The FT has an important article that will make grim reading for the 22,000 AIDS activists descending on Mexico this weekend for their biennual conference. According to the piece, resistance to ARV is becoming an acute problem in the poorest countries, and is set to get worse.
The problem is exacerbated, as the article intimates, by the WHO-backed “public health approach” to AIDS treatment. The overriding focus of this approach is to get as many patients on treatment as quickly possible.
In order to meet their self-imposed treatment targets, global donors and health agencies (MSF, Clinton Foundation, Global Fund etc) have ridden roughshod over the IP rights of ARV innovators, purchasing bulk quantities of cheap copy drugs to minimise costs.
Their treatment programmes have been built around the use of cheap copy drugs, often made in India, but often lacking in quality (as demonstrated by the 2004 WHO prequalification debacle and the current Ranbaxy investigation, and the GPO situation in Thailand).
Poor quality copies of ARVs can accelerate resistance, as well as increase the likelihood of clinical failure. Most of the drugs procured by these global agencies are not true ‘generics’ that are demonstrably identical to the original, but cheaper copies that have not undergone testing to demonstrate 'bioequivalence'.
Unfortunately, this is beginning to blow up in the face of the authorities who promoted this approach. Scary numbers of patients in Africa are rapidly developing resistance to existing therapies, and are then forced to move onto costly second and third line therapies.
Fragile African health systems cannot cope with the extra costs of caring for patients on these more complex therapies, and neither can stretched government budgets.
Meanwhile, new therapies are desperately needed to keep one step ahead of the wily AIDS virus. But the global authorities’ cavalier attitude to the IP rights of R&D companies mean there are few reasons to stay in the ARV research business (witness, for example, the recent exit of Roche from the market).
The WHO and its activist friends have created a perfect storm. Luckily for them, they won’t have to pick up the pieces.
Comments