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Govts make us sick

By Franklin Cudjoe

YET another boring report on a boring topic sounds pretty boring. But the World Health Organisation (WHO)’s attack on drug patents calls fo

r more official meddling and distracts from the real health problems of the poor: tariffs, bad infrastructure, official interference and poverty.

The WHO’s culprit, however, is the drug industry that invent new cures and that protects those discoveries with patents to cover their (gigantic) costs. The report by its Commission on Intellectual Property Rights, Innovation and Health (CIPIH) recommends weakening patents and strengthening government-funded research.

This meddling is not just irrelevant, it is damaging to medical research and therefore damaging to the poor. Worse, it gives incompetent and corrupt governments an excuse to point the finger elsewhere.

In fact, even if all medicines were free, most poor people would still be denied them. As for patents themselves, just 2% of the WHO’s own list of essential medicines are still under patent. The report could not avoid a reference to “weak health systems” but it concentrated on the illusory problem of prices.

The truth is that up to 50% of people in parts of Africa and Asia have no access to medicines because of bad official policies, described in the international Civil Society Report on Intellectual Property, Innovation and Health, published last week by 15 organisations.

The real problem is getting the many cheap and available medicines to the people who need them: it is the problem of under-development–roads, education (health staff), communications (health campaigns) and government (corruption, inefficiency and tariffs). The real cure is prosperity.

Intellectual property is the wrong battle: patented medicines affect a tiny number of diseases of the poor. The biggest killers such as diarrhoea and lung infections are a question of education and way of life: no drug can prevent infection if you drink downstream from a village that chucks its waste in the river; no drug prevents you inhaling smoke from the dung or wood that you have to use for cooking.

When it is not your way of life killing you, it is your government: malaria is hard to fight in a country where the government (under the influence of the WHO) has refused to use DDT for decades; cures are complicated and, unbelievably, most governments tax those medicines. Thankfully, the WHO report does at last call for those levies to be removed, following pressure from the US, Singapore and Switzerland.

Tariffs and taxes on medicines in Congo-Kinshasa, Morocco and Zimbabwe, for instance, are 39,5%, 18,3% and 22,5% respectively, listed in the American Enterprise Institute’s recent Taxed To Death. Brazil levies nearly 30% on imported medicines and South Africa slaps 14% sales tax even on Aids drugs, driving many patients to traditional quack cures or cheap counterfeits.

On top of that, inefficient and corrupt countries make registration of new drugs lengthy and expensive, so that some companies just do not bother trying.

Another barrier is good intentions. Price controls on drugs are alleged to help the poor but in reality they cut supply by making it uneconomical for pharmacies to stock them. Even in relatively well-off South Africa, price controls have closed scores of rural pharmacies, leaving thousands with no supply of medicines at all.

Last year, Aids campaigner and former US president Bill Clinton defined the problem: “You just can’t get the medicine, ship it into a country and drop it from the sky. If it is going to save people’s lives, the medicine must be accompanied by instructions, monitoring, by follow-up and changing the medicine if necessary.”

But sub-Saharan Africa averages 12,5 doctors per 100 000 people, with dilapidated or non-existent health structures in most countries. Tanzania would have to find nearly 10 000 more workers to address the rising needs of HIV and Aids patients and three times that number to meet the UN’s Millennium Development Goals.

In Malawi, there are only three doctors for every 100 000 people. Bad roads prevent the delivery of medicines in rural areas and there is inadequate storage and refrigeration for drugs.

As for the cost of patented drugs, many companies already operate “differential pricing”: the Aids retroviral Kaletra sells for US$1,17 in Brazil but US$4 in the USA. But Brazil still threatens to break the patent, saying it can copy it for US$0,41: maybe it can, but who will then invest hundreds of millions of dollars in researching the next anti-retroviral when the virus becomes immune to Kaletra?

Without that research, everyone will suffer: as ever, the poor will suffer most.

Pressure at the WHO and the World Trade Organisation to break patents on drugs deemed “essential” has serious repercussions for poor people. It does not just undermine research in the future, it boosts the market for fake drugs right now. Counterfeits already threaten all poor countries, reaching 50% of the market in Nigeria.

Counterfeits, quack remedies and trafficking in expired drugs thrive where there is disregard for the rule of law. That disregard is part of what keep people poor. To really tackle disease, poor people need to be allowed to prosper, because wealth and health are directly linked.

But that cannot happen without freeing them to plant, manufacture, trade and innovate freely under the protection of the law. Prosperity would then become the bulwark against disease.

Without those changes in the oppressively bureaucratic and corrupt régimes of poor countries, health aid can only remain permanent emergency assistance, keeping the poor on handouts while stifling their self-reliance.

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