How Not to Win the Fight Against AIDS

Worldwide, nearly 40 million people are living with HIV and AIDS. Over 13 million children have been orphaned due to AIDS. Six hundred thousand children are infected with HIV each year. And 25 years into the AIDS pandemic, no vaccine or cure is in sight. The numbers speak for themselves. What are you doing to help?

— Joe Cristina, Founder of the Children Affected by AIDS Foundation

Starbucks has begun printing kernels of wisdom like this on its coffee cups as part of a series called “The Way I See It.” And Joe Cristina is right — AIDS is a formidable foe.

But more than ever, there’s hope for AIDS patients. Effective treatments are here or on the horizon, and good prevention practices are well known. Some in the public health community even argue that AIDS should be re-classified as a chronic disease, manageable much like diabetes and hypertension.

Such thoughts would have been out of the question just 10 years ago. So isn’t some measure of optimism warranted?

Perhaps it is in the developed world. But new infections are still increasing globally. This year, 2.5 million people will be infected with HIV — and more than 2 million will die of AIDS. As long as weak infrastructure and disastrous political interference plague poor countries, where the disease hits hardest, it’s unlikely that AIDS will be successfully managed worldwide.

This systemic failure is worth pondering, particularly as global “advocates” call for poorer countries to be allowed to revoke the patents on AIDS medications in a misguided attempt to gain access to the medications.

These advocates ignore the pharmaceutical industry’s generous philanthropic programs to make their medications available to poorer countries at little or no cost.  The advocacy community isn’t satisfied and wants to impose “compulsory licensing,” a World Trade Organization-sanctioned practice.  It allows governments to break patents during public health emergencies in order to produce copies of branded drugs locally.  This may sound like an effective way to get AIDS drugs to the world’s poorest people, but such policies generally wreak havoc.

Low-quality copies of drugs are the immediate danger. Most local industries in Africa and Southeast Asia lack the technology and regulatory incentives to produce high-quality copies of pharmaceuticals. Exposing HIV/AIDS patients to substandard products and doses creates drug resistance, worsening the epidemic and increasing costs.

This is exactly what is happening in Thailand. In 2005, resistance emerged to an untested antiretroviral cocktail called GPO-vir, which was produced by Thailand’s Government Pharmaceutical Organization. Many Thai AIDS patients suffered or even died as a result of GPO-vir.

Despite this failure, many activists today support the compulsory licenses for the Thai government to try to copy other antiretroviral drugs developed and patented by pharmaceutical companies.

Given Thailand’s history, support of its practices is misplaced.

Thailand is a relatively wealthy and undeserving candidate for a breach of global trade laws. The Thai army is fortified with more than $1 billion for discretionary spending, and less than 1 percent of its populace is infected with HIV/AIDS.

Over the long term, violating patents also results in fewer new cures. Drug companies have no assured return on their investments into potential AIDS cures. The weaker their patent protection, the less economic incentive they have to develop new vaccines.

It takes more than 10 years of research and at least $800 million in testing to bring a new drug to market. No company could afford such a cost if international patent theft were to make it impossible to recoup that investment.

Most activists who support compulsory licensing recognize this reality. That’s why they want to replace the patent system with prizes for new discoveries and “patent pools” that subsidize investments and projected returns.

But how could governments and United Nations AIDS experts possibly determine the optimal value for such a prize? After all, the scope of the AIDS problem isn’t even clear to experts. Just last month, U.N. officials revised their estimate of 40 million cases worldwide down to 33 million – a drop of nearly 20 percent.  Good intentions are a poor substitute for market-driven investments. 

Neither drug companies nor AIDS patients who depend on timely, quality treatments can afford to have the brakes put on the market-driven innovation that’s characterized the past 25 years of AIDS research. Market incentives have brought roughly 90 HIV/AIDS drugs to patients in the past two decades. Even more are under development. An artificial market stewarded by bureaucrats and one-dimensional activists will bring this trend to a grinding halt.

Stopping the spread of AIDS in the developing world is no small task. But the solution is not to decry those trying to find cures — nor to remove their incentive to develop new treatments. Rather, activists and leaders must work to reform the systemic problems — like dysfunctional health systems and poor governance. Those are the biggest obstacles to stopping AIDS worldwide. Something to think about during your next visit to Starbucks.

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on free-market solutions to health reform.  She can be reached at P.O. Box 19080, Alexandria, VA, or at turner@galen.org.

