Tuesday 2 April 2013

Indian court rules that you can’t hold the developing world to ransom when it comes to medicines that would save millions of lives

I just saw this on the BBC and had to cover it because it highlights some of the many issues surrounding patients’ access to effective long term medical care in the developing world, illustrating how the humanitarian issue of global health can become subject to issues of profit, politicking and power.

The Swiss pharmaceutical company Novartis has had its patent application for a newer version of an already-available, expensive and effective leukaemia drug called Glivec rejected by the Indian Supreme Court. Novartis had been trying for six years to obtain the patent, but the court ruled that patent status requires and recognises clear innovation resulting in proven increased efficacy  rather than minimal adjustments to an existing product.

This ruling sends a strong message about the potential for patients in developing countries to access affordable medicine. First, it prevents large, international pharmaceutical companies from protecting much-needed medicines through patents which result in product exclusivity, lack of competition and the levying of a high sale price by the drug’s ‘owners’. Second, the court’s ruling indicates support for the manufacture of non-brand-name copies of the drug by generic companies in India (a major medical manufacturer serving many developing world countries). These can be sold at a much lower price to meet widescale medical need. For example, Glivec costs nearly thirty times as much, per patient, per year, as the generic version of the same drug manufactured in India.

As Avert, the international anti AIDS/HIV charity, explains:
A generic drug is an identical copy (bioequivalent) of a brand name (or proprietary) drug. Generics are exactly the same as their branded counterparts in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. The notable difference between the two is the price.
 While this week’s ruling concerns a leukaemia drug, its principle can be extended to treatments for HIV and AIDS medicines. India’s manufacture and export of affordable HIV medicines (and other generic drugs) has benefited millions of sufferers in the developing world, most notably to treat AIDS epidemics in Africa.

The competition amongst generic manufacturers, consciousness-raising among global health advocates and close collaboration with pharmaceutical companies have resulted in falling prices, which have put medicines – especially specific treatments for HIV and AIDS – into the reach of many millions more people in poorer regions.

At the heart of the issue in this particular ruling is patients’ right to affordable treatment. The right to be healed, where healing is available and has been proven effective, should not be denied to a sufferer because they are poor.

What is chilling, however, is Novartis’s response. In a TV interview after the ruling, the company’s vice chairman (and MD in India), Ranjit Shahani, hinted that the decision would have a negative impact on Novartis’s plans for investing in India, doing further research and development or introducing new drugs to India.

This is, effectively, a blackmail threat*: allow us to keep our vital drugs exclusive and expensive or we will freeze you out of the game completely, new research will grind to a halt, new medicine access (no matter how inaccessible, discriminatory and unaffordable) will cease altogether and millions will die.

The fact that large companies are willing to try and play tactical threat-games with people’s lives is disturbing and amoral. If international pharmaceutical corporations cared about people suffering major illnesses it would back the democratisation, universalisation and affordability of treatments and demonstrate through its actions that it values curing people more than making a profit, because human beings are more important than money.

Further reading:
-        Sarah Boseley has covered this particular case very clearly and thoroughly here in The Guardian
-        There’s a clear BBC new report with a very interesting analysis by Indian journalist Shilpa Kannan on the Glivec case.
-        The international AIDS/HIV charity Avert has comprehensively set out the basics when it comes to costing, manufacturing and supplying treatment and medication for sufferers.
-        Avert has also produced an interesting report on the history of, challenges to and ways forward for universal access to HIV/AIDS treatment, if you click here.
-        There are extremely thorough reports on the provision of AIDS/HIV medicines in the developing world, produced by the Interagency Coalition on AIDS and Development (ICAD). Click here and then click on the Our Work and Publications Tab.

…And, to add my feminist twist, there’s also a very pertinent feature on the link between HIV/AIDS and gender inequality:
Many of the social and economic barriers that stand in the way of effective HIV prevention, treatment, support and care for people living with HIV are the same barriers that impede access to comprehensive sexual and reproductive health programs and services. For instance, the circumstances that can lead to unintended pregnancies can also lead to infection with HIV and other STIs. Sex is the common denominator. In societies where cultural and gender norms tightly restrict the sexual and reproductive lives and choices of women and men, the risk for both unintended pregnancy and HIV infection is greatest.
Jennifer Kitts and Nicci Stein, ICAD

Bidisha is a 2013 Fellow for the International Reporting Project. She is reporting on issues of global health and development. 

* and one which is common in the rhetoric of many large companies – I don’t want to single out Novartis for blame in behaving like all its peers