Statement by Stephen Lewis, the UN Secretary-General’s Special Envoy for HIV/AIDS

Nairobi, Kenya
September 25, 2003

Allow me to make one point directly on the matter of resources at the outset.

It is worth noting that the industrial world is spending $600 billion a year on defense, and $350 billion on agricultural subsidies. That is to say, on those two items alone, the rich world spent almost a trillion dollars while Africa had slightly less than a billion dollars to spend on AIDS. That’s a ratio of a thousand to one. For the mathematically-inclined, it means that the rich world, annually, spends 600 times as much on defense as Africa has for AIDS, and 350 times as much on subsidies as Africa has for AIDS.

My use of the phrase “grotesque obscenity” at the conference opening may sound strong, but it wilts in the face of those numbers.

However, there are many ways to free resources. I want to suggest an approach that is somewhat unorthodox, but gains significant credibility in the light of recent events.

At the end of August, the World Trade Organization finally reached a compromise on generic drugs. After two painful years of dispute and delay, it was agreed that African countries could import generics if they were clearly in need, and other countries could export generics to meet that need. It was also decided that any such import/export activity would not violate international trading rules, or trade-related intellectual property rights.

This week, at the UN General Assembly session on Monday in New York, the World Health Organization announced its determination to achieve the goal of “3 by 5”, that is, to make sure that three million people are receiving treatment by the year 2005. In the UNAIDS report that accompanied the debate, it was said that 50,000 people are in treatment now in Sub-Saharan Africa, as compared with 4.1 million who are eligible for treatment. In other words, the numbers receiving treatment represent roughly 1% of those eligible.

I want to suggest that the two events --- the WTO agreement and the WHO pledge --- yield a truly interesting possibility which I should like formally to advance.

It’s time for one of the major industrial countries, in particular, one of the G7 countries, to announce the manufacture and export of generic drugs to Africa. I would wish it to be my country, Canada, but it doesn’t really matter which.

The proposition is simple: if the WHO is going to move from 50,000 now in treatment in Africa to over two million by 2005 (Africa’s share of the 3 million target), then they will need a fast, reliable, scientifically sound, continuous flow of generic drugs in order to keep the prices low enough --- roughly $250 to $300 per person per year --- for the plan to succeed. There will obviously be some provision from Brazil, Thailand and India, but much more will be needed. A western country could fill that need and do it at the highest standards of quality.

All that is required is to issue a compulsory license which lifts the patent protection from anti-retroviral drugs on the WHO approved list. Every G7 nation has a robust generic industry with great production capacity. In Canada, the Generic Pharmaceutical Association has already asked the government to issue a compulsory license so that they can export to Africa. The big pharmaceutical industry would suffer not one whit: these drugs would be for export only, domestic prices would not change, and there could even be a time limit on production … say, five years, until Africa develops an indigenous manufacturing capacity of its own. It would be expected that the generic manufacturers would help build this manufacturing capacity in Africa by transferring the necessary technology.

If this were done, it would be entirely consistent with the WTO negotiations completed at the end of August. No rules broken, millions of lives prolonged and saved. It would be a huge testament of good faith from the industrial world towards Africa.

I want to emphasize that there is absolutely nothing standing in the way of such an initiative except a paralysis of political will and the influence of the big pharmaceutical companies. But the political will can change. And the drug companies could do the right thing. If the pharmaceutical industry were to throw up obstacles, they wouldn’t have a leg to stand on: on the one hand, it’s entirely legal, and on the other, there is no damage whatsoever to the corporate balance sheet. You’d have to have pretty twisted motives to oppose a compulsory license. After all, we’re talking about millions of lives.

When the WTO agreement was reached, the drug companies said they could live with it. Some of the major NGOs, like MSF and Oxfam and Health Gap, fear that the big drug companies really agreed to the deal only because it imposed conditions on the African countries which those countries would fail to meet. The result, they feel, would be that Africa wouldn’t be able to import generic drugs, and would have to fall back on non-generics from the big pharmaceutical companies at higher prices.

So what were those conditions? The importing country would have to go before the WTO Council to prove the need to import (that is, to show that there was no local manufacturing capacity); the importing country would have to go before the WTO Council to show that the drugs were for “health purposes” and not “commercial purposes”; the importing country would have to guarantee protection against black market activity; and any third country could challenge the transaction by issuing a formal complaint within the WTO.

The NGOs see these conditions as potentially crippling obstacles to the import of generics. But they want to test the agreement before deciding that it won’t work.

And that’s a key reason for one of the industrial countries to leap into the fray. If a G7 country issues a compulsory license so that its generic industry can provide the drugs, then the G7 country can join the African importing country when it goes before the WTO Council or responds to some challenge. The presence at the table of Canada, or the UK, or France would change everything. It would make the entire process possible. It’s all a matter of clout and influence.

One final item: It was only ten days ago, in Cancun, that the wealthy nations of the west took a position on agricultural subsidies so intransigent and unjustified as to cause a collapse of the talks. In so doing, they doomed Africa to continuing poverty. It would at least be a small act of redemption if the same wealthy countries now provided low cost generic anti-retrovirals to help to diminish the scourge of AIDS.

It might not usher them into the kingdom of heaven, but they’d be further removed from the inferno.

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