SHARE THIS ARTICLE

About the author

Worldwide, nearly 40 million people are living with HIV and AIDS. Over 13 million children have been orphaned due to AIDS. Six hundred thousand children are infected with HIV each year. And 25 years into the AIDS pandemic, no vaccine or cure is in sight. The numbers speak for themselves. What are you doing to help?

— Joe Cristina, Founder of the Children Affected by AIDS Foundation

Starbucks has begun printing kernels of wisdom like this on its coffee cups as part of a series called “The Way I See It.” And Joe Cristina is right — AIDS is a formidable foe.

But more than ever, there’s hope for AIDS patients. Effective treatments are here or on the horizon, and good prevention practices are well known. Some in the public health community even argue that AIDS should be re-classified as a chronic disease, manageable much like diabetes and hypertension.

Such thoughts would have been out of the question just 10 years ago. So isn’t some measure of optimism warranted?

Perhaps it is in the developed world. But new infections are still increasing globally. This year, 2.5 million people will be infected with HIV — and more than 2 million will die of AIDS. As long as weak infrastructure and disastrous political interference plague poor countries, where the disease hits hardest, it’s unlikely that AIDS will be successfully managed worldwide.

This systemic failure is worth pondering, particularly as global “advocates” call for poorer countries to be allowed to revoke the patents on AIDS medications in a misguided attempt to gain access to the medications.

These advocates ignore the pharmaceutical industry’s generous philanthropic programs to make their medications available to poorer countries at little or no cost.  The advocacy community isn’t satisfied and wants to impose “compulsory licensing,” a World Trade Organization-sanctioned practice.  It allows governments to break patents during public health emergencies in order to produce copies of branded drugs locally.  This may sound like an effective way to get AIDS drugs to the world’s poorest people, but such policies generally wreak havoc.

Low-quality copies of drugs are the immediate danger. Most local industries in Africa and Southeast Asia lack the technology and regulatory incentives to produce high-quality copies of pharmaceuticals. Exposing HIV/AIDS patients to substandard products and doses creates drug resistance, worsening the epidemic and increasing costs.

This is exactly what is happening in Thailand. In 2005, resistance emerged to an untested antiretroviral cocktail called GPO-vir, which was produced by Thailand’s Government Pharmaceutical Organization. Many Thai AIDS patients suffered or even died as a result of GPO-vir.

Despite this failure, many activists today support the compulsory licenses for the Thai government to try to copy other antiretroviral drugs developed and patented by pharmaceutical companies.

Given Thailand’s history, support of its practices is misplaced.

Thailand is a relatively wealthy and undeserving candidate for a breach of global trade laws. The Thai army is fortified with more than $1 billion for discretionary spending, and less than 1 percent of its populace is infected with HIV/AIDS.

Over the long term, violating patents also results in fewer new cures. Drug companies have no assured return on their investments into potential AIDS cures. The weaker their patent protection, the less economic incentive they have to develop new vaccines.

It takes more than 10 years of research and at least $800 million in testing to bring a new drug to market. No company could afford such a cost if international patent theft were to make it impossible to recoup that investment.

Most activists who support compulsory licensing recognize this reality. That’s why they want to replace the patent system with prizes for new discoveries and “patent pools” that subsidize investments and projected returns.

But how could governments and United Nations AIDS experts possibly determine the optimal value for such a prize? After all, the scope of the AIDS problem isn’t even clear to experts. Just last month, U.N. officials revised their estimate of 40 million cases worldwide down to 33 million – a drop of nearly 20 percent.  Good intentions are a poor substitute for market-driven investments. 

Neither drug companies nor AIDS patients who depend on timely, quality treatments can afford to have the brakes put on the market-driven innovation that’s characterized the past 25 years of AIDS research. Market incentives have brought roughly 90 HIV/AIDS drugs to patients in the past two decades. Even more are under development. An artificial market stewarded by bureaucrats and one-dimensional activists will bring this trend to a grinding halt.

Stopping the spread of AIDS in the developing world is no small task. But the solution is not to decry those trying to find cures — nor to remove their incentive to develop new treatments. Rather, activists and leaders must work to reform the systemic problems — like dysfunctional health systems and poor governance. Those are the biggest obstacles to stopping AIDS worldwide. Something to think about during your next visit to Starbucks.

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on free-market solutions to health reform.  She can be reached at P.O. Box 19080, Alexandria, VA, or at turner@galen.org.

SHARE THIS ARTICLE

About the author