[Pharm-policy] Lowest cost for HIV/AIDS drugs?

[James Love]

        In recent discussions with generic producers, I was told that
with
large production runs for global delivery (in more than one national
market), it would be possible to produce Nucleoside Analogue Reverse
Transcriptase Inhibitors (drugs such as AZT, ddI, ddC, d4T, 3tC and
Abacavir) for about 5 cents per pill, or 21 cents per day, for a 4 pill
daily regime.   The company that made this estimate is already producing
4 of these drugs in smaller quantities (at higher costs).   

        I was also told that the producer thought that it could produce
Protease Inhibitors and  Non-Nucleoside Reverse Transcriptase Inhibitors
(NNRTI) for about the same cost, and that a three drug regime (two from
Nucleoside Analogue Reverse Transcriptase Inhibitors and one drug from
either of the other class of drugs), could be produced for about 63
cents per day, or about $230 per year.  

        I was told there are very large economies of scale, and that it
would
only be possible to get these low unit costs if there was large
production.  But the sense was that such prices are possible, if society
has the will to organize efficient production and registration
globally.  I think this is very encouraging.   Even if millions of
persons could not afford medicines at less than $20 per month and could
not afford the supporting care, there are many that could, using their
own resources and the existing medical infrastructures.  Certainly many
of the skilled workers in a country could, for example.  

   In my mind, the international institutions need to work on 2 related
strategies.

1.  There needs to be an comprehensive examination of the barriers to
entry for cheap drugs in every developing country.   This should include
an examination of regulatory (drug registration requirements, health
registration data exclusivity, etc) and intellectual property issues
(compulsory licensing authority).  This is what the WHO should be doing,
but other agencies could do this too.  

2.  It would be extremely useful to have a global effort to obtain
compulsory licenses and drug registrations for inexpensive generic
versions of HIV/AIDS drugs.  If an international agency like the WHO,
UNAIDS or the World Bank applied for the compulsory licenses and sought
registration, governments would be more likely to move ahead, quickly,
because there would be less negative publicity regarding the weakening
of intellectual property rights.  This is unlikily to happen in the face
of opposition from the US and the EU. 

  If we don't do (1) and (2), it is because we don't think it is
important to get the price of drugs down as much as is possible.  In
other words, we are willing to tolerate hundreds of thousands of
preventable deaths, in deference to the power of the large
pharmaceutical companies.   I think this is wrong, and I think we need
to push harder for real action.


  Jamie
-- 
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James Love, Director           | http://www.cptech.org
Consumer Project on Technology | mailto:love@cptech.org 
P.O. Box 19367                 | voice: 1.202.387.8030
Washington, DC 20036           | fax:   1.202.234.5176
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