Hyderabad, the historic ‘City of Pearls,’ well known as the hub of the Indian pharmaceuticals industry, ranks third globally in terms of its production volume, with a turnover of ₹18 billion a year. Most of the generic medicines and vaccines manufactured here are what help India become known as the ‘pharmacy of the developing world.’
What does this ‘pharmacy’ mean to the organisation, Doctors Without Borders/Médecins Sans Frontières (MSF)? As a treatment provider, our medical teams are often stuck without appropriate and affordable access to medicines and vaccines that we need to care for people in our programmes. For example, in the early 2000s, the price set by pharmaceutical corporations to provide one person with HIV treatment for a year was more than $10,000, limiting our ability to respond to the epidemic.
At the time, each day, more than 500 people in South Africa alone were dying of AIDS-related illnesses. Fortunately, the introduction of generic competition from India drove prices down, by putting an end to the monopolies that allowed companies to charge unconscionably high prices that put treatment out of reach for people who needed it. Those same medicines are today priced at just $100 per person per year — a decrease of 99% from 2000. The availability of affordable generic medicines has allowed MSF, ministries of health and global treatment providers to scale up access to lifesaving HIV treatments, with more than 18 million people on treatment globally today.
Generic competition is a proven way to promote access to low-cost generic medicines needed by millions of people worldwide, not just for HIV, but for many other diseases including TB, viral hepatitis and cancer. Yet, the benefits of robust generic medicines competition may not be available to people in need in the future.
Next week, Hyderabad will host the 19th round of the Regional Comprehensive Economic Partnership (RCEP) talks– a regional trade deal between India, the 10 member states of ASEAN, and their major Asia-Pacific trading partners, Australia, China, Japan, New Zealand, and the Republic of Korea.
The stakes are high; if certain proposed provisions vis-à-vis intellectual property (IP) monopolies are adopted at this meeting, the repercussions may be permanently damaging for people’s access to affordable medicines the world over.
The RCEP negotiations have been shrouded in secrecy, with limited opportunities for meaningful inputs from health ministries and health experts. Yet, leaked drafts of the negotiating texts reveal proposals put forward by Japan and South Korea that threaten to undermine access to medicines in a number of ways.
For example, Japan’s proposal for ‘patent-term extensions’ may mean that people have to wait another five years after the expiry of the mandatory 20-year patent monopoly before cheaper versions of new lifesaving medicines can be produced. This delay will necessarily affect the most vulnerable people who are in urgent need of reasonably-priced medicines.
Putting up barriers
Japan and South Korea are also demanding a ‘data exclusivity’ period of “no less than five years.” Data exclusivity creates a barrier to entry for generic producers, even when patents no longer apply or exist. India has purposely not adopted data exclusivity, and introducing it via RCEP would mean additional delays in approvals of low-cost generic medicines, which in turn will restrict access. Already, pharmaceutical corporations have successfully pushed for increasingly restrictive IP monopoly provisions to be adopted around the world. In the U.S. and Europe, where restrictive IP provisions are in place, high medicine prices are crippling health-care systems. For example, in the U.S., some cancer treatments are priced at more than $100,000 per person per treatment course; and a new hepatitis C medicine was introduced at $1,000 per pill. In Europe, governments are forced to ration expensive new hepatitis C treatments, which could benefit millions more people than those who currently have access. In Greece, in our efforts to protect refugee children at risk of highly-contagious pneumonia, the number one childhood killer globally, MSF had to pay about $68 per dose for the pneumonia vaccine — over 20 times more than the lowest global price available. Despite this, Japan and South Korea are aiming to boost the monopoly control of pharmaceutical corporations and are stepping up pressure on IP issues in the negotiating rounds.
When the talks begin in Hyderabad, it’s crucial that RCEP negotiators from India and ASEAN countries protect existing safeguards for access to medicines. As treatment providers, we have watched too many people die because the medicines they need to stay alive or healthy are too expensive. And everyone knows a family member, a friend or a colleague who has difficulty paying for medicines because they cost too much. We cannot allow RCEP to threaten lives and shut down the pharmacy of the developing world.
Rohit Malpani is Director of Policy & Analysis at MSF’s Access Campaign. The views expressed are personal