Brazil’s pharma pressure campaign for cheap HIV/AIDS drugs

Of all the many things that outgoing Brazilian President Luiz Inácio Lula da Silva has been praised for, his work on HIV/AIDS is one of the most impressive. Brasilia decided a decade ago to give lifesaving anti-retroviral (ARV) treatments away to anyone who needed them, and by 2007 those drugs were reaching 80 percent of the country’s AIDS patients. Recently released WikiLeaks cables give us a behind the scenes look into how Brazil convinced international drug companies to sell their patented AIDS drugs at a low price: with a lot of pressure. 

By way of background, Brazil is member to the 1996 International Agreement on Trade Related Aspects of Intellectual Property (TRIPS), a convention meant to boost respect for intellectual property rights in the pharmaceutical industry in a world of mass-produced generic drugs. In short, TRIPS is meant to increase the generic production of patented drugs. But there’s one interesting clause in that agreement, allowing countries’ governments to issue a "compulsory license" for any drug they deem necessary to ward off a crisis situation. And in Brazil, HIV/AIDS was deemed exactly such a crisis. 

Brazil used that crisis clause to negotiate extremely low-cost drug imports from major pharmaceuticals, including Gilead Sciences, Abbott Laboratories, and Merck & Co. subsidiary Merck, Sharp & Dohme. In short, it threatened to issue compulsory licenses for the drugs to pressure the drug companies to lower their prices. In a meeting with the U.S. embassy in 2003, for example, a Merck communications director noted "Merck’s position that the prices demanded by the MoH [Ministry of Health] are below cost and even lower than those Merck has granted to least-developed countries in Africa." In 2005, they were still negotiating. And in 2007, Brazil actually did issue a compulsory license, proving they were serious. Through it all, the U.S. embassy served as a channel to relay messages to the drug companies; its officials also insisted that Brasilia respect intellectual property rights and were dismayed by the unrelenting drug price policy.

I asked Eduardo J. Gómez, an expert on Brazil at Rutgers University, what he made of the cables. Brazil’s policy, he said, was a product of overstretched health budgets, public opinion, and even self-imposed pressure to uphold a reputation as a leader in HIV/AIDS treatment. "The government feels that it’s painted itself in a corner, and that to maintain its global reputation, it must do whatever it can to guarantee access to medicine," he told me by e-mail. "In short, this is just further evidence that Brazil places its people and social commitments well above and beyond anything else."