THE BATTLE FOR GENERIC HIV DRUGS [PN 6.03]
One man has given hope to millions by making and selling cheap generic copies of anti-HIV drugs. Dr Yusuf Hamied of Cipla Pharmaceuticals spoke to Martin Flynn
Dr Yusuf Hamied has been accused by the former head of GlaxoSmithKline of being "a pirate and a thief" for manufacturing and selling cheap generic copies of anti-HIV drugs.
With over 90 per cent of the 40 million people living with HIV in world unable to afford potentially life saving medications, Dr Hamied's company Cipla is now selling antiretroviral combination therapy for as little as $1 a day.
By doing so he has challenged the huge international pharmaceutical giants to cut their own prices and has given hope to millions living with the virus.
Cipla was founded by his father in 1938 and received the endorsement of the British Raj as well as Gandhi and Nehru by providing self-sufficient Indian solutions to massive health problems.
"The philosophy of Cipla is self-reliance and self-sufficiency," explains Dr Hamied.
After the Indian government repealed the old patent laws in 1972, Cipla was given the all clear to make cheap copies of expensive western drugs.
"We were then able to legally supply them in India and around the world, wherever they were needed."
In 2000 Dr Hamied shook the world by announcing that he was producing a combination of three anti-HIV drugs in one tablet. Better still, patients would only have to take two tablets a day and the drug would only cost $350 per patient per year instead of the over $10,000 for other combination therapies.
The new tablet, called Triomune, combines three separate antiretroviral drugs: d4T, 3TC and nevirapine. It was the first effective HIV combination therapy in one tablet, and was sold so cheaply that even the millions of people with HIV in poor countries might afford it.
"We felt that this triple combination was one of the best - it was affordable, efficacious with sustainable production. Because three different companies originally made the three drugs we could legally put the three of them together into one pill."
Who is buying Triomune?
"Many countries: Senegal, Cameroon, Malawi. Zambia, Honduras. We're also offering free technology to the developing world to produce its own drugs.
"Many countries: Senegal, Cameroon, Malawi. Zambia, Honduras. We're also offering free technology to the developing world to produce its own drugs.
"At the World Trade Organisation (WTO) meeting at Dohar in 2001 it was proposed that each country could decide for themselves if they had a national health crisis and could import cheap generic drugs if they needed them. But the Americans said no. So they put it to the vote and 143 countries voted in favour and just one, the USA, voted against. And guess who won? The USA."
Cipla produces hundreds of different generic drugs at its factories in India
What is your motivation for taking on the big drug companies?
"Three thousand people a day are dying in Africa from Malaria and 8,000 a day are dying from HIV. My own theory is that HIV is a silent killer, and I liken it to breast cancer or prostate cancer. It's not being detected early enough and very few people go for testing until it's too late."
What happens when the WTO enforces patent laws in 2005?
"It only means an end to drugs which are invented and patented post 2005. What is pre 2005 we'll still be able to produce as we do now. We're now looking at making tenofovir and adefovir. We've also made a once-a-day kit of three pills of efavirenz, DDI and 3TC called Odivir"
How do you react to being called 'a pirate and a thief'?
"Was Robin Hood a pirate or a benefactor? To be a pirate you have to be a thief. What laws have I broken? I do not break laws. I abide by the laws of the land."
The major drug companies say it costs them many hundreds of millions of dollars to research and develop a new drug from the test tube to the market.
"We have offered to pay royalties. Nobody denies that patents are valuable and that the person who invents a drug should be adequately rewarded. But not obscenely rewarded. We believe in patents but we don't believe in a monopoly. What we want is a system of licensing where we can manufacture and pay a suitable royalty. I think that this is more than fair for the third world. We will then give an understanding that we will only sell our generics in selected countries.
"Pharmaceutical companies don't price their drugs according to cost but rather to their market value. The customers for drugs in India cannot afford to pay high costs for drugs. So what's the point of charging obscene prices? In Europe and the USA it's another ball game altogether."
Are you still optimistic for the millions of people with HIV?
"I'm saddened that the international community is not doing more. It's shameful that over three million people a year are dying from Aids when the drugs are available to keep them alive.
"But the good news recently is that the major drug companies are being forced by both commercial and moral pressure to cut their prices and I hope they'll cut their prices still further.
In India, for instance, there are over 400 million people living on less than $1 a day. These people cannot even afford the Cipla drugs. What can be done for them?
"They should be subsidised by the governments, the World Bank, The Global Fund. Price competition is working at lowering prices and the drugs are getting cheaper."
What can the average person do to help?
"You've seen it happen recently. The pressure from investors and activists has forced the drug companies to listen. But I would appreciate if the non-governmental organisations (NGOs) did more, rather than just preaching and attending seminars.
"People can help through education. More workshops are needed to train doctors, nurses and social workers to help people use the drugs, adher to treatments, interpret CD4 counts. It's not just a matter of having the drugs, they have to be taken at the right time and in the right way and countries need the health infrastructure to deliver them effectively. Before you treat HIV you have to test and monitor your patients.
Will you be able to get the HIV drugs out to the millions of people who need them?
"That's where the international bodies like the UN and The Global Fund should be helping. Unfortunately we're finding out too late that people in Africa have this disease and by then they're coming down with serious opportunistic infections and dying.
"We have to educate, educate, educate even before we put the drugs in. But I'm optimistic that if that can be done and Cipla continues to sell HIV drugs as cheaply as possible then we can save many, many lives.
"One person and one company can't do everything but if we all work together we can make a huge difference."
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