Make Vital Medicines Available for Poor People: Dominican Republic | Pharmaceutical Drug | Patent

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The high price of medicines in the Dominican Republic is costing poor people their lives. Mike Lanchin reports
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  Dominican Republic Make vital medicinesavailable for poor people CUT THECOST    K  a   t  e   l   i  n  a   A  n  e  c  a  Dominican Republic Like many other familiesin the poor district of  Puerta Plata  ,Belkis andher three daughters facea bleak future withoutaffordable medicines Condemned to death,because she is poor  It has been only two weeks since Belkis Perez summoned the courage to tell hereldest children about the AIDS virus that isdestroying her life and the lives of two of her young infants. Having kept her secret for almost three years, worried that herchildren would be picked on at school, shestill doesn’t know if she did the right thing.“It was one afternoon when I felt sodown, I just took the decision. I wantedthem to know. I thought they were ready,”she says, tears beginning to flow down hercheeks. Her lorry-driving husband chastisedher for the impulsive decision but, on beingtold the news, her eldest child Jessica, eight,simply looked up at her mother and saidquietly: “I think I already knew. Yania (who is two years old) is always getting sick, and you take medicine all the time. I knew something was wrong.” Later she told hermother that when she grows up she wantsto be a doctor and work with AIDS patients.Unable to afford costly life-saving anti-retroviral drugs, Belkis, who is only 31 yearsold, fears she may never live to see that day.“I can’t really see a future, not for me, notfor my children. But we will just keep onstruggling.” Belkis and her second child, Jennifer,seven, were diagnosed HIV-positive three years ago when Belkis was pregnant withher third daughter, Yania. She did notreceive the simple medication that wouldhave prevented the virus jumping to herchild, so Yania was also born with AIDS.Since then, a large slice of the family’s budget goes on buying medicines, since thelittle girl is often prone to sickness, withamoebas, colds, or flu. When I visited Belkisand her three children, she complained of stomach pains, but had not gone to thedoctor, concerned about the cost of themedicines that she might be prescribed.  The family home is a cramped, 20 squaremetre tin shack, part of an illegal settlement just outside  Puerto Plata , or “Silver Port”, oneof the Dominican Republic’s major touristattractions. It is also top of the national AIDS’ league. No one has running waterhere, nor indoor plumbing. People have to buy water for washing from a truck twice a week. Fifteen pesos ($0.91) buy enough to fill a large tin drum. Drinking water has to be hauled up from a small store twenty minutes away. The high price ofmedicines in the Dominican Republic iscosting poor people their lives.Mike Lanchin reports    K  a   t  e   l   i  n  a   A  n  e  c  a  Specialised medicines that will save lives are out ofthegovernments reach Poverty and sickness go side by side in theDominican Republic, where tourism, andfactories in the free trade zone have boostedthe economy to an average annual growthrate of around 7%. The government is now spending more on health than in previous years (9.01% of the budget in 1998 compared with 8.4% in 1993). But expensive specialisedimported medicines, like the cocktail of anti-retroviral drugs that would change thelives of Belkis and her girls, are out of the Treasury’s reach. “We just cannot budget for them,” says Dr. Raul Benou, head of the government’s Essential MedicinesProgramme, Promese. A monthly course of the drugs can cost up to 20,000 pesos($1,200). The minimum monthly wage varies between 1,800 pesos ($109) and 1,600 pesos($97.50). While the governmental SocialSecurity Institute provides some anti-retroviral drugs, only 6% of the populationof working age are affiliated to the Institute– and you have to be in full time work toqualify. But with one quarter of the eightmillion population officially classified aspoor, it is not just impoverished AIDS victims who are unable to meet theirmedical fees. According to some studies, as many as one in five Dominicans cannotafford basic medical care or commonly prescribed medicines. In recent years, the quest by governmentand local industry in many developingcountries to assure cheap, safe medicines for their population has taken on a new dimension. It has now spilt over into aconflict around patent rights on essentialand specialised medicines. On the one hand,developing nations and their national pharmaceutical industries – which areincreasingly able to produce more cheapgeneric versions of expensive importedmedicines – are lining up against the richnations and the powerful multinationaldrug companies, on the other. It has becomea struggle for control over lucrative markets,principles of patenting and inventions, butalso a battle over the right of poor people toaccess medicines. In the battle to control theproduction ofmedicines,poor people will be left dying on the sidelines  The latest frontline in this battle is theDominican Republic, where an undeclaredcommercial war has broken out with the US pharmaceutical firms, backed by the US Trade Representative, threatening tradesanctions if the government does notprotect them against local competitors. “This is a fight between David and Goliath.Some of the multinational companies weare facing are bigger than the DominicanRepublic itself,” says Ho-Chy Vega, ExecutiveDirector of the Dominican Pharmaceutical Trade Association,  Infadomi . Dominican Republic         > 3 Families in Puerta Plata  live in cramped,unsanitary conditions;their houses little morethan tin shacks    K  a   t  e   l   i  n  a   A  n  e  c  a  Dominican Republic > 4 Government-runcommunity pharmacies,or boticas  ,like this onein Los Guandules,provide cheapmedicines for poor families  The root of this conflict lies in global rules on patenting called Trade RelatedIntellectual Property Rights, or TRIPs.Subscribed to by more than one hundrednations at the World Trade Organisation six years ago, the TRIPs accords standardisedglobal patent rules. Although they weretermed a set of “minimum standards”,  TRIPs increased the scope, length and geo-graphical coverage of patents. Under theagreement all countries must provide 20 years protection for patents – not just forproducts and processes in all areas of technology. In the case of medicines – areasoften excluded from patent laws in thosefew countries where such legislation already existed prior to the TRIPs accords – it wasargued that the agreements would allow multinational drug companies to recoupand protect their investments made inresearching and developing new drugs. By patenting each new medicine in eachcountry, the argument went, the manufac-turers guarantee that local pharmaceuticalfirms will not copy their product and “steal”their invention. That way research anddevelopment costs can be recuperated andfurther investigation will be stimulated.“Although we have to provide someprotection for the local medicine industry,there has to be some way of compensatingthe inventors and the capital they haveinvested,” says José Maria Carbal, ExecutiveDirector of the Dominican-British Chamberof Commerce, and a lawyer for several inter-national pharmaceutical companies. New patent rules could force local pharmaceutical companiesout ofthe market  The Dominican Republic had until the year2000 to incorporate the new patent rulesinto its national law. But, like otherdeveloping nations with an expandingdomestic industry producing a wide rangeof cheaper generic medicines, the intro-duction of TRIPs in the Dominican Republichas had a rough ride. Initially, many of those working in the health sector wereunsure of what TRIPs really meant. “To talk about TRIPs some years ago was totally unknown, it was something from anotherplanet to most of us,” said Ho-Chy Vega. Butsoon, doctors, researchers and local pharma-ceutical companies began worrying thattighter patent rules could mean lesscompetition in the domestic market, forcingout local companies and eventually leadingto higher prices of not just more commonmedicines presently in use, but also new drugs. “Since there are active ingredients being used for which the patent will have to be paid... this will mean a price increase formedicines,” says Dr. José Matos, NationalDirector of sexual health and reproductionfor the government Health Secretariat. “Theknock-on effect of having to pay for a patentmeans costs are passed onto the consumers.”  According to research commissioned by Oxfam GB in November 2000, a mere 10%contraction of the local market, wouldresult in a rise in the price of the most five    K  a   t  e   l   i  n  a   A  n  e  c  a
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