The New Straits Times, July 16, 2000
By Prof Dzulkifli Abdul Razak
THE statement that the Ministry of Health will continue pressing for the price of the life-saving HIV cocktail to be lowered is reassuring. During a recent interview, after attending a talk by Prof David Ho - the discoverer of the anti-HIV cocktail - Health Minister Datuk Chua Jui Meng was quoted as saying that "although western countries champion human rights, they are still hesistant to reduce the price of drug cocktails that will help reduce death due to AIDS in developing countries".
Reportedly, about 90 per cent of the world's population do not have access to the cocktail due to its exorbitant price. In Malaysia, the cost of such drug treatment is about RM24,000 a year. Worldwide, the estimated cost of providing HIV drugs for all those who need them would be a staggering US$60 billion (RM228 billion) a year.
The most controversial healthcare issue today - and one that is being highlighted at the World AIDS Conference now being held in Durban, South Africa - is, understandably, the high price of life-saving drugs.
The pharmaceutical industry has long maintained that it alone should have the right to manufacture and sell the drugs it invents. Drug companies have a simple rationale for this: huge financial risk is involved in developing and manufacturing drugs. And this stance is often supported by the countries they are domiciled in - usually in the more economically well-off West.
But the voices of dissent and concern from coalitions of public interest groups across the globe, advocates for those with AIDS, and even Third World governments, have recently forced drug companies to reconsider their position.
Similar sentiment of dissatisfaction was demonstrated on July 9 as a week-long 13th International AIDS Conference got under way in Durban.
Thousands came out to protest the high cost of HIV/AIDS drugs, criticising Government inaction and the restrictions in providing access to the medications from those who need them most.
AIDS, now spreading fast in Asia, will continue to devastate families, communities, nations and the entire world. In Malaysia, as at December last year, the total number has exceeded 33,000 HIV cases according to the Ministry of Health records. There have been 2,685 recorded deaths.
Winnie Madikizela-Mandela, ex-wife of former President Nelson Mandela, and who now heads the African National Congress' Women's League, in an impassioned address said: "We are marching to demand that our elected Government puts the interest of its people before the profits of the drug companies."
On the home front, the South African Government should permit the import of inexpensive generic HIV drugs and allow local companies to produce the drugs without patents, she said.
In Africa, the struggle for HIV/AIDS medications has been likened to the fight for social justice during the days of apartheid. This assertion, unfortunately, is also true for the larger part of the world (Poison Control, May 21).
According to the Nobel prize-winning organisation, Doctors Without Borders (MSF), the generic triple-drug cocktails that are credited with transforming HIV infection from an almost certain death sentence to a manageable disease could be manufactured for as little as US$200 (RM760) per year.
But the cost for the potent medication combinations often run upward of US$15,000. Patients finding the high price too much to bear will stop taking them, and the disease often quickly rebounds.
Even for a single drug like fluconazole - an anti-fungal medication used to fight AIDS-related infections - is being sold for about US$6. This compares with its manufactured cost of about US 15 cents a tablet.
Why this must be so is mind-boggling, especially when millions of lives are at stake. What is more surprising is that companies have the capacity to offer cheaper drug prices if they are pushed to a corner. Also, said the Health Minister, companies which had "previously promised to reduce prices are still keeping mum on the matter".
It looks as if the move by some drug companies towards cheaper prices was in anticipation of the crescendo of public outcry during the Durban conference. Thus, it appears to have been motivated more at cushioning the mounting criticism being heaped on the industry than fulfilling a social obligation.
The questions then are: how long will such a charity-driven move last once the Durban meeting is over? How can we ensure the affordability of drugs?
A spokesman for one drug company has, at least, been honest on the issue: "The industry has never been philanthropic. It has always made products with an aim of getting a return on investment".
THIS issue of drug prices is a serious one and not confined to AIDS. In reality, it epitomises a broader underlying issue.
For example, earlier this month US Vice-President Al Gore reportedly blamed "drug company price-gouging" for the soaring cost of prescription drugs in general.
According to Gore, some sectors of the population, namely the elderly, have been forced to choose between buying drugs or going without other necessities. He insisted on putting "the power of medical science back in the medicine cabinets of our mothers and fathers".
Drug expenditure in the US is now the fastest-growing component of health care costs, increasing at the rate of about 15 per cent per year, wrote Marcia Angell in an article in the New England Journal of Medicine recently.
To put the pieces together, it is worthwhile citing the said article, entitled The Pharmaceutical Industry - To Whom Is It Accountable?
For instance, the article says that the top 10 drug companies are "reported to have profits averaging about 30 per cent of revenue - a stunning margin".
Further, it highlighted the fact that "over the past few years, the pharmaceutical industry as a whole has been by far the most profitable industry in the United States".
"According to a recent issue of Fortune, in 1999 the pharmaceutical industry realised on average an 18.6 per cent return on revenues". This is far better the other industries - including commercial banking.
"An industry whose profits outstrip not only those of every other industry in the United States, but often its own research and development costs, simply cannot be considered very risky."
More so when it is pointed out that "the pharmaceutical industry enjoys extraordinary government protections and subsidies. Much of the early basic research that may lead to drug development is funded by the National Institute of Health. It is usually only later, when the research shows practical promise, that the drug companies become involved".
These firms also enjoy tax advantages, not only on research and development costs, but also marketing expenses.
"Most important, the drug companies enjoy 17-year government-granted monopolies on their new drugs - that is, patent protection.
"Once a drug is patented, no one else may sell it, and the drug company is free to charge whatever the traffic will bear."
It is obvious therefore that there is more to the overpriced AIDS drugs issue than meets the eye. Countries like Malaysia, which is very much dependent on imported drugs for its need, must take heed and act accordingly.
It is imperative that the government takes the lead in ensuring all essential drugs, not only AIDS medications, are available, accessible and affordable to the majority, if not all who need them.
Like Winnie Madikizela-Mandela, we too expect that "our elected government puts the interest of its people before the profits of the drug companies".
Durban meeting website, http://www.msnbc.com/news/aids2000_front.asp
