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Ivory Coast Winning AIDS Drugs War

By: The Associated Press
The New York Times, March 20, 2001

Far from the big courtroom battle over HIV-drug patents in South Africa, the West African nation of Ivory Coast quietly imports knockoff generic HIV drugs as it has for years -- without fuss, patent payments or apologies.

``Believe me, I don't care,'' Kassim Sidibe, director of Ivory Coast's AIDS program, said Monday of patent rights.

``Our concern is what we can do for our people,'' said Sidibe, who runs the national program out of a dusty concrete compound in a working-class Abidjan neighborhood.

``The lower the prices are for us, the better for our people.''

With that attitude, Ivory Coast has become one of the first African nations to negotiate at-cost deals for leading HIV drugs. And now the country has reached a new deal that is expected to bring down the cost of a month's HIV drug treatment from $410 this year to $88 to $112 next year.

Senegal, Rwanda and Uganda announced similar deals with drug makers this month. In the West, a month's HIV treatment would cost about $1,000.

It's an example of the pressure the West's big drug makers are facing from generics, from AIDS activists -- and from Africa.

``We feel drug makers should make profits in Europe and North America,'' said Sidibe. ``Not from us. We don't have anything.''

In South Africa, leading drug companies went to court this month to block a law that would let South Africa both import generic drugs and make its own.
But as the West pays more attention to demands for affordable HIV drugs for sub-Saharan Africa, the impoverished region with more than two-thirds of the world's HIV-positive people, drug makers simultaneously announced a rapid-fire series of concessions in recent weeks.

Most have been price cuts for Africa, to production cost or even below.
Bristol-Myers Squibb went even further last week, saying it would make its patent for the drug Zerit available in South Africa at no cost -- effectively opening the market to its generic competitors.

Bristol-Myers stressed it would stick with the drug companies' lawsuit in South Africa, however -- portraying the case as a broad defense of patent rights for all its drugs.

It's a different story in the rest of sub-Saharan Africa, where Bristol-Myers says it holds no patents for its HIV drugs. So when it comes to acquiring HIV drugs there, it's a little more like the Wild West.
In Ivory Coast, the government gets the HIV drugs it wants by taking bids for them worldwide.

When two of the bids for 2001 came back for knockoff drugs at what Ivory Coast deemed the lowest and best offer, Ivory Coast took them.
The national AIDS program shipped in AZT and stavudine from a Bombay-based generic company, Cipla Ltd., bypassing their brand-name makers, GlaxoSmithKline and Bristol-Myers. Bristol-Myers markets stavudine as Zerit.

The result was a 20 percent savings in the average monthly therapy -- down to $410 from nearly $500, said Makan Coulabily, an official with the AIDS program.

Sidibe, the national AIDS director, didn't bother to determine whether there were patent rights at issue or not.

``We bargain until we get the minimum price,'' he said Monday.
GlaxoSmithKline officials in London and Abidjan did not return calls Monday for comment on the patent rights issue. Neither did Bristol-Myers spokesmen in the United States.

In a statement announcing the patent concession in South Africa, executive vice president John L. McGoldrick said, ``We at Bristol-Myers Squibb certainly do not have all the answers.

``But we hope our initiatives can be of some help to African AIDS sufferers and may help energize and accelerate world understanding and action.''
Negotiating the lowest price for AIDS drugs without regard for patent rights comes easier in the many sub-Saharan countries that are both poorer than South Africa and perhaps less conscious of staying on the right side of international investors. Ivory Coast's per capita gross domestic product is one-fourth that of South Africa.

Ivory Coast, long West Africa's financial hub, has been wracked in the past 15 months by a coup, coup attempts and cocoa and coffee price drops that have made life much harder for its 16 million people.
With the savings expected from drug companies' concessions, the government said, in 2001 it should be able to triple the number of patients it can treat.

Even so, that's just 3,000 people getting government-backed treatment next year, up from 1,000 this year, Coulabily said.
And that, he agreed with a shrug and woeful smile, is out of 1 million believed living with the virus in impoverished Ivory Coast.