With the "Aids time bomb'' widely perceived as having been brought under control in the industrialised world, new figures show that despite strenuous efforts in many African countries, the Human Immunodeficiency Virus (HIV) is beginning to exact its deadly toll in the continent. At least 30 million Africans are expected to die from Aids in the next 20 years: it will kill more people than war or famine, it will undermine young democracies and put millions of orphans on the streets.
Among Africans whose nutritional intake is poor, Acquired Immune Deficiency Syndrome (Aids) kills quickly. Among the uneducated and superstitious, where the status of women is low, Aids spreads unhindered and sufferers are thrown out by their families or have their homes burnt down. Only a tiny elite can afford drugs such as AZT, 3TC and protease inhibitors, which can make Aids a chronic disease rather than a death sentence.
Yet drug companies - Britain's Glaxo Wellcome foremost among them because it manufactures the costly AZT and 3TC - are fighting tooth and nail, with the support of the United States, to prevent developing countries from importing cheap substitutes for these high-profile treatments or from manufacturing their own generic equivalents.
The benefits of these drugs in stopping or slowing the transmission of Aids in Africa is undoubted. But the human toll of not having access to them is only now being appreciated. AZT, taken in a one-off, month-long course at the end of pregnancy, has proved enormously efficient in reducing mother-to-child transmission of HIV.
"If 20 per cent of Britain's young people were about to die from an illness, I think everything would be done to reduce infection rates. There would not be talk of protecting intellectual property rights or patents," said James Love of the Consumer Project on Technology, a lobby group based in Washington, DC, and founded by the US consumer rights pioneer Ralph Nader. "But because we are dealing with Africa, the powers that be treat this as a trade issue, raising it in the same breath as the dumping of steel on the US market."
In South Africa, where it is estimated that 1,500 people are currently being infected with HIV every day and a quarter of the population, in some areas, carries the virus, the authorities are only just beginning to wake up to the devastating syndrome.
But in doing so, the government of President Thabo Mbeki, which benefits from the sympathy of the US Congressional black caucus, has struck a blow that could benefit the entire developing world and, consequently, the 90 per cent of the world's Aids sufferers who live there.
In 1997, South Africa passed legislation aimed at allowing the government to do whatever is necessary to secure cheap, effective drugs, not merely for fighting Aids. In essence, the government gave itself the right to bypass the West's powerful pharmaceutical companies, either by shopping around or manufacturing cheaper drugs. The legislation, known as the Medicines and Related Substances Control Amendment Act, in many respects merely brought South Africa into line with countries, like Britain, that import cheap substitutes of drugs from countries like Spain and Portugal.
Mark Heywood of the South African Aids Law Project said: "What was revolutionary was for a developing country to stand up to international drug companies. The old [apartheid] government in South Africa never controlled the pharmaceutical industry and, as a result, this country became one of the most highly profitable in the world for them.''
The industry responded by claiming that South Africa's move threatened its patents and, consequently, the revenues it relies on for funding research. It launched a two-pronged attack, going first to the US government, claiming violation by Mr Mbeki's government of World Trade Organisation rules, and then to the South African Constitutional Court.
It is a tactic that has worked before, in Thailand, where Aids is the leading cause of death and which sells 30 per cent of its exports to the US. Some brief finger-wagging by Washington last year led Bangkok to scrap provisions for parallel imports and "compulsory licensing" - the practice that allows local companies to produce their own versions of drugs.
South Africa has not yet won the war. "The [US] vice-president, Al Gore, who is due to meet Mr Mbeki in the US in a fortnight, has indicated that US trade officials will give way to South Africa. It is after all, a country which benefits from a sympathetic ear in Washington," said Mr Love.
But even if Mr Mbeki gets Mr Gore's blessing, the South African government still has to tackle the legal challenge in the Constitutional Court from 41 drug companies which argue that the 1997 Act - still not in force because of the court case - offers the "potential for abrogation" of intellectual property.
The drug companies prefer to take a charitable approach to Africa. Nancy Pekarek, the UK communications manager for Glaxo Wellcome, one of the companies challenging the South African legislation, said: "Clearly, in Africa, we are dealing with a desperate situation. But if you undercut patent protection, you undermine the industry and its ability to produce new medicines," she said.
Rather than allow developing countries like South Africa to go it alone, manufacture cheap drugs and shop around for bargains, Glaxo Wellcome and other companies maintain their market share while at the same time offering generous discounts or free drug trials.
To Ms Pekarek, it is constructive partnership. "We have offered AZT to the South African health service at a 70 per cent discount for an unlimited time and with no obligation linked to the 2006 expiry of AZT's patent. In developing countries we are working with UNAids in programmes to reduce mother-to-child transmission. We also have a programme centred on Aids education."
Similarly, in May this year, another drug company, Bristol-Myers Squibb, launched a $100m HIV/Aids research programme for five Southern African countries. But South Africa turned it down, arguing that it was a guinea- pig programme. It also took a sceptical view of the Glaxo Wellcome offer, saying that, even with the discount, the cost of the AZT would be prohibitive.
Glaxo Wellcome refuses to disclose the cost of manufacturing AZT because it is "competitive information". Mr Heywood of the South African Aids Law Project said: "We are short of information but we know that Cipla, an Indian company, produces a generic equivalent of AZT which might be an option for South Africa. The prohibitive prices of drugs in South Africa means the government does not have an essential drug list for HIV/Aids, and that is an untenable situation."
But he agrees with the government and the drug companies that the answer, for Africa, is not a massive influx of cheap drugs, from whatever source. "There will always be the problem, where you have a weak medical infrastructure, little follow-up and people who are not eating properly, that it is possible to do more harm than good if you just hand out doses of 10 or 12 pills a day and leave people to it."Reuse content