- The Washington Times - Monday, May 14, 2007

Former President Clinton recently announced he was supporting the decision of Thailand and Brazil to revoke the patents of HIV drugs made by Merck and Abbott. Standing beside Thai Public Health Minister Mongkol Na Songkhla, Mr. Clinton said: “I strongly support the position of the governments of Thailand and Brazil and their decision after futile negotiations.” Mr. Clinton justifies the action by stating, “No company will live or die because of high price premiums for AIDS drugs in middle-income countries, but patients may.”

Of course, this endorsement couldn’t come at a better time for Thailand’s military junta, whose popularity is so low (it yanked a parody of its heavyhandedness from YouTube) that it is paying an America PR firm to burnish its image. And the suspension of civil liberties and imprisonment of political opponents have not stopped Doctors Without Borders or Oxfam (which is boycotting Israel to boot) from rallying behind the junta in its effort to deflect attention from suppression of civil liberties by positioning itself as a defender of AIDS patients against the evil drug companies. Having Bubba — who has his own HIV foundation — endorse the whole charade was a nice touch.

Thailand and Brazil are strongly supported by public health activists, nongovernmental organizations and even some members of Congress, as the path for solving the health problems of people in poor countries. Yet, when I attended a global health conference sponsored by the University of Toronto’s McLaughlin-Rotman Center for Global Health with hundreds of health-care entrepreneurs from Africa, Asia and India, distrust of government solutions to HIV and other health problems was intense. Why? Because despite Mr. Clinton’s rhetoric the local health-care providers and start-ups have seen how the drug companies and governments behave and know they can and must do better. In particular, the focus on pricing products for government controlled HIV programs breeds corruption and health risks. According to the Hudson Institute, out of 18 first line drugs for HIV, five patented are cheaper than the lowest copycat price available (including efavirenz). Of the 18 drugs, only four patented drugs are more expensive that the highest copycat price. The same goes for patented versions of combination HIV products. Indeed, Abbott Laboratories, recently offered to sell its drug Kaletra to Thailand at a 55 percent discount a price that would have been far cheaper than any generic version of the drug that’s available.

Both Thailand and Brazil decide to break private patents because they see they can make a profit. Because both have state-owned drug manufacturer that will produce copycat medicines and give their companies a monopoly to boot. And in turn both Brazil and Thailand collect tariffs, taxes and fees that tack on an additional 80 percent to the price of medicines which they then sell back to their health ministries.

But Thailand and Brazil came up short on the quality and quantity of HIV medicines in the past. As a result, HIV patients in both countries developed resistance to their medicines and wound up sicker than before. Hence, Mr. Clinton is supporting governments that are less interested in helping people than they are in making money. And the NGOs are shills for this rip-off and assault on patient health.

Another round of company discounts and giveaways to government programs are not the answer. Indeed, if donations were a panacea free food would eliminate starvation and free vaccines would eliminate measles. Rather, the underinvestment in health-care delivery — as well as the quality of medicines — is threatening to doom millions to death. Neither Mr. Clinton nor the NGOs have done anything to attract private investment into the delivery of health care in poorer nations.

Indeed, conference delegates were quite clear that the public health model is inadequate and a failure. Rather, the solution will come from start ups who see in the provision of low cost health care to the poor both profit and social opportunity. Which is why the Gates Foundation is investing its $37 billion in entrepreneurs, not government-run health-care programs.

Moreover, partnerships with pharmaceutical and health-care firms are critical to their success. Dr. Yaw Gyamfi, who runs a start-up drug company in Ghana that produces generic HIV and TB medicines, put it this way: “I don’t want loans or handouts from NGOs. I want investors. Unless the private sector is encouraged to mobilize vast amounts of capital and create a market for global health, this challenge will not be solved.”

Mr. Clinton and the governments he supports may guarantee “cheaper” medicines for the media. But without engaging the entrepreneurs to help those who are suffering, such guarantees will no longer matter. What Mr. Clinton and the NGOs have done in Thailand and Brazil is embolden those who can only undermine the forces of good in the struggle against disease.

Robert Goldberg is vice president of the Center for Medicine in the Public Interest.

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