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AFRO-NETS> Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa
- Subject: AFRO-NETS> Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa
- From: Holly Ladd <email@example.com>
- Date: Wed, 7 Feb 2001 10:22:57 -0500 (EST)
Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa
Copyright 2001 The New York Times Company
February 7, 2001
By DONALD G. McNEIL Jr.
PARIS, Feb. 6 - In a move that could force big drug multinationals to
cut the prices of their AIDS drugs in poor countries, an Indian com-
pany offered today to supply triple-therapy drug "cocktails" for US$
350 a year per patient to a doctors' group working in Africa.
The Indian company, Cipla Ltd. of Bombay, a major manufacturer of ge-
neric drugs, made the offer to Doctors Without Borders, which won the
Nobel Peace Prize in 1999 for its work in war-torn and impoverished
areas. In Africa the group sets up small pilot programs to develop
models for broader approaches to combat AIDS, and would distribute
the Cipla drugs free.
As part of its program, Cipla would also sell the drugs to larger
government programs for US$ 600 a year per patient, about US$ 400 be-
low the price offered by the companies that hold the patents. "This
is the way to break the stranglehold of the multinationals," said Dr.
Yusuf K. Hamied, chairman of Cipla, who will meet with the doctors'
group on Feb. 15 to discuss strategy.
For two years, Doctors Without Borders has led an aggressive campaign
to force multinationals to cut prices on life-saving drugs for the
world's poorest patients.
Other parties in the campaign are the Philadelphia and Paris chapters
of the AIDS Coalition to Unleash Power, and the Consumer Project on
Technology, a Washington group started by Ralph Nader.
The normal cost of the AIDS cocktail in the West is US$ 10,000 to US$
15,000 a year. Last May five multinationals, backed by the World
Health Organization and other United Nations agencies, offered to
sell their components to poor nations at sharply reduced prices.
But Cipla and other makers of generic drugs in Brazil, Thailand and
other countries have not been part of the talks with W.H.O., a situa-
tion that Cipla hopes to change with its aggressive entry onto the
The country-by-country negotiations about how the multinationals dis-
tribute the drugs have gone slowly, and so far only Uganda, Senegal
and Rwanda have agreements. The companies refuse to release figures,
but the cost of a typical cocktail in Senegal is US$ 1,000 a year,
according to Doctors Without Borders.
Dr. Bernard Pecoul, director of the Access to Essential Medicines
project for Doctors Without Borders, said the Cipla offer, which he
learned of only today, "will let us start up our pilot projects on a
The doctors' group has 40 AIDS projects around the world, about half
in Africa, where the infection rate reaches as high as 36 percent.
Only five of these pilot programs are giving out antiretroviral cock-
tails. With the Cipla offer, or matching ones from other companies,
up to 20 could be distributing the drugs by the end of year.
Cipla is offering to sell the agency as many doses as it is wants at
US$ 350 a year. Dr. Hamied said that his company would lose money at
that price, but that he would supply "10,000 doses or 20,000 or
30,000, however many they want."
The US$ 600 price to governments is near Cipla's break-even point, he
said, but costs could drop with greater production. If that happens,
he would cut prices further.
In India he sells the same cocktail for about US$ 1,100 a year. But
he denied that he was trying to grab market share in Africa. "What do
I want with market share?" he asked. "I don't have a monopoly, and
the only way to make real money in drugs is with a monopoly. In this
disaster, there is room for everybody."
Wide distribution of the drugs in Africa is not without critics,
given the attendant need for careful monitoring. Some experts argue
that it would be better to spend the money on providing clean water,
controlling malaria and increasing the use of condoms. But Doctors
Without Borders says that the dangers and side effects of the drugs
pale beside the immensity of the epidemic itself, and that Western
testing standards are overcautious.
The typical AIDS cocktail is a combination of any three of about nine
protease inhibitors or reverse transcriptase inhibitors. The chemi-
cals suppress the human immunodeficiency virus but, as with any
chemical therapy, they are toxic and can damage the liver. In the
West, doctors carefully monitor the levels of the drug in the blood,
test for organ damage and check the levels of the virus in the blood-
stream. If the virus mutates to resist the therapy, the combinations
are changed. Careful monitoring may not be possible in many African
But with 25 million Africans infected with the AIDS virus, Doctors
Without Borders and other agencies argue, imperfect treatment is bet-
ter than none.
Dr. Pecoul pointed out that large numbers of infected Africans live
in urban areas where, "with a quite simple clinic, you can deal with
He is also "not convinced" that the batteries of tests routinely or-
dered for Western patients are really necessary. "Some people suggest
that H.I.V. testing and clinical followup can be enough," he added.
The Cipla drug combination is two tablets of 40 milligrams of sta-
vudine, two tablets of 150 milligrams of lamivudine and two tablets
of 200 milligrams of nevirapine.
In the United States and many other countries, the Bristol-Myers
Squibb Company holds the patent on stavudine, also known as Zerit or
d4T; Glaxo-Wellcome of Britain holds the patent on lamivudine, also
known as Heptovir or 3TC, and Boehringer Ingelheim G.m.b.H. of Ger-
many holds the patent on nevirapine, or Viramune.
Western drug companies have shown themselves determined to defend
their patent rights to be sole distributors throughout the world, and
Dr. John Wecker, head of Boehringer Ingelheim's efforts to negotiate
cheaper prices in Africa, said he did not yet know what his company
would do if Cipla undercut its prices. "We offer a standard quality
from the original manufacturer and can meet any demand that exists
out there that can be delivered with safe procedures," he said.
He refused repeatedly to say at what price Boehringer Ingelheim sells
nevirapine to Senegal or Uganda, saying, "Affordability is an issue,
but not the major issue."
Representatives from Glaxo-Wellcome and Bristol-Myers did not return
phone calls, but the three companies can be expected to wage a hard
fight against the distribution of generic versions of their drugs.
Late last year, Glaxo-Wellcome threatened to sue Cipla when it tried
to sell Duovir, its generic version of Glaxo's Combivir, a lami-
vudine/zidovudine combination, in Ghana.
Cipla offered the drug for US$ 1.74 a day; Glaxo had cut its price to
US$ 2, from US$ 16. But even though the African regional patent au-
thority said Glaxo's patents were not valid in Ghana, Cipla backed
down and stopped selling Duovir.
Asked what he would do if the three drug companies sued to stop him,
Dr. Hamied said: "We won't fight it. I don't look at it as a fight.
There's room for everybody. This is a holocaust in Africa. It's like
the earthquake in India right now - everybody is helping out. I'm not
looking to pick anybody's business; there's room for the multination-
als at their price and room for us at our price, a partnership."
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