system, and as a result the virus causes the syndrome of AIDS where the immune system is so depleted that opportunistic diseases like colds or pneumonia become fatal. The most common cause of death in HIV/AIDS patients is tuberculosis or malaria in warmer countries like those in Sub Saharan Africa, South America, and Asia. (UNAIDS, 2003) HIV can be transmitted by bodily fluids, and is deemed to be a sexually transmitted disease. (Trechler, 1999 Health Canada, 2003) However even though this epidemic has lasted for over twenty years there is still a lack of information and education in the younger generations. The AIDS scare of the 80’s created a push for abstinence-only education in the states, as it was believed that the teaching of safe sex practices like condoms would encourage younger people to become sexually active earlier. (Wohlgemut, 2002) Today the impact of AIDS is widely downplayed by the younger generation; they think that it is a ‘live able’ problem that they can still live a ‘normal life’, this is demonstrated by the statistic that half of the newly infected are under 25 but received education on AIDS prior to infection. (UNAIDS, 2003, UNICEF, 2002)
Response to the epidemic
The United Nations formed a special commission to deal with the AIDS epidemic in 2001, and declared its millennium goal to halt and reverse the spread of AIDS by 2015. (UNAIDS, 2003) Mentioned specifically was the region being hit hardest by the AIDS epidemic, sub-Saharan Africa. Africa has 95% of the world’s HIV infected population, leading the UNAIDS commission to focus special attention in the region. (UNAIDS, 2003) Kofi Annan in his Abuja Address states that Africans are particularly vulnerable because they are poor, undernourished and too often uninformed of basic precautions or unwilling to take them. (Harker, 2001)
Canada as well has been touched by the AIDS epidemic. In 2002 AIDS/HIV reached an all-new high with 56, 000 individuals either infected or living with the disease. Canada also spends 3.9 million dollars on AIDS prevention per year out of the 42.2 million dollars allocated for AIDS policy. (Health Canada, 2003) Canada also spends an equal amount on the UNAIDS project as their education budget, and Canada has remained a central player in the UNAIDS commission as the Special Envoy Steven Lewis is himself a Canadian. (Health Canada, 2003)
The global community has spent millions of dollar on AIDS prevention methods in Africa, but has run into major roadblocks. There are language differences that make it difficult to transmit the knowledge to prevent HIV and are often not tailored to the needs of the community they are serving. (Trechler, 1999, Nelson, 2003) There is also an elevated level of sex trade and child prostitution in Africa, only a portion of it is voluntary. (Wohlgemut, 2002) A study in Uganda revealed that 49 percent of sexually active primary school girls say they had been forced to have sexual intercourse. (Noble et al. 1996). The age range of women in Africa becoming sexually active is getting younger and younger as men seek sexually safe partners. (UNICEF, 2002, Wohlgemut, 2002) The involuntary sex trade workers have little access to the resources to gain knowledge about the disease, and health officials are often hesitant to report the ones they find for fear of the pimps taking them underground and loosing contact. (Burkhalter, 2004)Countries are often dealing with civil unrest and men spend long periods of time away from their home, often in the company of prostitutes or camp followers, and then bring the problem home to their wives. As well, women in Africa do not have the power to demand that their partners wear condoms or to encourage safe sex practices. (Africa Action, 2001, Nelson, 2003) “Surveys conducted in sub-Saharan Africa reveal that 46 percent of Ugandan women, 60 percent of Tanzanian women, 42 percent of Kenyan women, and 40 percent of Zambian women report regular physical abuse.” (Odunjinrin, 1993) With such high rates of physical abuse women’s power over the relationship is less than equal.
