- The Washington Times - Wednesday, April 7, 2004

Two million people die from malaria each year. According to the conventional wisdom, many of them died in the past decade because the necessary medicines were unavailable and unaffordable. But that’s not true. They died, according to a sobering study by Amir Attaran in the Lancet, a prestigious British medical journal, because the principal group that buys and distributes these drugs — The Global Fund to Fight AIDS, Tuberculosis and Malaria — bought cheaper and less effective generic medicines to appease the activist organizations and liberal foundations who fight against intellectual property protections for innovative drugs.

Mr. Attaran’s article clearly showed that the cheaper approach cost more in lost lives and long-term medical expenditures than use of brand-name, newer anti-malarial medicines. The Global Fund and the World Health Organization (WHO) actively lobbied against using the better drugs when the article came out and retreated only after withering editorials in the Wall Street Journal and New York Times endorsed his view.

Now, the Global Fund and the WHO — with the help of Bill Clinton — are hell-bent on imposing the same failed approach in the procurement and purchase of an untested combination of HIV drugs and shoving it down the throats of Third World countries in a take-it-or-leave-it fashion. At a conference held in Botswana, these organizations joined forces with activists and generic lobbyists to force the United States to spend every dime of its $15 billion AIDS initiative on this deadly dose. Predictably, activists are claiming that the Bush administration’s refusal to go along with their generics-only approach is simply an effort to protect the profits of big drug companies.

That’s not true. There are virtually no patents in the countries under discussion on any of the drugs in question. According to Doctors Without Borders’ own price lists, many of the generic drugs and drug combinations are not cheaper than brand medicines sold at discounted prices. This week, Mr. Clinton recycled a claim made months ago that he’s enticed companies to virtually give away their medicines under the right conditions in order to put more pressure on the Bush administration. It is simply talk and nothing more: At present, Cipla, the large Indian generic company, has balked at lowering the price for the HIV drugs it sells to the Indian government.

The real issue is that African nations want evidence that lumping three generic versions of three HIV drugs into one pill is safe or effective. The WHO and the activists that support it don’t want any testing to determine if this combination works or if the drugs’ manufacturers — none of whom have to meet any international manufacturer or bioavailability standards — are producing bogus drugs. In doing so, the WHO and activists are ignoring the WHO’s own internationally accepted standards for evidence that drugs are safe and work as promised.

African public health officials are demanding that their people receive generic medicines that are as good as those Americans get. An official from Botswana’s medicines control agency told the WHO that it needed to “hold all drugs to the same high standard. We want to see the data because we have an obligation to protect people. The African regulators aren’t being unreasonable by asking the generic companies to show them the data.” Eric Kari-Kari Boatleng of Ghana’s Food and Drug Board responded to activist fury that Africans weren’t willing to go without American-style quality assurances by stating: “Yes, people are dying in Africa, but should we throw out standards and buy anything?”

Africans seem to understand what the activists care nothing about. As Precious Matsoso of the Medicines Control Council of South Africa noted, “Poor quality means poor access. We have to keep this in mind as we look for solutions that can turn the tide. We have to balance quality and need.” Responding to activists and generic drug lobbyists who were furious at the Africans,SegoLamelekoko Ramotlhwa, of MASA, the national HIV treatment program arm of the African Comprehensive HIV/AIDS Partnership in Botswana, stated, “Generics should be held to the same standard because bad products have broad implications.”

For many activists, the fight against AIDS is just another front in a more important fight, the fight against medical progress. The very idea that private ingenuity and private investment drive medical progress drives the activists wild. But while they jet around the world fighting their ideological jihad, millions of sick people in the Third World are waiting — and waiting — for the medicines that could save their lives.

So far the Bush administration and our FDA have stood shoulder to shoulder with these courageous folk. America should continue to work directly with African health officials to assure that the AIDS drugs they are getting are the best medicines money can buy, not the kind of drugs that advance the activists’ political agenda.

Robert Goldberg is director of the Manhattan Institute’s Center for Medical Progress.

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