Christopher Moraka Defiance Campaign Against Patent Abuse and AIDS Profiteering by Drug Companies

Defy Trade Laws That Place Profits Before Health

We are faced with the choice of watching our children, families, friends, neighbours and strangers die because medicines that can save their lives cost too much, or, defying unjust trade laws that protect AIDS profiteering by multinational companies. The choice is clear. The rights to life and access to healthcare are non-negotiable. Profiteering at the expense of life, even when protected by law, is not a right.

In March 2000, TAC challenged Pfizer to lower its price for fluconazole to R4.00 per 200mg capsule (still double the generic price). After TAC’s campaign started, Pfizer had announced a donation of fluconazole for cryptococcal meningitis free for all people with HIV/AIDS who could not afford the drug.  Pfizer has made its donation a public relations exercise to disguise profiteering. Daily people are still dying because of conditions that are treatable and preventable with fluconazole – yet, Pfizer has not yet finalized its agreement with the Ministry of Health, neither has it met the Health Minister’s request for a lower price.  On 13 July 2000, TAC announced its Defiance Campaign Against Patent Abuse and AIDS Profiteering at the International AIDS Conference in Durban.

As part of this campaign, TAC organised a visit to Thailand, where the new rules of the WTO are not yet enforced, and where many essential drugs can still be produced as generics.  The aim of this visit was to buy generic fluconazole (a drug that is patented by Pfizer) to improve and prolong the lives of people with HIV/AIDS.   The Thailand visit exposed the profiteering and patent abuse by Pfizer.

What is Fluconazole

Fluconazole is an essential drug for treating some common oppurtunistic infections associated with HIV, particularly Cryptococcal Meningitis and Systemic Thrush. In the private sector, Fluconazole costs approximately R50 (USD$7) per 200mg tablet. It is a simple drug to administer. Usually two pills a day are required. The South African government buys Fluconazole from Pfizer for approximately R29 (USD$4) per tablet. However, it is sold by many generic manufacturers at less than R2 (USD$0.28) per tablet. Pfizer uses its patent to prevent the South African government from importing Fluconazole from generic drug manufacturers.

TAC has launched a campaign to make fluconazole more widely available to the public health sector. At the moment, the only barrier to the widespread use of Fluconazole by people with HIV/AIDS is its high price. TAC has asked Pfizer, the manufacturer of the drug, to either lower its price or give the South African government a voluntary license to distribute it locally. Pfizer responded by offering Fluconazole for free to people with cryptococcal meningitis. TAC welcomed this offer, which has not been implemented yet, but pointed out that Pfizer has not offered anything to people with systemic thrush (the more common of the two diseases) and has declined to implement the offer on a global basis to other poor countries.

Facts About Fluconazole

Fluconazole is better known under the brand name, Diflucan (or Triflucan). The brandname version is produced by Pfizer. It is an "antifungal" used to prevent and treat common HIV-related diseases (opportunistic infections), especially:

• Cryptococcal Meningitis, a fungal infection which results in inflammation of the covering of the brain, commonly causing fevers, acute head-aches and leading to death,
• Coccidiomycosis,
• Systemic candidosis (Systemic Thrush), a fungal infection whose symptoms include white plaques in the oral area and then spreads throughout the body, often accompanied by a burning chest pain upon eating and difficulty with swallowing.

Fluconazole Prices

TAC's Demands

TAC has begun to establish a network of doctors and pharmacists who will prescribe high quality low cost generic medicines that are imported from countries such as Thailand and Brazil.  We ask all doctors to place their patients before patents.

TAC asks Minister Alec Erwin to give the full support of his Ministry and Department to the Defiance Campaign and to the Minister of Health’s efforts to make healthcare accessible and affordable to all people.

TAC asks all civil society organizations to endorse and help develop the Defiance Campaign against Patent Abuse and AIDS Profiteering.

In 1997 there were more than 12 000 deaths related to tuberculosis (TB). Last year more than 120 000 people died as a result of AIDS.   The health crisis facing South Africa is getting worse.
· On October 11th 2000, Business Day reported that: “A funeral parlour in Alexandra buries on average between 50 and 100 people a weekend who are known to have died of AIDS-related sickness.”
· The Educator’s Voice, a paper produced by the South African Democratic Teachers Union (SADTU) reports nearly 400 AIDS-deaths of members aged 20 and 40 between August 1999 and May 2000.

