In 2009 I was on my second course of antiretroviral therapy as part of post-exposure prophylaxis. I sat on the edge of the bathtub heaving. My organs felt like they were being pummelled mercilessly. The taste of metal permeated my mouth. Were these really the drugs that were meant to help me?
Nursery rhymes were furthest from my mind because an inevitability in the medical profession is a needle-stick injury. I pricked myself while drawing blood from an HIV-infected newborn and was placed on the new triple-therapy regimen for a month. The side-effects were intolerable. In my mind the risk of the virus replicating in my body was sidelined by a more urgent desire to stop the treatment.
On the advice of an occupational health specialist, I stopped the third drug. After a day the symptoms lifted. This “third drug” is protocol treatment in one of the paediatric HIV regimens. Apparently, children’s bodies adjust to the side-effects with time, but I struggle to accept that children are forced to cope with such miserable side-effects, even for a limited period when there are alternatives.
Newer antiretroviral drugs are constantly being developed. Some have fewer side-effects, some are more effective against emerging resistant HIV strains and some require taking fewer pills daily. Johnson & Johnson, the pharmaceutical company usually associated with caring mothers and gently cared-for babies, refused to licence patents on three key new HIV drugs desperately needed throughout the developing world into the Medicines Patent Pool.
Médecins Sans Frontières says the patent pool “has been set up to increase access to more affordable versions of HIV drugs, including fixed-dose combinations that include multiple medicines in one pill, and to develop much-needed paediatric HIV drugs. The pool would license patents on HIV drugs to other manufacturers and the resulting competition would dramatically reduce prices, making them much more affordable in the developing world. However, since the pool is voluntary it will only work if patent holders like Johnson & Johnson choose to participate.”
“Big Pharma” does have a system of preferential pricing for various countries according to the country’s income status or GDP. In many instances, these prices were still substantially higher than the costs of generic medication. At this year’s International Aids Society conference on HIV pathogenesis, treatment and prevention in Rome, MSF reported that this preferential pricing would no longer be available to many middle-income countries where HIV is rife. The manufacturer, Merck, proposed instead to negotiate discounts on a case-by-case basis.
In South Africa, many of our HIV-infected children don’t have a legion of dedicated advocates lobbying government, business and the media on their behalf. In stark contrast, the Information from the Centre for Public Integrity, shows that “Big Pharma”, the enduring epithet of the world’s leading pharmaceutical companies, spent $182 million on federal lobbying in the US between January 2005 and 2006. In her book The No-Nonsense Guide to World Health, Shereen Usdin, a public health specialist, explains: “Much of this influence plays out at the WTO negotiating table. The WTO’s Agreement on Trade-related Aspects of Intellectual Property Rights (Trips) has been one of the biggest obstacles to affordable medicines. Completed in 1994, it requires member countries to pass laws requiring patents for any product filed after 1995. Patents provide for intellectual property and are used to incentivise research and development. They prohibit a country from producing or importing generic drugs for at least 20 years. By preventing competition, drugs can be priced into the stratosphere.”
Although there are some flexibilities around Trips, those countries who wish to explore the flexibilities are often faced with risks of litigation, trade disputes and loss of aid, imposed on them by countries with vested interests in Trips.
“Big Pharma” could argue the knowledge belongs to them, so they are free to do as they choose. But is the knowledge really theirs? Usdin points out that substantial research and development for many drugs has been paid for with public money through research institutes (such as the National Institutes of Health in the US) and universities.
Like so many other problems dogging the developing world, this is emblematic of a greater malaise. The needs of people in the developing world are drowned out by the relentless drive for yet greater profits in the developed world. In Making Globalisation Work, Joseph Stiglitz says, “The fight over intellectual property is a fight over values. Trips reflected the triumph of corporate interests in the United States and Europe over the broader interests of billions of people in the developing world. It was another instance in which more weight was given to profits than to other basic values — like the environment, or life itself.”
That morning at the bathtub, my husband put his arm around my shoulders and told me everything was going to be alright. I believed him. I was young (enough), financially secure and was taking these drugs as a prevention measure for a month. I was not on lifelong life-saving treatment and “voiceless” in a time when appeals to altruism are met with no response. DM
Bladerunner (1980s version) is a visual feast due in large part to the Hollywood Actors Strike. This allowed the designers an extra three months to refine the sets and props.