In September at the World Summit on Sustainable Development, the head of UNAIDS, Peter Piot, told delegates he was upset that AIDS discussions were not higher up the agenda of the summit. He will be even more upset when he sees the latest data about AIDS research.
There are between 5 and 30 percent fewer anti-AIDS drugs in development than there were a few years ago. A UK government commission would further reduce the number of AIDS drugs in development if its recommendations are followed.
PharmaProjects is an independent consultancy, employed by the pharmaceutical industry to survey companies working on all forms of anti-infective drugs.
The consultancy found that the overall trend in drug development is slightly upwards, roughly 5 percent more anti-infectives in development than in 1998. But the overall increase was lower than had been expected and hides an interesting, but worrying, trend in one sector of the market, which pulled down the average.
Companies producing anti-AIDS drugs were developing fewer products than in the late 1990s—almost one-third fewer in 2001 than in 1998.
Some industry representatives are skeptical the reduction is as substantial as one-third, and an academic researcher working on another survey, which is yet to be published and hence he wouldn’t give full details, said the drop may only be 5 to 20 percent.
But whether it’s 5 percent or 33 percent, any reduction at all seems inconceivable at a time when the developing world is finally waking up to the dangers of the AIDS pandemic; companies are giving drugs to Africa; and donations of more than $2 billion have already been sent to a new UN Global Fund on AIDS to purchase AIDS drugs.
Unintended Consequences
Dr. Des Martin, president of the South African HIV Clinicians Society, has his suspicions as to the cause. “Among several reasons, the threat of generic competition and attacks on multinational companies could be behind the recent decline in HIV anti-retroviral compounds,” he noted.
The latter point is one the pharmaceutical industry apparently does not want discussed widely. According to Ruth Rabinowitz, a Member of Parliament with the South African Inkatha Freedom Party, “industry has been numbed into silence” by the activist and media attacks in South Africa and in the West. I could find no industry executives to go on the record.
One of the rare industry executives who would actually discuss the topic, but did not wish to be identified, agreed that although he didn’t like to admit it, “we have lost the battle with the activists, and now the market is less profitable.
“The result is that we are spending less R&D time on anti-retrovirals. Why bother to innovate these products when any advance will not be profitable?” he said.
There may be one benign reason for having fewer products in development: When new approaches to combating a disease are tried, there may be numerous avenues of research begun, which subsequently are shown to be fruitless. Perhaps the drug development drop-off is because several research projects have been unsuccessful.
The anti-AIDS drugs that remain in development today are of higher quality and are more likely to succeed in clinical trials. The data could be slightly misleading, therefore, and the picture rosier than imagined.
But if that were the case, surely the industry would be spinning this line rather than ducking the question. It seems more likely that it’s the lack of potential profitability that is driving industry away from research.
Patent Protection
After all, a reduction in research into AIDS would be consistent with drug companies’ general message that patent protection is essential as an incentive for research. So perhaps governments should be strengthening patent protection on AIDS drugs.
Yet the UK government’s recently formed Committee on Intellectual Property Rights (CIPR) calls for just the opposite approach in its first paper, “Integrating Intellectual Property Rights and Development Policy.”
Although a scholarly work, the paper favors weakening patent protection of anti-AIDS drugs in developing countries. It hides this advice by using language of increasing generic competition for life-saving drugs and arguing that technology transfer will not occur quickly in countries with a Western-style patent system.
Although its technical arguments about access to drugs through parallel importing and compulsory licensing agreements may have some validity in strict economic theory, the disincentive to investment is massive. This report will send the wrong signals to an industry already moving away from AIDS drug development and into the more fruitful areas of erectile dysfunction, baldness, and hypertension.
Unintended Consequences
If the CIPR recommendations become policy, Africans may well have perfect access to drugs in a few years, only to find there are few drugs for the diseases they face.
In the past three years, activist groups like Doctors Without Borders have been celebrating the numerous climb-downs from the industry. Companies have been giving AIDS drugs away for free; they have drastically lowered their prices; and they have voluntarily licensed their drugs with generics manufacturers in South Africa. Meanwhile, in the boardrooms, decisions have been made to steer research in other directions.
It’s ironic that activists have scared drug companies into action that will harm AIDS patients in the long run. While the government and activists blame capitalism, the drug giants, and profiteering, the latter actually develop solutions; the former just talk about them.
The writer is a director of the South African NGO [non-governmental organization] Africa Fighting Malaria. This article was first published in the September 17, 2002 Web edition of the Jerusalem Post.
