IN CONVERSATION
AIDS: drug wars
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TISHANI DOSHI spoke to Dr. Y.K. Hamied, Chairman of Cipla about the role of generic drugs in the fight against AIDS, the consequences for India, and more. Excerpts.
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TISHANI DOSHI
Y.K. Hamied in London ... "I am against monopoly".
In the past 20 years, HIV/AIDS has killed 22 million people worldwide. Today, 45 million people suffer from HIV with the concentration being in sub-Saharan Africa. But the global hotspot is going to shift to India by 2015, with nearly half the total number of people suffering from HIV, a staggering 35 million, living here. With battle lines like these, a war against AIDS seems inevitable. Yet what exactly is being done to root out this weapon of mass destruction?
Dr. Y.K. Hamied, Chairman of Cipla, India's most successful pharmaceutical company, has been battling it out for years by producing generic anti-retroviral drugs (ARVs) at hugely lower costs than multinational corporations. In 2001, Cipla offered its version of the AIDS cocktail drug (Triomune) at less than a dollar a day which shook up the pharma industry, previously charging $10,000 to $15,000 per patient per year. Consequently, Dr. Hamied has been accused of being a "thief" and "pirate", but legally, India's current patent laws allow no monopoly in the area of health and food which has made it possible for him to manufacture and market almost any drug available.
Today, 80 per cent of the Indian pharma market of $4 billion and virtually all the pharma exports of $3 billion are controlled by Indian companies. But how will all this change, when the World Trade Organisation's Trade Related aspects of Intellectual Property Rights (TRIPs) becomes a law in January 2005? How will the seesaw between intellectual property rights and human rights play out? Surely the accessibility and affordability of ARVs is one of the few life lines available to developing countries?
HOW has the fight against AIDS become your personal crusade?
It hasn't been. My fight has been intellectual property and HIV/AIDS has become an interesting example of what the power of monopoly can lead to. Let me give you the Indian scenario.India today has a population of 1.2 billion. What is the disease pattern in India? Fifty million cardiac patients, 60 million diabetics, 50 to 60 million asthmatics, 50 to 60 million infected with Hepatitis B. One in three Indians has latent TB. What are we talking about? And you want to give companies a monopoly in India? This is what I've been shouting from the rooftops about. It's not that I'm against intellectual property, I'm against monopoly.
How has the attitude towards AIDS in India changed, and do you perceive it to change in the future?
I can only tell you about my personal experience. Fifteen years ago we started a hospital in Poona under the banner "Cipla foundation for Cancer and AIDS", and do you know because of the word AIDS, no cancer patient would enter the hospital! The stigma is so phenomenal. We spent crores on commercials trying to show that AIDS transcends all boundaries, that it's normal people who get it, not just sex-workers and truck drivers. We tried to show people doing normal things and carrying on with their lives, and basically to say that AIDS is a chronic illness, not a death sentence. Can I tell you something? No ad agency in India could recruit models for these ads, because nobody wanted to say they had AIDS on TV. So, it's a nasty situation.
Recently, World Health Organisation pulled out two of Cipla's anti-retroviral drugs, saying they weren't biologically equivalent to patented drugs. How has Cipla reacted to this?
In 2001, when we announced the dollar a day treatment therapy, MNCs turned around and said Cipla was not qualified. At that time, the WHO was considered the last word in approvals. We applied to the WHO, they inspected our factories, cleared them, and qualified 10 to 15 of our drugs. Now you must understand what approval means — quality, safety, and testing. Some of the testing is done by outside agencies, not in-house, and the results are presented later on. We found when we visited the labs jointly with them, that there were some irregularities with documentation. Nothing wrong, but we withdrew the products with a view to reinstate them later. We've given the deadline of July 31 for resubmission, but another 10 of our products remain qualified.
Who are the people doing things in India, championing the cause so to speak?
Well, there are at least half a dozen companies in India who are manufacturing the AIDS drugs which is a very good thing, because the demands are going to be so large.
It has to be a team effort. No single company can provide everything, it's impossible. There are bottlenecks in providing medication, and apart from this, to treat HIV you need infrastructure.
What happens when the WTO's TRIPS becomes a law in January 2005?
Please bear in mind that it is only what is patented post-2005 that will apply to me, and any drug that's made in 2005 will only come into the market in 2020 ....
But you're talking about monopolies surely....
Yes, unless the government brings in compulsory licensing. It will be dividing the world between those who can afford life-saving drugs, and those who cannot. What are our safeguards? We need safeguards for a population like ours. Every one of us Indian should be aware of the situation. We've been brainwashed into thinking we need a monopoly. What have they done so far? If you look at the world's top 50 drugs, 70 per cent of them have been in-licensed which means that the fellow who's selling them hasn't invented them. Stavudine, the drug that I'm making is marketed by Bristol Myers Squibb, but it wasn't invented by them, it was invented at Yale University.
Yet MNCs claim that the reason for their high prices is because of the money they put into R&D ....
Yes, this is the whole situation. Ask any doctor in India, how many of your patients come to you for HIV. They'll say none. They come to you for TB or something, and out of every 10 cases, two will be for HIV. So you get a test, you take it and confirm it as positive, and you go to your doctor. He looks at you and sees you're hale and hearty, he'll say, go home, don't bother, don't do anything until you find something like a loss of appetite, weight loss and so on, then come back to me ....
There are people the doctors have sent home and for 10 years nothing goes wrong with them. With this situation of treatment, you need to tackle it on a war footing. War footing means you must have mandatory testing. How is that done? We were talking earlier of truck drivers. They have a licence valid for 20 years. Why can't we say that their licence is valid only for a year, and to revalidate the licence he must take an HIV test, and if the test is positive, the licence is revoked. I'm talking war footing.
What does the truck driver do then?
He'll be treated for HIV free by the State, something like that. In my company all workers have to have a health test, but the HIV test is optional; however, if the person volunteers for the test, the company pays for the test and if it's positive, these are the three things: his/her job is not in jeopardy, everything is kept in confidence, and the company pays for his/her treatment. What more can we do? And yet, how many people will avail of this service? Because unless it's done on a war footing ....
Basically you're saying extreme situations call for extreme measures.
Exactly. You have to. It's an epidemic. And I'm following the work done on vaccines... I think it's a good 15 years down the line. Eight thousand people are dying of HIV everyday. What is the international community doing about it?
Do we have no shame or something? The issue is access to medicine at affordable prices. The issue is not HIV/AIDS. Our fight in the third world is a fight to access to medicines and health.
E-mail the writer at tishanidoshi@yahoo.com
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