Access to medicines and healthcare services would have saved the lives of many people.  Although there are many factors that prevent equal access to health care the price of medicines is one of the most significant obstacles to healthcare in both the public and private sectors. The medicines that are needed to treat HIV/AIDS fall into two categories

(a) opportunistic infection drugs (drugs that prevent or treat illnesses that occur because of HIV) and
(b) anti-retroviral drugs (drugs that fight HIV directly).

All anti-HIV/AIDS drugs are manufactured by multinational companies under patent and imported into South Africa.  Because the drugs are patented they are very highly priced (see separate table). The result is that only the very rich and people with good medical aid coverage can access these medicines.

This is the reason why, since its inception, the TAC has demanded lower drug prices from multinational companies.  TAC has pressurised the drug companies through pickets, marches, meetings, parliamentary hearings, complaints to the Competition Commission and threatened legal action. Specifically, TAC requested that:

· major pharmaceutical companies such as Glaxo Wellcome, Bristol-Meyers Squibb, Pfizer, Boehringer Ingelheim, Abbott, Roche provide the government with voluntary licences for generic manufacture or import of their anti-HIV/AIDS drugs;

· Glaxo Wellcome, reduce the price of AZT to R180.00 for 100 X 100mg capsules; and that

· Pfizer lowers it price to R4.00 for 200mg capsules of Fluconazole or grants the government a voluntary licence to produce or import generic medicines.

These requests have been spurned. Meanwhile people continue to die. We believe that now is the time to intensify the campaign for access to essential drugs including life-saving HIV/AIDS drugs.  We are calling on civil society organizations in South Africa and everywhere to join TAC’s campaign to defy patent laws. These laws prevent people from enjoying their right to health. They amount to discrimination on the grounds of poverty.  We ask you to publicly endorse the defiance of laws that place profit before people, and condemn millions to death from preventable and treatable illnesses

TAC has begun to establish a network of doctors and pharmacists who will prescribe high quality low cost generic medicines that are imported from countries such as Thailand and Brazil. TAC challenges Pfizer, drug companies and their parent body, the Pharmaceutical Manufacturers Association to take action against us for defying their patent on fluconazole and preparing to defy patents on all HIV/AIDS drugs.

TAC’s Defiance Campaign will show that it is possible to save lives by taking a stand against drug company profiteering.   ENDORSE THE DEFIANCE CAMPAIGN

Comparison of costs

  Patent Abusers and AIDS Profiteers:

• Bristol-Meyers-Squibb  (ddI – didanosine)
• Bristol-Meyers-Squibb (d4T – stavudine)
• Glaxo-Wellcome  (AZT – zidovudine)
• Glaxo-Wellcome  (3TC – lamivudine)
• Glaxo-Wellcome  (AZT/3TC)
• Pfizer   (Fluconazole)
• Boehringer Ingelheim (Nevirapine)

*Lower cost AZT is the result of activism. The AZT price has been reduced from R5.54 in the public sector following TAC demonstations and protests. The same applies to the lower cost of Nevirapine for mtct.

Sources: Thai GPO and Biolab; India CIPLA; South Africa Department of Health; Private Discount Pharmacy. Valid as of 16 October 2000.
These drugs and dosages are used to compare prices rather than proposed treatment regimens.

Important Documentation Regarding the Defiance Campaign

• TAC brings in another generic fluconazole shipment, 12 January 2001
• Biozole tests equivalent to Diflucan, 18 December 2000
• MCC agrees to grant conditional section 21 exemption for generic Fluconazole, 30 November 2000
• TAC press release regarding Pfizer and SA government reaching an agreement, 28 November 2000
• TAC press release demanding section 21 exemption for generic Fluconazole, 19 November, 2000
• TAC announces the Christopher Moraka Defiance Campaign Against Patent Abuse, 17 October, 2000
• Letter sent by TAC to Pfizer on 20 June, 2000
• Press Release by TAC, 20 June, 2000
• Please support the TAC Fluconazole campaign by printing and signing this  letter, and then faxing it to Pfizer. Fax number:  (27) (11) 884 8409
• Letter delivered to William C. Steere Jr., CEO of Pfizer, globally.
• Business Day report on the TAC Fluconazole campaign

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