It is 1996 and the scene is starting with the plight of HIV hitting the news. By 2000, it was clear for all to see that the medicines available to treat this deadly disease are in the North while the disease is most prevalent in the poorer countries in the South. It was estimated that one in five South Africans was infected.
Yet 39 multinational pharmaceutical companies decided to take Nelson Mandela’s Government to court over an Intellectual Property Bill that tried to prevent patents from hindering access to medicines. Thanks to a global public campaign and patients’ advocacy, the companies were forced to withdraw their case in 2001.
Talk to “big pharma” and they will tell you that the South Africa court case was a landmark in their history. Some even say that such a thing would not happen again. One cannot help a cynical smile when remembering that in 2006 Novartis took the Indian government to court over the claim that India’s intellectual property law is not TRIPS compliant. Needless to say Novartis lost its case. At least this time other companies watched from a distance without giving public support for Novartis.
TAKE 2: CLACKET SECOND TIME OF THE SAME FILM
It is 2014 and the scene is of a world waking up to the growing plight of non-communicable diseases. The latest WHO report estimates that cancer cases are expected to soar by 70% over the next 20 years . Although the big talk is still about prevention (which of course is critical), very few are talking about treatment. In the current debates on post MDGs cancer is hardly mentioned and in the discussions on Universal Health Coverage one rarely hears about how to make detection and treatment (surgery, radiotherapy and medicines) available and affordable.
Roche markets a drug for cancer (Avastin) which was discovered to also cure a type of blindness affecting older people. So Roche patented another form of the drug (Lucentis) as specific treatment for the eye condition. The catch is that one injection of Avastin costs $50 while a Lucentis injection costs $2,000. Another example that recently hit the headlines is that of a new medicine to treat Hepatitis C (made by Gilead) but alas it costs $1,000 per day.
Needless to say that access to affordable medicines for HIV and other infections remains an “unfinished” agenda – the debate on medicine price is just as important today as it was in late nineties and early 2000s.
And now back to South Africa again. In February this year, a leaked document shows that the Innovative Pharmaceutical Industry Association of South Africa (IPASA) and its sister organisation in the US (PhRMA), hired a PR company to conduct a covert campaign against the South African government. The campaign intended to delay and undermine the Government’s new Intellectual Property Bill which seeks to use internationally agreed legal instruments such as the TRIPS flexibilities included in the Indian law, to enhance access to more affordable generic medicines in South Africa.
But the pharmaceutical industry does not want the South African government to take such actions to protect public health. IPASA made a submission to the DTI on the Draft National Policy on Intellectual Property in support of the current status quo.
The South African Department of Health condemned the recently leaked pharmaceutical industry strategy. The Minister of Health described the proposal as a “genocidal conspiracy of satanic magnitude”, accusing pharmaceutical companies of “conspiring against the state, the people of South Africa and the populations of developing countries” – and of planning what amounts to “mass murder”.
SO HAVE PHARMACEUTICAL COMPANIES CHANGED?
I cannot answer this question any better than the honest statement given by Marijn Dekkers, CEO of Bayer who said in reference to Bayer’s medicine Nexavar for the treatment of liver and kidney cancer:
“ .. we did not develop this product for the Indian market, let’s be honest. We developed this product for Western patients who can afford this product, quite honestly. It is an expensive product, being an oncology product.”
These simple words tell us the whole story of multinational pharmaceutical companies’ approach to access to medicines: that they are about maximizing profits and not about contributing to advancing public health. All their talk of “putting patients at the front of our business” is just talk for public consumption to improve their PR image. The business model of multinational pharmaceutical companies – founded on maximizing profit – dictates the Research & Development agenda and the pricing and marketing pathways. Companies still refer to compulsory license, a legal instrument under TRIPS, as “essentially theft.”
We must always remember that it was this industry –chiefly Pfizer- which lobbied and succeeded in designing a global Intellectual Property system (TRIPS) and fought hard against the flexibilities and instrument included there for countries to use to protect their citizens. It is pharma that continues to lobby for stricter Intellectual Property rules in free trade agreements that further tie the hands of governments so that companies’ monopoly is extended.
So what has changed apart from adopting new tactics? Well at least some companies remembered – and perhaps did not want to repeat – the old South Africa saga and started to withdraw from the IPASA campaign plan. The Danish company, Novo Nordisk dissociated itself from IPASA and more recently Roche followed suit.
The big question remains though: when will multinational pharmaceutical companies realise the failure of their Intellectual Property-dependent business model and seek alternatives?
Dr Mohga Kamal-Yanni is a Senior Health Policy Advisor at Oxfam GB