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The end of cheap medicine?

By Adam Robert Green | Published:  15 November, 2011

The Bric countries have redefined affordable drugs, making access to medicines possible for millions in low income regions. Yet changing priorities for major generic drug producers, such as India, could reshape the African pharmaceutical landscape

Access to medicines has improved dramatically over the last decade, driven by the rise of cheap pharmaceuticals from Asia, domestic efforts by governments of developing countries, commitment from donors, and price cuts from brand producers.

Smallpox is eradicated, the end of polio is nigh, and the number of children dying from measles has dropped by over 80 per cent. HIV-Aids, once a hopeless diagnosis for most people in developing countries, is now treatable for as little as $87 per person each year, down from around $10,000 in the late 1990s.

Brazil, India and China have been essential in driving this transformation, pushing down the price of drugs and introducing new business models that have re-shaped how medicines are consumed in Africa. But their changing interests, and greater adoption of intellectual property rules, some warn, could unleash price rises. How African governments respond to this changing terrain will determine whether the progress of the last decade can be quickened.

To understand the global health revolution of the last decade, and the decisions that confront African governments now if they are to sustain that progress, it is necessary to step back to the 1980s when the Brazilian government helped public labs develop yellow fever vaccines that Western producers were not providing – becoming the first developing country to enable cheap copies of brand drugs, now known as generics.

A more assertive stance was taken in 1996 when, to tackle a potential Aids epidemic, policy makers passed a law guaranteeing free, universal access to treatment. Brazilian domestic manufacturers were allowed to make copies of patented antiretroviral (ARV) drugs, which delay the onset of Aids from the HIV virus, provoking at times hostile responses from some Western governments, particularly the US. Drug companies were pressured to lower their prices or have their products copied.

“Brazil changed the landscape by proving that treatment in resource-limited settings was possible, by forcing pharmaceutical companies to reduce prices, and by ushering in global policy changes to promote more equitable access to essential medicines” says Amy Nunn, assistant professor of medicine at the Division of Infectious Diseases, Brown University Medical School.

In 2001, the Doha Declaration globalized Brazil’s innovation, allowing all developing countries to copy brand drugs – whose patent life is typically 20 years – if public health demands were serious enough, or to import generics if they did not have manufacturing capacity. India seized the opportunity, producing and later exporting cheap generics around the world. Africa became India’s second largest market after the US, with Kenya, Nigeria and South Africa the biggest recipients. India also provides most essential medicines procured by global health funds.

China later emerged as an exporter of chemical raw materials - especially artemisinin for malaria. At the Sino-African Summit in 2006, President Hu Jintao pledged Africa $37.5m in grants for artemisinin, part of a broader charm offensive geared to boost pharmaceutical exports, says Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations and an associate professor at Seton Hall University. “China wants to use health aid not just to expand political influence and improve its international image, but also to open the market for Chinese medicines and equipment,” says Professor Huang. In its most blatant form, doctors dispatched to Africa are encouraged to dispense Chinese-made drugs.

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