As U.S. Balks on Medicine Deal, African Patients Feel the Pain
- Big Drug Firms, Protecting Their Patents, Seek Limits to a Global
Trade Accord By ROGER THUROW and SCOTT MILLER Staff Reporters of THE
WALL STREET JOURNAL
N'DJAMENA, Chad -- At the central hospital in this decrepit capital,
the lone cardiologist writes prescription after prescription for
medicine to relieve hypertension. But he acknowledges that few of his
patients will ever fill his orders.
"They often can't find the medicine in Chad, and if they do, they
can't afford it," says Dr. Mouanodji Mbaissouroum.
By now, Dr. Mbaissouroum and many of his colleagues throughout the
developing world had hoped that relief would be on the way for the
chronic affliction of unavailable and unaffordable drugs. Wealthier
countries, where the drugs are produced and patented, promised 18
months ago at global trade talks in Doha, Qatar, to loosen patent
restrictions in order to ease shortages and reduce prices. It was
just after Sept. 11, 2001, and the U.S. led the rhetorical charge,
eager to demonstrate its desire to battle suffering among the world's
poor, while mounting a war on terrorism.
But last December, when all of the other 143 countries in the World
Trade Organization had lined up behind a new plan on the trade of
medicines, the U.S. blocked the proposal. The Bush administration,
under heavy lobbying from a pharmaceutical industry seeking to limit
the scope of the deal, endorsed a list of some 20 infectious diseases
that it was willing to address. These included HIV/AIDS, malaria,
tuberculosis, typhus, haemorrhagic fever and others categorized as
epidemics in developing countries -- but that was it. Drug
manufacturers feared that without the limitation, the deal could lead
to a broader undermining of their lucrative patent rights.
Poor nations were outraged. Dr. Mbaissouroum and other doctors here
point out that they treat more patients, combined, for heart-related
problems, diabetes, cancer and chronic respiratory diseases -- which
aren't on the U.S.-backed list -- than for AIDS. Many AIDS sufferers,
they say, don't seek formal treatment out of ignorance or fear of
stigma. Malaria kills one million Africans each year. Yet nearly
twice as many, combined, die of heart or respiratory ailments,
diabetes and cancer, according to the World Health Organization.
In the crowded diabetes ward here, a floor above the cardiology wing,
Bechir Soumaine is recovering after several days without insulin,
which he couldn't find in any local pharmacies. "People in the
developed world think AIDS and malaria and communicable diseases are
the biggest problems in Africa," says Dr. Mbaissouroum. "But we also
suffer the same illnesses as rich people do."
Fifteen months before Doha became the central command post for the
U.S. campaign to oust Saddam Hussein, it was the stage for a mission
to effect potentially even bigger change: liberalizing global trade
for the benefit of the developing world. While the military mission
has been largely achieved, the grandly named Doha Development Round
of trade talks has deteriorated into a major letdown for those it was
supposed to help.
"We're disappointed, extremely frustrated and very concerned that
this round of negotiations won't achieve the vision it set out to
achieve," says Faizel Ismail, South Africa's trade representative in
Asked to explain the U.S. position, Deputy Trade Representative Peter
Allgeier cites the importance of zeroing in on AIDS and other
epidemics: "As agreed by ministers in Doha, the WTO's efforts must
focus on helping the poorest countries have access to medicines to
fight infectious epidemics like HIV/AIDS, tuberculosis and malaria
and those that may arise in the future." He adds that it is crucial
not to stray from that focus by emphasizing other diseases, such as
cancer and heart ailments. "We think the WTO needs to keep its eye on
the ball to fulfill the Doha mandate," Mr. Allgeier says.
The clamor for action has grown in recent days, as President Bush and
the heads of the other largest industrialized countries, known as the
G-8, have gathered in Evian, France, for their annual economic
summit, which concludes Monday. Thousands of protesters, marching
from Geneva toward Evian on Sunday, carried placards
proclaiming "People before profit." The group Doctors Without
Borders, pushing its campaign for cheap and accessible medicines,
fervently handed out "Too poor to pay" stickers. At the WTO
headquarters in Geneva, before it was ringed by police in riot gear
over the weekend, demonstrators scrawled graffiti on the surrounding
stone walls: "WTO kills" and "No justice, no peace."
Since the breakdown in December, there has been no action on the
medicines stalemate. Neither has there been much movement on scaling
back the agriculture subsidies that keep U.S. and European Union
farmers in business. By encouraging surplus production that drives
down world prices, the farm subsidies undermine the economies of many
agricultural-based developing countries.
