Friday, April 13, 2007

Brazil: HIV versus medicine patents

To the combined oil and sugar crises Brazil reacted with a characteristic pragmatism and with a strong focus on social aspects. In a land with severe cultural and economical contrasts, every
problem is a social problem by definition. The role of then minister of finance Fernando Henrique Cardoso (FHC), former professor sociology, is and example in this perspective. He was able to win control over hyperinflation with the introduction of a new valuta, the Real. [1]

In 1990 the same Cardoso, now Brazil’s president, was forced to take action against the further spreading of the Aids virus. In those times the percentage of HIV infected was a about 1% of the population, comparable to that of South Africa at that moment. Though Brazil is the world’s biggest Roman Catholic country, the campaign was characteristic not for its moralism but for its pragmatism. The taboos about sexual relationships were confronted in a preventive campaign aimed at prostitutes, drug users, truck drivers, prisoners and street children but also married women, an important group as they consider themselves safe for the virus within their marriage. The government started to spread 10 million condoms during Carnival 2005 in cooperation with nongovernmental organisations (NGOs) and minister of health Saraiva Felipe announced the construction of a federal condom factory. [2]

Next to prevention another focus point in the campaign was medication, which started with the free distribution of an anti Aids cocktail of 12 medicines. In 2001 the cocktail was issued to about 100.000 people, which took about 28% of the available buget (USD 88,5 M). The limited budget, a growing amount of infected people combined with the fact that some medicines in the cocktail were disproportional high, made an efficiency check necessary. For those medicines for which the patents were expired, Brazilian laboratories were contacted in order to develop cheaper versions of the medicines. For the patented medicines, then minister of health José Serra took the initiative in 2001 to contact a number of pharmaceutical industrials to urge them to give a discount on the delivered medicines. In exchange stability in the market was offered for a period of six years. This way the producers would have a guaranteed market and the patent would be respected. [3]

The proposal was met with great indignation. The United States took the initiative at the World Trade Organisation to protest the act of disrespect for intellectual property. Under public pressure, the Americans were silenced in June 2001, the day the UN Aids convention opened in New York. Ultimately the American producers Abott (producer of Kaletra) and Merck, Sharp & Dohme (Efavirenz) issued substantial discounts on the medicines, the latter even up to 64%. Also an agreement was made with Abbott for a technology transfer for the produce of medicine, once the patent would expire in 2015. [4]

[Aids has barriers - protect yourself - use a condom]

Apart from these agreements the Brazilian government considered it important that also the Swiss producer Roche would issue a substantial discount, as their medicine Viracept (or Nelfinavir) was responsible for about 25% of the costs of the cocktail. Roche refused, even when Serra reminded them that Brazilian law permits the violation of intellectual property when an emergency is involved. When preparations were made to allow a Brazilian laboratory to start the production of the medicine and de facto actually breaking the patent on Nelvinavir, the Swiss resigned and reduced the price with 40%. Finally the WTO agreed with India and Brazil for a more flexible interpretation of IP law with the TRIPS protocol (Trade-Related Aspects of Intellectual Property Rights). It was acknowledged that public health and national emergency have priority over the protection of free enterprise.

As a result of the campaign Brazil counted 597.000 HIV infected patients in 2001, when the
campaign was five years in progress, half of what was predicted by the UN 10 years before. Also the amount of Aids victims were halved, an the number of hospitalized patients was diminished by 80%, with help of improved medication. Today the percentage of infected is 0,3%, contrary to a dramatic 20% in South Africa, where the situation was comparable to Brazil’s in 1990. [5]

[1] The Accidental President of Brazil - Fernando Henrique Cardoso - Public Affairs Books – 2006
[2] Brazil plans massive condom drive – BBC News – December 1, 2005
[3] Swiss giant bows to Brazil over pricing of anti-Aids drug – Alex Bellos – Guardian Weekly – September 6,
[4] Defiant Brazil gives go-ahead for copies of anti-Aids drug – Alex Bellos – The Guardian – August 24, 2001
[5] The Accidental President of Brazil - Fernando Henrique Cardoso - Public Affairs Books – 2006

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