HIV/AIDS also hits countries on an economic level as well. Often third world countries where HIV/AIDS is highest, will offer workers at lower wages in order to entice companies to bring their business into their country. But, this government relies on the company to decide what they do with the HIV/AIDS employees. (Freund et al 2003, Trechler, 1999) HIV/AIDS disrupts the workplace and by correlation disrupts the economy of the countries. Workers have a higher rate of absenteeism either due to being ill from HIV, the other opportunistic diseases that are associated with HIV, caring for family who are ill, and eventually the need to attend funerals of those coworkers who had HIV. This translates into loss of skilled workers that means more money is necessary to hire new workers and train them, and to cover health and funeral costs for employees. (Daly, 2000; Trechler, 1999)
The latest development in the AIDS battle was the creation of several retroviral vaccines. These vaccines keep HIV infected individuals from progressing into the AIDS stage, and they prevent the transmission of HIV from mother to fetus. (Bloom et al, 1995) These drugs offer a glimmer of hope to those already afflicted by HIV. Unfortunately the cost of one round of treatment is prohibitively expensive due to drug patents. “As of May 2003, the least expensive brand name combination recommended by WHO for low-income countries was approximately US $675 per person per year and the least expensive generic combination recommended by WHO was just under US $300 per person per year.” (Nelson,2003, UNAIDS, 2003)
Pharmaceutical Industries
Developing drugs for treatment is a lucrative business. Competition is fierce and most of the research and development dollars goes into improving already existing drugs. There is a built-in financial incentive for drug companies to spend large amounts on the research and development of new drugs. When a breakthrough occurs, the company in question is guaranteed a medical patent on the drug for a specific period of time, sometimes more than 20 years. (Freund et al, 2003) Medical patents were recognized in the Trade Related Intellectual Properties accord at Uruguay in 1994. (Chatrand, 1995)This allows the drug company to have a legal monopoly on the drug and sell it at high prices to recoup investment capital and turn a profit. These artificially raised prices decrease purchaser accessibility to the drug due to fiscal constraints. (Freund et al, 2003)
In a 2001 address, the Secretary General of the United Nations called for drug conglomerates to waive their patents and allow for generic copies of the anti-retroviral drugs to be manufactured and provided to nations in need. (Harker, 2001) Special Envoy Stephen Lewis voiced the concern that the patent-protected AIDS drugs cost between $8,000 and $15,000 per person per year as compared to a regime of generic drugs that would cost only hundreds of dollars per person per year. (UNAIDS, 2003, Silversides, 2003, Harker, 2001) Some governments that have been hit the hardest by AIDS, including South Africa and Brazil, ignored the TRIPPS agreement and created generic copies of the more effective anti-retroviral drugs which they provided to their own citizenry. (Burkhalter, 2004; Incardi, 2000; Itano 2001)This drastic action undertaken by desperate AIDS-ravaged countries has resulted in sanctions, lawsuits, and censure from other patent-abiding nations. It is worth noting, however, that South Africa’s and Brazil’s actions have led to a significant decline in their AIDS-related mortality figures. (Burkhalter, 2004; Incardi, 2000; Itano 2001)
Canada and the Pharmaceuticals
Like South Africa and Brazil, Canada also has a history of sidestepping drug patent laws as evidenced by their response to the Anthrax virus scare following September 11th, 2001. (Weissman, 2001) The company Bayer and Cipro currently holds the patent to the antidote to the Anthrax virus. When the Anthrax scare happened, Canada suspended Bayer’s patent and bought several thousand generic antidotes from a Canadian pharmaceutical company. Bayer and Cipro challenged the Canadian government through legal channels that ended up with Canada buying an equal amount of Anthrax antidotes at the brand name price in an effort to appease the companies. (Singh, 2002)
The Chretien government reversed it’s stance again on drug patent laws within the last year with the introduction of Bill C- 56 “Act to Amend the Patent Act and Food and Drug Act” sponsored by the Honorable Don Boudria. (Canada 2003) This Bill proposes that the AIDS drug patents be suspended for countries that fit a certain criteria; on the list of eligible nations are many third world countries including most of sub Saharan Africa. This bill is currently in its second reading before parliament and there has been a strong movement for it to be adopted by the Martin government. (Canada 2003)
Theoretical Perspective
For many people, the AIDS epidemic underscores major moral and ethical considerations. These can best be understood by examining the AIDS crisis from several different theoretical perspectives - humanitarianism, structuralism, Marxism - and comparing these to the economic theory of capitalism and the phenomenon of globalization.