U.S. Trade Representative Robert Zoellick and Pascal Lamy, his EU
counterpart, said earlier this spring that they wanted to start by
finding an easier target and had decided to join forces on the
relatively attainable goal of reducing tariffs on manufactured goods.
Focusing their efforts on that, they said, might create some momentum
at the WTO that could spill over into other areas, such as medicines
The explosive spread of AIDS in Africa has drawn international
attention to the issue of access to patented medicines readily
available in the West but scarce and prohibitively expensive in most
developing countries. At Doha, trade ministers agreed that poor
countries should be able to override patent protections and use
cheaper generic copies of drugs to attack mass health problems. Mr.
Zoellick repeatedly stressed the need to reach out to struggling
nations. "One of our primary objectives in launching a new global
negotiation is to use trade and openness to bring new opportunities
and new hope to the poorest among us," he said in a speech to the
Council on Foreign Relations in October 2001.
But the Doha agreement didn't spell out how poor countries, with no
capability to manufacture generic drugs of their own, could import
the generics from a third country. The pact also didn't specify
precisely which diseases it covered. The key language referred
to "public-health problems afflicting many developing and least
developed countries, especially those resulting from HIV/AIDS,
tuberculosis, malaria and other epidemics."
The developing countries interpreted this as covering any disease
they would identify as a public-health problem. But as the round-the-
clock talks neared a final deal last December, U.S. negotiators
argued that the patent exception should apply only to epidemics such
as AIDS, tuberculosis and malaria.
Drug companies, led by their trade group, the Pharmaceutical Research
and Manufacturers of America, mounted an 11th-hour lobbying blitz
aimed at the White House and members of Congress. The industry had
spent more than $50 million to help Republicans gain control of
Congress in November 2002.
About three dozen lawmakers signed individual and group letters
beseeching Mr. Zoellick to limit the scope of the deal. Chief
executives of 19 drug companies signed a separate letter to the trade
representative. And the White House kept "in very close contact" with
Mr. Zoellick, as is standard practice in such negotiations, an
administration spokeswoman said.
The drug industry fears that relaxing patents beyond those for a
limited list of epidemics would set a precedent leading to much
broader erosion of their intellectual-property rights. That could
spark an open season on lucrative drugs of little relevance to
African public-health crises, the industry says, specifically citing
Pfizer Inc.'s impotence remedy, Viagra, and products designed to
prevent baldness. Without the exclusive right to produce innovative
drugs -- and collect commensurate profits -- manufacturers say they
won't have enough incentive to research new treatments. In the long
run, that will undercut medical science and harm those who suffer,
both rich and poor, the companies add.
"We care a lot about people having access to our medicines," Raymond
V. Gilmartin, Merck & Co.'s chairman and chief executive, said at a
European Commission conference in Brussels in April. He pointed to
Merck's distribution of reduced-cost drugs in the developing world,
including antiretroviral medicines for HIV/AIDS and treatments for
river blindness, an affliction transmitted by flies that breed on
water. "Many of the medicines that have come from Merck laboratories
have changed the way diseases are treated and changed millions of
lives," the executive said. But Mr. Gilmartin also said that the
original broad Doha declaration could lead to future pressure to
relax patent protection of other products.
U.S. trade representatives also bristle at the perception that they
are keeping drugs out of the hands of those who need but can't afford
them. At the Brussels conference, Grant Aldonas, under secretary for
international trade at the U.S. Department of Commerce, deflected
questions on the topic, stressing that drug prices are only a small
part of the health problem facing developing countries. More
important than prices, he said, are ineffective distribution systems
and endemic corruption in developing countries, which make it hard
for the needy to get their hands on any medicine that does arrive
from abroad. "It's not just about intellectual property," he said.
The U.S. tried to counter international critics late last year by
announcing a temporary moratorium on export laws governing patented
drugs for poor nations facing certain epidemics. And, several weeks
later, in his State of the Union address, President Bush pledged that
the U.S. would spend $15 billion over five years to fight AIDS around
the world. The Bush plan, focused largely on African and Caribbean
countries, aims to provide care for those already infected with the
disease, as well as bolster programs designed to prevent its spread.
Representatives of African countries praise the U.S. AIDS money and
the temporary export-law moratorium, but they question why similar
steps aren't taken for other diseases that are big killers. And, they
ask, what about diseases that materialize in the future and medical
breakthroughs? If new cures are patented and not included on the U.S.-
favored list, they will be largely out of reach to the sick of Africa.
