NAIROBI – At the headquarters of UNITAID and other groups seeking to boost access to HIV/AIDS medicine, the notion of a patent pool where drug companies would combine their intellectual property is seen as an important way to drive down drug costs. In the Kenyan capital Nairobi, home of AIDS activist Nelson Otwoma, the patent pool is a matter of life and death.
Otwoma is the chairman of the National Empowerment Network of People Living with HIV/AIDS in Kenya, or NEPHAK. He has watched people simply go without treatment – and lose the battle with HIV – because they can’t afford antiretroviral drugs, particularly second-line medicines.
“People understand that if we pressure pharmaceutical companies, governments, and researchers to put their patents in the pool, drugs will be cheaper and better,” Otwoma told Intellectual Property Watch. “They have an interest in us. Those pharmaceutical companies want to have communities on their side. It’s a matter of public relations. I don’t think they are so insensitive that they don’t want to listen to what we are saying.”
Otwoma is one of the hundreds of HIV/AIDS activists across Africa who have been pushing for a patent pool as quickly as possible, hoping to whip up a sense of passion among those who might not appreciate the urgent need for cheaper medicines in places like Kenya, or understand that the patent pool may be the only way to bring prices down.
To its advocates, a patent pool would bring crucial drugs into the hands of more Kenyans. Drug companies agree to put their patents in one place, and drug manufacturers can buy a licence to produce a drug with that knowledge. Competition among them will drive down the cost of doing so. Because all the patents are in one place, manufacturers will also be able to make paediatric formulations that are not normally profitable for drug companies, or produce a single pill combining the medicines patented by several companies.
It can be difficult to understand without proper explanation, a fact that has slowed advocates from spreading the word about it. But they hope pharmaceutical companies will realise that a patent pool is the only way they will sell their drugs in Africa. They hope to play on a sense of moral obligation combined with the financial fact that HIV/AIDS numbers in the West are falling, so companies will need to look elsewhere.
“My sense is essentially that a lot of people see this whole patent pool idea as a new concept,” said Wariara Mugo, coordination manager for the French branch of Médecins Sans Frontières in Nairobi. “We need to make an effort to educate people on the issue and have the health ministries and the government of Kenya buy into and lobby for the patent pool.”
UNITAID’s board of directors is expected to adopt a patent pool for HIV/AIDS drugs in mid-December. The next step will be persuading drug companies to contribute their patents so manufacturers can get started.
“It’s about collective responsibility from all the players and the pharmaceuticals have a huge role in it,” said Lucy Chesire, an HIV and tuberculosis health advocate who was diagnosed with HIV in 1992. “Getting drugs in the pool would mean greater competition and lower costs.”
Kenyan officials say it now costs about US$60 to keep a patient on first-line antiretroviral treatment for a year. Second-line drugs can cost hundreds of dollars a month. Second-line ARVs are so out of reach for many AIDS patients that in some rural areas of Kenya they are not even told of the existence of a more powerful set of drugs to fight the illness. And there aren’t the laboratory or testing facilities to judge whether a patient needs to make the change.
Part of the problem for advocates of the pool has been to explain that the price of second-line HIV/AIDS drugs will not fall on their own like the prices for first-line drugs did. India in particular has adopted new patent laws that restrict generics manufacturers from making second-line drugs. Officials hope the patent pool will be the mechanism to bring down drug costs.
“It’s absolutely true that there aren’t enough people who understand that (cost reductions) will not happen automatically without deliberate intervention,” said Ellen ‘t Hoen, head of the medicine patent pool initiative at UNITAID.
Kenya is in the middle of a full-blown epidemic, with a seven percent infection rate.
There are currently 300,000 Kenyans receiving HIV/AIDS drugs, which are paid for mostly by the Global Fund, the World Bank and the US President’s Fund for Emergency AIDS Relief. The country has also launched a campaign to encourage more people to get tested. Kenyan government statistics show that 80 percent of the country’s people do not know their status and many are reluctant to learn for fear of being stigmatised.
A new HIV/AIDS strategy is expected to bring more people onto antiretrovirals earlier in their illness, a fact that will put greater demand on the donor system. But because of funding caps by PEPFAR limiting numbers to 190,000 for the next five years, Kenya’s only option is to decrease the cost of the drugs.
“We see we are not getting additional commitments yet the need is increasing,” said Dr. Nicholas Muraguri, director of National AIDS/STI Control Program. “The more we can do to make sure people have access to ARVs the better, and the patent pool is one of those things.”