From a humanitarian perspective we like to think of ourselves as individuals striving for the common good; as individuals motivated to help out our ‘fellow humans’. Humanitarians strive for a society in which all members share in the environmental conditions consistent with good health and emotional wellbeing. With respect to the AIDS epidemic, medical humanitarianism butts up against capitalist economics. Medical practitioners are ruled by the Hippocratic Oath which states, “I will apply, for the benefit of the sick, all measures which are required”. Medical researchers developed the anti-retroviral drugs to help people, but the patent-holding pharmaceutical companies have placed such a high price sticker on them that individuals who need these drugs the most are unable to access them. The Oath further says, “I will prevent disease whenever I can, for prevention is preferable to cure.” The statistics indicating babies born already infected with HIV vary, what does not vary is the irrefutable proof that these numbers are skyrocketing. The irony of this is that there are drugs available that prevent prenatal transmission, but governments are not funding their wide-scale use. The market value of the anti-retroviral drugs is too costly, and the governmental structures required to distribute the drugs are also too costly to put into place. From a theoretical perspective, the humanitarian notion of a common good where all AIDS patients have access to comparable medical treatment has been overruled by the capitalist reality of drug profiteering.
Another humanitarian belief articulated by Parson is that of the ‘sick role’. This notion is consistent with the ‘social safety net’ idea wherein the sick are excused from societal obligations in order to get better and, once their health has been reestablished, they retake their roles and obligations. This social support simply does not exist in impoverished third world countries where having AIDS equals a harsh and slowly executed death sentence.
The AIDS epidemic is also interesting to analyze from a Marxian, or structuralist, perspective. Karl Marx claimed that life was driven by capitalism and class difference. He describes the ruling class - the bourgeoisie - as controlling the means of production while the proletariat provides the labour that perpetuates the system. Proletariats lack both political and economic power. They are the unwitting recipients of an eco-political structure designed to secure the comfort of the bourgeoisie at the expense of the proletariat. With respect to AIDS, we can see this power-class dynamic played out on the international scale. In this case the bourgeoisie, the drug companies, are getting rich at the expense of the proletariat, the sick. The pharmaceutical companies have found a way to secure a legal and global monopoly on life-saving drugs that reduces peoples’ lives to a price sticker.
The Marxian analysis can also be applied to the international political arena where developing countries become the disempowered proletariat to the more developed and powerful bourgeoisie states. By producing generic anti-retrovirus drugs, South Africa and Brazil (i.e. proletarian states) have bucked the international order (i.e .as established by the bourgeoisie elite) and have been duly censored. Most of their third world counterparts are forced to go along with what their ‘big brothers’ want them to do. As these theories suggest there has to be a change to the laissez-faire philosophy of capitalism in order to change the grim face of those with HIV/AIDS.
Summary
In conclusion, HIV is a pervasive social problem. It has been around since the 1980’s and has become recognized as a sexually transmitted disease by World Health Organizations. It is found in developed and developing nations alike, though it is concentrated in the region of Sub-Saharan Africa. There are economic, social and political factors that contribute to the spread of the AIDS virus making it a fatal epidemic to those in developing nations. Conditions like social unrest; poverty and inequality make the job of health workers harder as they have to overcome cultural factors as well as health factors. There is a ray of hope; as new drugs are being developed and introduced into the market to combat AIDS and it’s transmission. However, the catch is that these drugs are too expensive for the nations that need them the most, leaving the pharmaceutical industry the opportunity to put price stickers on people’s lives. The theories that deepen our understanding of the moral and ethical dilemmas of this issue are Capitalism, Marxism, Structuralism, and Humanitarianism. Without a change in either the world order or the way in which Capitalism manifests itself the AIDS issue cannot be addressed in developing countries. Canada has proposed a solution to this problem by suspending the drug patents of AIDS drugs to nations that meet a certain standard to make them more affordable. This bill has not been fully passed but it demonstrates the initiative that Canadians are famous for in the arena of International Aid.
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