"The development of science is so great, we must be up to date," says
Dr. Mbaissouroum, the Chad cardiologist.
Chad, one of the world's poorest countries, where the vast majority
of the population lives on less than $1 a day, displays all the ills
of African health systems: little capacity to manufacture its own
drugs, broken-down distribution networks, no reliable record-keeping
to gauge medical needs and a lack of money to import medicine.
While the government has a list of over 400 drugs it considers
essential for treating its citizens, it can't afford many of them,
even in generic versions. Last year, according to the local WHO
office, the Chad government relied on $2.3 million in funding from
the EU and the World Bank to buy medicine for the country's eight
Shortages are common. Often, Chad patients have to cross into
neighboring countries, such as Cameroon, to find the drugs they need.
And when they do, they often find they can't afford them there.
Consider Dr. Mbaissouroum's dilemma: For hypertension, he usually
prescribes one of two drugs which sporadically make their way into
the country. One, Loxen, sold by Switzerland's Novartis AG and
patented in Europe, costs the equivalent of about $25 for a box of 60
tablets. He prescribes one or two tablets a day, so the box can last
for one or two months. Or he prescribes a generic version of the drug
alphamethyldopa that costs about the same: $8 for a box of 20
tablets. He prescribes several tablets a day, so this box lasts only
one week. Most of the patients prefer the $8 box because it costs
them less on the day of purchase, even though it lasts for a shorter
"They can't afford a second box, so they interrupt their treatment,"
the doctor says.
Mr. Soumaine, the diabetic, often interrupts his treatment, too,
because insulin supplies in Chad are spotty. Some pharmacies lack
refrigerators to store it, so they keep a low supply. Other times, it
isn't available at all. Most injected insulin is no longer under
patent. But potential new treatments that are currently being
researched and could be of particular benefit to Africans with
diabetes, such as inhaled or oral insulin, would probably be patented
if they ever come on the market.
For 16 years, Mr. Soumaine has battled diabetes, taking insulin
whenever he could to control his blood-sugar level. When he has a
job -- most recently he managed inventory for a French contractor in
Chad -- Mr. Soumaine can afford the monthly insulin purchases: $12 in
local pharmacies, $25 over the border in Cameroon. But now that he
has been out of work for eight months, the 42-year-old father of
eight children says, "When I need more insulin, I rush to my parents
or other relatives for money. It's embarrassing."
Two months ago, he traveled eight hours by car to Moundou, the
nation's commercial hub, to look for a job. The search dragged on,
and he ran out of insulin. There was none to be found in Moundou, he
says. Weak and woozy, he was rushed back to N'Djamena, to the
diabetes ward at the central hospital.
There, a medical student found that Mr. Soumaine's blood-sugar level
was severely elevated. The patient was stabilized with insulin from
the hospital's emergency supply while, for two days, friends and
relatives scoured N'Djamena for insulin. Finally, they bought some in
Preparing to leave the hospital, Mr. Soumaine says he is certain
he'll be back. "As a diabetic in Chad," he says, "every day I don't
know if I'll die."
- Government Shuts Down Two Magazines, May 20, 2003, Abidjan
The government of Gabon has suspended the publication of two
magazines in a move which "looks like a campaign of intimidation
against the privately owned press," the French-based campaign group
for press freedom, Reporters sans Frontieres, said on Tuesday.
It said that on 12 May the government's media watchdog, the National
Communications Council, had ordered Misamu, which appears once every
two months, to cease publication because of a dispute between the
founder and current editor over who owned the magazine.
However, Reporters sans Frontieres noted that this decision followed
the magazine's publication of an article about the mysterious death
of an aide to Pascaline Bongo, the eldest daughter of President Omar
Bongo, who is also the head of the president's office. Misamu
accused a sernior finance ministry official of murdering the
Reporters sans Frontieres said that three days later the govenment
had ordered the suspension for three months of the weekly newspaper
Le Temps. The government accused the newspaper of "besmirching the
good name of the nation" by publishing an article which alleged that
Bongo's government had "wasted more than 500 billion CFA (US $87
million)in two nights" on lavish independence day celebrations, it
Reporters sans Frontieres said these moves looked like "a campaign
of intimidation against the privately owned press and is nothing
more than a way of preventing the population from having access to
more objective information and knowledge of different manoeuvres by
Reporters sans Frontieres said two other newspapers, Jeunnesse
Action and L'Espoir, had received final warnings from the National
Communications Council this month.