Cipla is offering to sell the agency as many doses as it is wants at $350 a year. Dr. Hamied said that his company would lose money at that price, but that he would supply "10,000 doses or 20,000 or 30,000, however many they want." The $600 price to governments is near Cipla's break-even point, he said, but costs could drop with greater production. If that happens, he would cut prices further.

In India he sells the same cocktail for about $1,100 a year. But he denied that he was trying to grab market share in Africa. "What do I want with market share?" he asked. "I don't have a monopoly, and the only way to make real money in drugs is with a monopoly. In this disaster, there is room for everybody."

Wide distribution of the drugs in Africa is not without critics, given the attendant need for careful monitoring. Some experts argue that it would be better to spend the money on providing clean water, controlling malaria and increasing the use of condoms. But Doctors Without Borders says that the dangers and side effects of the drugs pale beside the immensity of the epidemic itself, and that Western testing standards are overcautious.

The typical AIDS cocktail is a combination of any three of about nine protease inhibitors or reverse transcriptase inhibitors. The chemicals suppress the human immunodeficiency virus but, as with any chemical therapy, they are toxic and can damage the liver. In the West, doctors carefully monitor the levels of the drug in the blood, test for organ damage and check the levels of the virus in the bloodstream. If the virus mutates to resist the therapy, the combinations are changed. Careful monitoring may not be possible in many African settings.

But with 25 million Africans infected with the AIDS virus, Doctors Without Borders and other agencies argue, imperfect treatment is better than none. Dr. Pecoul pointed out that large numbers of infected Africans live in urban areas where, "with a quite simple clinic, you can deal with anti retrovirals."

He is also "not convinced" that the batteries of tests routinely ordered for Western patients are really necessary. "Some people suggest that H.I.V. testing and clinical followup can be enough," he added.  The Cipla drug combination is two tablets of 40 milligrams of stavudine, two tablets of 150 milligrams of lamivudine and two tablets of 200 milligrams of nevirapine.

In the United States and many other countries, the Bristol-Myers Squibb Company holds the patent on stavudine, also known as Zerit or d4T; Glaxo-Wellcome of Britain holds the patent on lamivudine, also known as Heptovir or 3TC, and Boerhinger Ingelheim G.m.b.H. of Germany holds the patent on nevirapine, or Viramune.

Western drug companies have shown themselves determined to defend their patent rights to be sole distributors throughout the world, and Dr. John Wecker, head of Boerhinger Ingelheim's efforts to negotiate cheaper prices in Africa, said he did not yet know what his company would do if Cipla undercut its prices. "We offer a standard quality from the original manufacturer and can meet any demand that exists out there that can be delivered with safe procedures," he said.

He refused repeatedly to say at what price Boerhinger Ingelheim sells nevirapine to Senegal or Uganda, saying, "Affordability is an issue, but not the major issue." Representatives from Glaxo-Wellcome and Bristol-Myers did not return phone calls, but the three companies can be expected to wage a hard fight against the distribution of generic versions of their drugs.

Late last year, Glaxo-Wellcome threatened to sue Cipla when it tried to sell Duovir, its generic version of Glaxo's Combivir, a lamivudine/ zidovudine combination, in Ghana. Cipla offered the drug for $1.74 a day; Glaxo had cut its price to $2, from $16. But even though the African regional patent authority said Glaxo's patents were not valid in Ghana, Cipla backed down and stopped selling Duovir.

Asked what he would do if the three drug companies sued to stop him, Dr. Hamied said: "We won't fight it. I don't look at it as a fight. There's room for everybody. This is a holocaust in Africa. It's like the earthquake in India right now - everybody is helping out. I'm not looking to pick anybody's business; there's room for the multinationals at their price and room for us at our price, a partnership."

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Pharmaceutical manufacturer offers cheap AIDS drugs
7 February 2001, CNN (excerpts)

NEW DELHI, India – "This is my contribution to fighting AIDS," Hamied told The Associated Press in an interview Wednesday. He said the inspiration for his decision came from the January 26 earthquake in western Gujarat state - where more than 17,000 people have been confirmed dead - and the outpouring of relief for the 1 million people left homeless.

The key to the program, Hamied said, is a three-tiered pricing scheme, under which wholesalers would pay $1,200 for drugs to treat one patient for a year, governments would pay $600, and Doctors without Borders would pay $350. "We're not making money, but we are not going to lose money either," Hamied said. "With the average of the three prices, we should break even."

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Oxfam: Drug firms waging war on poor
12 February 2001, CNN

LONDON, England -- The relief agency Oxfam is accusing the pharmaceutical industry of keeping lifesaving medicines beyond the reach of the world's poor. The UK-based charity said on Monday that drug companies and wealthy nations are "conducting an undeclared drug war against the world's poorest countries."

Oxfam is urging the World Trade Organization to change its patent rules to allow developing countries to produce low-cost versions of drugs that fight major killers such as AIDS, respiratory tract infections and childhood diarrhoea. It is calling for a $5 billion international fund to assist disease research and subsidise drug distribution in poor countries.

Launching a Cut the Cost Campaign, Oxfam said locally produced low-cost medicines are a lifeline for poor people. India, it said, could make antibiotics at an eighth of the price of patented versions.

Oxfam singled out British-based drugs giant GlaxoSmithKline, which has major U.S. operations, urging it to set an example for the industry by abandoning legal battles and forgoing patent privileges in the developing world.

Oxfam's director of policy, Justin Forsyth, described lawsuits and trade-sanction threats against (India), South Africa, Brazil, Thailand and other countries as "the shadowy side of globalisation." He said: "The availability of cheaper drugs will save lives.

"We know that making lifesaving drugs more affordable isn't the whole answer. However, the balance has skewed too far toward corporate wealth rather than public health." The high cost of medicines, the patents of which are held by multi-national pharmaceutical companies, has become a major complaint in many developing nations in recent years.

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