Leading HIV activist Sean Strub has stated that: “at the beginning of the fourth decade of the HIV epidemic, profound stigma and discrimination is a fact of life for those with the disease – not just socially, but within our legal system.” Perhaps this is an understatement; the staggering revelation that, today, nearly 20 million people living with HIV still lack access to medicine globally, bears witness to the inadequacy of our global health infrastructure.
According to Professor Mariana Mazzucato, what is missing from the war on AIDS is a thriving health innovation system capable of generating new technologies that improve public health and ensure access to effective treatment. She and charities such as Youth Against Aids envision a healthcare system in which medical costs are constrained, and where healthcare is driven by public good rather than the profit of the pharmaceutical industry. But why bother? What is at stake is of utmost importance: the human right to health, which includes access to medicine. What we need is justice for the 3,300 people who die from AIDS related causes every day.
The Joint United Nations Program on HIV/AIDS (UNAIDS) aspires to prevent an additional 18 million HIV infections and 11 million AIDS related deaths occurring by 2030. This ambitious yet attainable goal can be achieved by tackling the problems of the pharmaceutical industry.
Through patent rights, the pharmaceutical industry exercises a monopoly, negating any competition that would otherwise drive down the price of drugs. Patent rights were introduced primarily with the aim of encouraging innovation, yet the contrary has happened. This point is articulated by Sir John Sulston, 2002 Nobel Prize winner for Physiology of Medicine who claims that “intellectual property in the form of patents should be thought of as a very useful tool with a relatively narrow applicability rather than as a means for owning ever larger swathes of human knowledge which is the way it is being used at the moment.”
Entitlement to charge extortionate prices has alarming repercussions: the World Bank estimates that high medicine prices lead to an additional 100 million people annually being pushed below the poverty line. For example, Harboni (a breakthrough Hepatitis C drug) is listed at a staggering £39,000 for a 12 week course, forcing the NHS to ration access to the drug. Patients have been told to return for treatment when their condition worsens, inevitably causing suffering for extremely vulnerable patients.
The AIDS epidemic could be ameliorated by price reduction and improved accessibility. Notably, global improvements in access to antiretroviral treatment (ARV) for HIV was only possible thanks to the dramatic reduction in treatment price from over$10,000 to less than $100 per patient per year in the US. This was achieved through generic production and competition, which successfully averted an estimated 9 million deaths worldwide between 2007-2016.
The United Kingdom and indeed the rest of the world should follow suit. Youth Stop Aid’s campaign “It Ain’t Over” reminds us just why this is necessary: because “time is ticking.” Alarmingly, the number of young people dying from HIV & AIDS has tripled since 2000. We cannot ignore AIDS any longer.
Breaking up the monopoly of the pharmaceutical industry and improving patient medicinal access is key to tackling the AIDS epidemic.This is because the right to health is codified in the Universal Declaration of Human Rights (1948), the World Health Organisation Constitution (1946), and the International Covenant on Economic, Social and Cultural Rights (1966).
Whilst this in itself should provide sufficient cause to tackle the pharmaceutical monopoly on drugs, there is also a socio-economic case to be made. This is exemplified by the effort to combat AIDS, where the case for a concerted global response was underpinned by research detailing the significant positive impact of delivering access to ARVs had on the economy, education and employment. According to Mazzucato, these effects, “which can be replicated across healthcare, underline the importance of ensuring access and affordability, and are central to the medical innovation mode.”
BBC News also reported that a drug called Prep “could dramatically cut the risk of HIV infection during sex which would save the UK around £1bn over the next 80 years.” Research conducted by University College London has revealed that while the cost of HIV treatment and prevention would rise for the first 20 years of providing Prep as part of a larger healthcare programme, a quarter of new infections of HIV among gay men could be avoided.
Further, costs over 80 years would drop from £20.6 billion to £19.6 billion, saving £1 billion. Notably, the point was raised that if the cost of anti-HIV drugs fell by 70% or more, the programme would be considered cost effective after 20 years and save the NHS money within 30 years. Here, extortionate costs of drugs can be seen as prolonging the fight against AIDS.
Several strategies can be employed to tackle the intellectual property system that enables pharmaceutical companies to secure patents whilst charging extortionate prices.
Policymakers must enforce the stringent patentability criteria set by patent offices, as consistent with the TRIPS agreement – an international legal agreement between member nations of the WTO which incorporates international property law into the global trading system. The final report of the UN High-Level Panel on Access to Medicines emphasises the flexibility of the TRIPS Agreement offers and encourages the WTO’s’ members to apply rigorous patentability criteria to ensure only true innovations are rewarded.
Further, the government can utilise existing legal powers to improve access to affordable medicine. Patent holders charging extortionate prices can be subject to a compulsory license, granted by the government, ensuring access to medicines devised by that company whilst still rewarding the patent holder through payment of a fair royalty on medicinal sales. This method has already shown promise in Germany where courts awarded a compulsory licence on the HIV drug Isentress, thus increasing its accessibility and reducing its price.
Monopolies must be managed. Mazzucato has argued that governments should not adopt TRIPS-plus provisions in patent or medicine law (provisions that go beyond what is required in the TRIPS agreement). These include rules that prevent the production of generic medicine in the absence of a patent and interfere with the use of compulsory licensing.This is because they prohibit the registration of generic medicines, by strengthening monopolies and exacerbating medicinal accessibility issues by creating legal barriers to implementing TRIPS flexibilities.
The last demand is emphasised by the charity Just Treatment, who advocate greater transparency to facilitate access to medicine. For example, further information could be sought on how much public and private investment was made in the development of a medicine, how much drug companies spend on marketing and sales, as well as the full disclosure of all trial evidence and transparency of pricing.
There is no better time to tackle the pharmaceutical industry than now, as complacency is a killer. Please take time to view the Youth Stop AIDS website, in which campaigns such as ‘Missing Medicine’ and ‘It Ain’t Over’ may inspire you to take action. If you’re a student envisioning an AIDS free future and want to get involved, come and join Youth Stop Aids at LSE! (Part of of the Amnesty International Society).
“It is bad enough that people are dying of AIDS, but no one should die of ignorance.” – Elizabeth Taylor
For more information:
UCL People’s Prescription Report: https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-purpose/files/peoples_prescription_report_final_online.pdf
Youth Stop Aids: http://youthstopaids.org/
