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The Not So Accelerated Access Initiative

In early April the World Health Organization (WHO) and the World Trade Organization (WTO) held a small, secretive meeting in Hsbjr, Norway, on “Differential Pricing and Financing of Essential Drugs.” Initially, the meeting was stacked with representatives from the big drug companies, the International Federation of Pharmaceutical Manufacturers Association (IFPMA), a slew of drug company consultants, and several fanatical free market zealot economists. After a good deal of backstage pressure, additional participants were invited, including representatives from Cipla, the head of the Brazilian AIDS program, and — the only representative of an AIDS organization — myself.

You couldn’t have been much further from the ravages of AIDS than the lovely hotel perched high on a snowy hillside above Norway’s largest lake than we were at the WHO/WTO meeting. At dinner one night a prominent WTO official told me that nothing was better suited than the free market and free trade system to meet “humanity’s needs, its hopes, its aspirations.” A pharmaceutical consultant darkly warned that price controls were destroying drug company R&D in Europe. The general plan seemed to be to impose a system of differential pricing on the world, with prices secret at all levels, with absolute prohibitions on parallel imports, and with nothing but pro forma protection of countries’ rights under the TRIPS agreement. The general philosophy of both the drug companies and the USTR seemed to be that “TRIPS is fine — as long as you don’t use it.”

On the bus on the way back to the Oslo airport I was talking with the head of Glaxo’s entire African program. “Drop the South African lawsuit,” I said. “It’s not about AIDS,” he protested. “I don’t care, drop it anyway!” “We can’t,” he said, uttering all the usual arguments about how if they let South Africa get away with reforming its drug laws, the entire bottom would drop out of the global pharmaceutical market, and R&D worldwide would come shuddering to a halt.

Throughout this entire process, perhaps 5,000 people received discounted AIDS drugs through the Accelerated Access Initiative. Perhaps 5 million new HIV infections occurred, and perhaps 5 million people died of AIDS. Meanwhile, at a glacial rate, additional countries were signing onto the Accelerated Access Initiative — Cameroon, Mali, Rwanda, Senegal, Uganda . . .

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