The Invisible Hand
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Sat Jun 17 06:05:57 MDT 2000
The New York Times, June 17, 2000
Prices for Medicine Are Exorbitant in Africa, Study Says
By DONALD G. McNEIL Jr.
NAIROBI, Kenya, June 16 -- The price of life-saving medicine in Africa,
where the need is greatest and the poverty is worst, is often higher than
in Europe and North America, according to a study issued here today.
The study confirms what doctors working in poor countries complain of: that
the medicine their patients need for AIDS and for tropical ailments like
malaria and worms are often available only at exorbitant prices.
"Pharmaceutical pricing is about the law of the jungle, where might is
right," said Kirsten Myhr, the pharmacist who oversaw the study. "Profit
maximization seems to be the only objective of the industry."
Ms. Myhr, a Norwegian who used to run the medical supplies system for
Botswana, said even malaria medicine was cheaper in her frigid homeland
than in much of Africa.
"It's ridiculous," she said. "They only sell a few boxes, and you have to
relabel them in a Nordic language, and it's still half the price."
Nevirapine, which prevents mother-to-child transmission of H.I.V., the
virus that causes AIDS, costs $430 per 100 units in Norway, where there is
hardly any market for it, she said, and $874 in Kenya, where the need is
desperate. Drug prices in Norway are about average for European Union
prices, which are generally lower than American ones.
Kenya's prices are among the highest in Africa, the study said, though
South Africa's are far higher. According to Dr. Sam Muziki, a World Health
Organization regional officer, most Africans must pay 80 percent of
prescription-drug costs out of pocket. If they cannot afford them, they
simply do without, and go home to die.
The imbalance is even greater when the low purchasing power of poor
countries is taken into account. A course of first-line tuberculosis
treatment would cost a Swiss worker only one hour's wages, Dr. Muziki said,
but would cost a Tanzanian laborer 500 hours' wages.
Ms. Myhr's study was one of two issued here at a conference on African drug
prices sponsored by Doctors Without Borders and other groups pressing drug
companies to cut prices.
Kenya was chosen because it is the center of the small East African drug
industry, and is now rewriting its patent law.
The second study was an analysis by Unaids -- a consortium of United
Nations agencies -- of prices for anti-AIDS drugs in Brazil. Like India,
Brazil ignores Western patents and lets its companies makes cheap copies of
the newest inventions of American and European drug companies. Unlike
India, it has not yet begun to export, but the study found it prepared to.
Brazilian prices were very low: the anti-retroviral cocktail ZDV/3TC, for
example, was $1.44 a dose there versus $18.78 in the United States and
$7.34 in Uganda. Uganda, unlike next-door Kenya, does not permit patent
monopolies, so drugs there are often cheaper.
The copying infuriates Western drug companies. Parmindar Singh Lotay,
regional sales manager for Glaxo Wellcome, the British-based drug giant,
told a generic maker at the conference: "The law still says 'intellectual
property.' You're telling me I should just give my property to you?" He
described millions of dollars worth of medicine his company now gives away
and argued that it still must make profits for shareholders, profits that
were "the engine that drives tomorrow's drugs."
It is hard to compare drug prices worldwide. The same pill is sold at
different prices in different countries, and at different prices in one
country to small pharmacies, bulk buyers and public hospital systems.
Retail markups, taxes and pharmacy discounts vary widely. Many poor
countries use the World Health Organization's bulk purchasing system, which
negotiates low prices. But the drugs may not reach consumers because of
theft, corruption and incompetence along the chain.
Also, imitations made in India, Brazil or elsewhere may be of excellent
quality or worthless counterfeits. One theme repeated often here was the
need for some sort of international generic-testing lab.
Kenya's minister of health, Dr. Amukowa Anangwe, opened the conference with
an aggressive speech defending the right of poor countries like his to
cancel the patents of companies whose medicines are beyond the incomes of
average citizens. The speech was drafted for him by Doctors Without
Borders, but he stuck by it in an interview afterward.
He said he expected Kenya's Parliament to soon pass the new patents law
with clauses on importing practices and patent seizure that the industry
"There are people in the Ministry of Trade, Tourism and Industry who have
reservations about it," he acknowledged, "but I think the government's mood
is that of the member of Parliament who asked, 'How can we be denied access
to drugs that prolong life when our people are dying?' "
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