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When MSF began providing antiretroviral treatment (ART) to people living with HIV/AIDS in 2000, a year’s treatment course cost more than US$10,000 per person. With the onset of competition among multiple producers, prices began to plummet in the years that followed. The most-used triple-drug AIDS treatment in the developing world now costs less than US$100 per year.
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This 99% price reduction over the course of six years was possible because several countries with pharmaceutical production capacity – such as Brazil, India and Thailand – did not grant medicine patents, allowing local producers to compete for the market and drive prices down.
Because there were no patents, generic manufacturers were also free to combine molecules in various ways, and an innovative new treatment option for AIDS was born: the ‘fixed-dose combination’ put all three drugs needed for treatment into one pill, which had to be taken twice a day. This dramatic simplification helped expand treatment to many more people.
Many of these affordable drugs were exported and used across the developing world. Indeed, India, which is the source of over 80% of ARVs used to treat more than 100,000 people in MSF’s AIDS projects, has been called the ‘pharmacy of the developing world.’
But this is likely to change. Key production countries have begun to grant medicine patents in order to comply with rules set out in the World Trade Organization’s TRIPS Agreement (Trade-related Aspects of Intellectual Property Rights). This will primarily impact newer ARVs, which are likely to be patented, meaning that production of affordable generic versions is likely to be restricted.
To treat patients with a newer, less-toxic first-line combination, recommended by the World Health Organization, treatment costs rise five fold, from US$99 to nearly US$500 per patient per year. And to treat a patient who has become resistant to their first set of medications with a ‘second-line’ would cost between 10 to 20 times more to treat a patient with second-line drugs than the cost of treating them with first-line drugs. In effect, the days of affordable AIDS drugs could be coming to a close, which will have a catastrophic impact on people living with the virus, who continually need access to newer drug options.
MSF is fighting to keep the door to affordable drugs open.
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Untangling the web
