Love And Other Drugs
One Man’s Fight To Make Life-saving Medicines Affordable To All.
More than a decade ago, only one in 1,000 people living with HIV in Africa had access to AIDS treatment. While a three-drug cocktail costing US$10,000 to US$15,000 per year was readily available to treat people with HIV in affluent countries, the prohibitive cost meant that a diagnosis remained a death sentence for the 24.5 million people in sub-Saharan Africa infected with HIV. James Love, founder of non-profit organisation Knowledge Ecology International (KEI), had a word for this state of affairs: racism.
“Even though racism isn’t the only issue and terrible inequalities do exist even in high-income countries, I don’t think the access barriers to HIV drugs would have tolerated, to that magnitude, if the problem existed with Caucasians in the US, Europe, or in Japan”, says Love. Having seen first-hand the way patents and intellectual property rights obstruct the delivery of health to the poor he finds “it is maddening to confront the needless human suffering for patients and their families, in cases where a serious disease such as cancer, AIDS or some terrible rare disease is involved, and a treatment exists, but it is priced too high”.
Outraged at this dire state of affairs, and armed with his encyclopaedic knowledge of patents and intellectual property rights, Love single-handedly pushed for AIDS drugs to be made accessible to Africa at a mere dollar a day, preventing the AIDS pandemic from escalating further. In 2000, when Jamie Love met the CEO of Cipla, Dr Yusuf Hamied, India’s leading manufacturer of generic drugs, Cipla was ready to sell Triomune — a combination of three foreign-patented pharmaceuticals combined together in one pill instead of the usual eight to be taken daily — at a price between US$600 and US$800. While this was a major saving compared to the US$12,000 that the cocktail of three individual drugs would otherwise have cost, this was not enough for Love.
How much did it actually cost to make the drugs to keep somebody with HIV alive? According to Dr Hamied, the cost of manufacturing a HIV drug cocktail was barely more than the cost of the raw materials. With that knowledge, Love daringly posed the question to Hamied, “is there any chance of providing that AIDS cocktail at a dollar a day?” Surprisingly, after much negotiation, Dr Hamied conceded it was possible and eventually proceeded to contact Médecins Sans Frontières, offering it Triomune at US$350 per patient, per year for distribution in Africa. By the end of 2000, access to antiretroviral drugs to treat HIV infection had dramatically increased to reach more than five million people in developing countries.
Since then, Love’s entire career has revolved around fighting for drugs to be made accessible for all; his main concern being the many millions of lives cut short for want of affordable medicines. “If you have drugs with proven outcomes, I feel personally uncomfortable that there is limited access to it,” says Love. His main gripe with the industry hinges on the incredible discrepancy between the cost of developing a drug or vaccine, an expensive and risky enterprise, and the actual cost of manufacturing a drug, which is often astoundingly cheap. According to Love, this is a systemic problem: “For drug developers to invest money to discover and establish the safety and efficacy of new drugs, there has to be robust financial rewards for the projects that succeed. Yet, right now, the reward is indirect, it is a monopoly for a period of time, during which the monopolist charges high prices, prices that are so high it is not an exaggeration to say the monopoly is killing patients, because that is a predictable consequence of very high prices on drugs that would otherwise save lives.”
However, it seems like the world has drunk the Kool-Aid; socialised into accepting that the often prohibitively high cost of drug treatments is completely justified by the immense amount of R&D that the big pharmaceutical companies need to recoup. Yet, according to Love, change is but a mere mind-set switch away: “Once you turn that corner and you realise that intellectual property rights are really man-made policies and they’re designed to do something, and there’s other ways to induce that same thing that can compete those ideas, then it just opens your mind up.”
His solution to turn this common misconception that patents are a necessary incentive in the invention of new medicines on its head sees a complete restructuring of traditional economic model funding R&D. KEI campaigns for the delinkage between high prices and R&D. “Essentially, it is a political demand that governments around the world abandon the use of monopolies and high prices as incentives for investments in R&D,” Love explains. Patents have led to monopolies on new medicines, diagnostics and other medical technology resulting in high prices, as well as wasteful outlays on marketing and development of medically important products. Under this perverse price incentives system, research-based pharmaceutical companies tend to focus on the most lucrative products, rather than the most needed, which is particularly damning for the global poor whose diseases lack profitability to attract the industry. Making matters worse, since the existing funding structure is grant based, thereby breeding excessive competition, basic research and drug innovation has traditionally been done in silos. Instead of sharing vital information that could expedite the process and time taken to bring new effective drugs to the market, there is limited communication across competing companies and labs. At the end of the day, the current systems of incentives to induce private property regimes only seek to serve the wealthy corporations.
To combat this, Love envisions “delinkage as a new business model, that does not rely upon monopolies and high prices to finance R&D for new drugs. Instead, governments commit to a combination of direct funding, R&D subsidies and monetary rewards, sometimes referred to as innovation inducement prizes or market entry rewards, to finance R&D”. For delinkage to work, he believes that “the commitments to funding R&D, including through the cash incentives for successful products have to be very large, and the financing has to be sustainable and dependable”. At the end of the day, this radical notion will pivot the international debate surrounding R&D and patents, away from an issue of price and negotiating the reasonable length of patents to one of ethics and realising the multi-fold benefits of reaping dividends on open-sourcing of R&D findings.
Despite his successes and having gone on to lead multilateral dialogues and WTO negotiations, the war on drug patents is scarcely over. Seventeen years on, the fight continues as it is no longer just the poor who primarily cannot afford the life-saving drugs they need. New medicines for lethal diseases such as hepatitis C and breast cancer have emerged on the global market at such immense prices that even the richest countries in the world are having to find ways to ration them and Love is right at the forefront fighting for these patents to be demolished. With his unshakeable drive to make delinkage happen within the next 10 years, the days when poverty alone could price the poor out of the necessary access to healthcare and medicines might be numbered.
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