Accessing AIDS drugs

Access to AIDS drugs for developing countries should be a focus of the federal election, say Canadian AIDS groups.

Richard Elliott, the executive director of the Canadian HIV/AIDS Legal Network (CHALN), says the legislation that allows Canadian generic drug manufacturers to supply cheap AIDS drugs to developing countries is ridiculously restrictive.

“We’ve heard repeatedly from developing countries that the prospect of trying to jump through all the hoops is daunting,” says Elliott. “This is not something where we can afford to have a lot of red tape when lives hang in the balance.”

Since Canada passed its current Access to Medicine legislation in 2005 there has only been one instance of a generic manufacturer actually providing drugs to a developing country. A shipment of a triple-combination AIDS drug from Apotex was scheduled to arrive in Rwanda on Sep 25.

But Elliott says that might be the only success under the legislation.

“All indications are it could be a one-hit wonder,” he says. “Apotex has expressed very real reluctance about taking further steps.”

Under the legislation a generic manufacturer — if it has reached an agreement with a recipient country — can reach an agreement with the patent-holding pharmaceutical company to manufacture and ship a generic version of the drug. The patent-holder is paid a fee. If an agreement is not reached — as happened with the Rwanda case — the generic company can apply for a “compulsory licence,” which allows manufacture without the patent-holder’s permission. The patent-holder still receives a fee.

Under a compulsory licence the generic manufacturer must specify the number of pills that will be sent and the licence only lasts two years. Rwanda wanted to increase the number of pills from the original 15.6 million, but couldn’t.

“They need to start the process all over again if they want to add to the number of drugs,” says Elliott.

CHALN is pushing for a much more simplified process, says Elliott.

“It would make so much more sense if you gave a generic manufacturer a licence upfront that isn’t limited to a specific amount or country, as long as they pay a fee,” he says.

Elliott says the process is further complicated by the fact that after the legislation was passed it was further limited to drugs approved at the time of passage in May 2005. Any additions require cabinet approval.

“It’s big pharma and its captive governments,” he says. “We started with a flawed system using this case-by-case basis and then big pharma and those sympathetic to it in government introduced further restrictions.”

Elliott says there is a similarly flawed system in place in every country that signed on to the original World Trade Organization agreement.

Elliott says there has been some success in getting the issue on the political agenda. He points to a 2006 initiative of the Stephen Lewis Foundation which brought together Canadian and African grandmothers as something that garnered publicity.

“They did a demonstration on Parliament Hill where they had African grandmothers with them,” he says. “Canadians are wondering why this promise we made to bring cheap drugs to developing countries isn’t being fulfilled.”