Nairobi: AIDS patients line up at dawn outside a small medical centre in one of Kenya’s teeming slums.
Dr Ivy Mwangi has 1,800 HIV sufferers on her books, but as the winding queue outside steadily grows, her thoughts are on a court case more than 5,000 km away in India.
The proceedings pit Swiss pharmaceutical giant Novartis AG against an Indian patent system that it says stifles innovation.
Mwangi fears it could end up costing many, many lives.
“Even with innovation and the development of new drugs, if this case goes through they won’t be available to millions who need HIV treatment in the developing world,” she said.
At first glance, the link is obscure. Novartis does not actually make AIDS medicines. The drug under discussion in a Chennai courtroom, Glivec, is a treatment for rare cancers.
But the trial has become a flashpoint in a long-running battle between “big pharma” and humanitarian campaigners who argue manufacturers are putting patents ahead of patients.
The AIDS virus infects around 40 million people globally, two-thirds of them in sub-Saharan Africa. Most, like Mwangi’s patients in Mathare slum, scrape a living in abject poverty.
Health campaigners fear stronger patent laws enacted by India in 2005, which Novartis is trying to shore up in the case of Glivec, will jeopardise India’s role as a source of cheap generic medicines for the most needy.
Medical aid agency Medecins Sans Frontieres estimates over half of AIDS drugs used in poor countries come from India. If Novartis wins its case, more medicines will end up being patented, making it very difficult for Indian firms to manufacture cheap copies, it says.
Stung by criticism from campaign groups, Novartis insists tighter intellectual property laws will, in fact, ensure future investment in new medicines by rewarding research.
“I’m convinced and I’m a scientist that patents save lives, because without patents you cannot discover and develop new drugs and get them to patients,” Paul Herrling, Novartis head of corporate research, said in an interview in London.
The company points out that safeguards already exist in international trade agreements. These protect access to essential medicines by allowing for the export of drugs which are produced under compulsory licenses, issued for public health reasons.
Many companies also run access programmes, which offer affordable brand-name equivalents to cheap generics.
Still, the row has uncomfortable reverberations for the global drugs industry, which is often accused of not doing enough to improve the health of the world’s poorest people.
Five years ago, 39 companies, including Novartis, took the South African government to court in an effort to defeat new legislation in that country designed to bring down drug prices.
That episode ended in a humiliating climbdown and a public relations bloody nose that industry does not want to repeat.
This time, Novartis insists the situation is different.
Herrling said Novartis simply wants patent protection in markets where patients are able to pay -- including India’s newly rich middle classes -- and will still make Glivec available for free to the poor in India.
Glivec has already been granted a patent in nearly 40 other countries, including China, he noted.
But Mwangi, speaking to Reuters as security guards ushered children and mothers carrying babies through the gates into her Blue House clinic, fears industry’s promised safeguards fall dismally short.
At the moment, all her hundreds of patients infected with the HIV virus are treated with generic medicines made in India.
“The access programmes and safeguards in place don’t allow anywhere near the number of drugs we need right now,” she said.
Seven years ago, Mwangi said, anti-retroviral drugs for AIDS victims cost about $10,000 per person per year. With the availability of generics, that has now fallen to around $70.
“Anything that’s going to stop any kind of access is a serious problem,” she said. “The only reason we reach tens of thousands in this region with these life-saving drugs is because of the availability of generics coming straight out of India.”
As pressure has grown on Novartis, Archbishop Desmond Tutu added his signature last month to a global petition of some 300,000 names calling on the Swiss drugmaker to drop its case.
Others calling on Novartis to change tack include former Swiss president Ruth Dreifuss; Stephen Lewis, former UN special envoy for HIV/AIDS in Africa and Michel Kazatchkine, new head of Global Fund to fight AIDS, tuberculosis and malaria.