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. Last Updated: 07/27/2016

Poor Get Access to AIDS Drugs

WASHINGTON -- Five pharmaceutical companies have agreed to drastically lower the prices they will charge for AIDS drugs used in developing countries.

Although the agreement announced Thursday by the United Nations AIDS agency so far amounts to little more than a statement of principles, the goal appears to be to price AIDS drugs such that manufacturers get little or no profit from their sales in poor countries.

To take advantage of the rock-bottom prices, however, a country's medical system would have to be able to test for the AIDS virus, counsel people found to be carrying it, deliver the drugs in a timely fashion and monitor the health of patients taking them. In many places, the cost of that medical "infrastructure'' may be prohibitive, even if the drugs aren't.

Nevertheless, the announcement may turn out to be an epochal moment in the 20-year AIDS pandemic. "It is a breakthrough in the sense that for the first time, a group of pharmaceutical companies are open to significantly decreasing the price of their products in poor markets,'' said Peter Piot, the head of UNAIDS, which is sponsored by UN agencies, the World Health Organization and the World Bank.

"Industry has taken a very big step in making pricing and profits no longer a major point of contention in the AIDS control discussion,'' said Nils Daulaire, president of the Global Health Council, a lobbying organization for international public health issues. "Now we can turn to issues of developing care programs, and better prevention programs.''

The price of AIDS drugs has been a source of rancor ever since AZT, the first one, was introduced in 1987. With the rise of life-extending, health-restoring "combination therapy'' in recent years, the cost of treatment has become a cruel symbol of the epidemic's inequities.

Of the 34 million people worldwide infected with HIV, the virus that causes AIDS, 95 percent live in developing nations. Nearly 70 percent live in sub-Saharan Africa, where only a handful of people can afford the $10,000-a-year, three-drug combinations used in industrialized nations.

Triple-combination therapy reduced AIDS mortality in the United States by 42 percent in 1997, the first full year the drugs were introduced. In some clinics with highly experienced practitioners and patients able and willing to take the pill-heavy combinations, deaths dropped by two-thirds. The drug companies agreeing in principle to lowering prices are British-based Glaxo Wellcome, Swiss F. Hoffmann-La Roche, German Boehringer Ingelheim and U.S. companies Bristol-Myers Squibb and Merck.

Representatives of the last two were present at the UN in early December when UN Secretary-General Kofi Annan convened a meeting to establish an "international partnership'' to address AIDS in Africa. Subsequently, the other three companies expressed interest in greatly improving access of their products to developing countries.

UNAIDS' Piot and Daniel Tarantola, senior policy adviser to Gro-Harlem Brundtland, head of the WHO, negotiated intensively with the companies over the last three weeks. Both men warned against any feeling that the announcement, reported Thursday in the Wall Street Journal, was the beginning of the end of AIDS in Africa.

"This is more than we've had before,'' Tarantola said. "But we have to be aware that there are risks attached, such as the risk of raising expectations unduly, the risks of draining resources from other high-priority health problems.''

Piot said the commitment to very low drug prices "is only one step in a complex process. Frankly, it would be outright irresponsible to dump these drugs where they wouldn't be used properly. It would promote [drug] resistance, and wouldn't help the patients anyway.''

One of the few hints at how low the prices might go was offered by Glaxo Wellcome. It said it would sell Combivir, which contains the antiviral drugs AZT and 3TC in one pill, for about $2 per daily dose. The current "average global price'' for Combivir is $16.50, said Ben Plumley, who manages the company's drug access programs for developing countries.

He wouldn't reveal how much it costs to manufacture the pills, or how much above cost $2 might be. He said the company's objective in setting that price "is really to try to help make a contribution to this public health crisis, rather than open up new markets.''

Piot said no guidelines on pricing had been set. Setting strict guidelines that all five companies - and possibly more in the future - would follow probably would violate anti-monopoly laws, he added.

Nevertheless, the pricing is expected to be very low. "Our position is that the benchmark is manufacturing cost and what it takes to get the drugs there'' to developing countries, Piot said. "The actual negotiations are starting now. My expectation is that it will be really production costs plus a few pennies for everything that is needed so that they won't lose money on it.''

Dismissed by some as ridiculous tokenism, this initiative now will offer crucial lessons in what it takes to deliver triple therapy in resource-poor countries, said its head, Badara Samb. One lesson is that the cost of the professional training, patient testing and equipment has been about $2,500 per patient per year in Uganda and Ivory Coast. Especially expensive has been the cost of the "reagents'' - chemicals and other items - necessary to run the equipment that measures bloodstream viral load.

Samb said he hopes that with drug companies committed to drastically reducing prices, the firms that sell laboratory stocks will soon follow.