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DS Global Forum
Gerald R Ford School of Public Policy ** Integrated Policy Exercise ** January 2003
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A Gerald R Ford School of Public Policy ** Integrated Policy Exercise ** January 2003
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China Now Set to Make Copies of AIDS Drugs
September 7, 2002 By ELISABETH ROSENTHAL
BEIJING, Sept. 6 - China took significant steps today to face up to its growing H.I.V.-AIDS epidemic, raising its estimate of the number infected to one million and saying it would manufacture a full complement of AIDS drugs if Western patent holders did not lower prices within the next few months.
It was a striking reversal by Chinese health officials, who previously insisted that as a new member of the World Trade Organization, China had to be especially vigilant about respecting patents and would not permit the use of generic AIDS drugs.
But even as the government was articulating its new sense of urgency and commitment to action, the wife of one of the country's most outspoken advocate for AIDS patients, Dr. Wan Yanhai, who disappeared in Beijing two weeks ago, said State Security Bureau officials had acknowledged that he was in custody.
In their announcements today, health officials for the first time publicly asked for international help with the country's AIDS problem, which they had insisted they could handle on their own.
"We need international organizations to help us in this battle to control AIDS," said Qi Xiaoqiu, director general of the Department of Disease Control at China's Health Ministry. "We need more capital support and expertise."
It is unclear exactly why the government decided to take the plunge and talk more candidly, but China is in the process of submitting a $90 million grant application to the Global Fund for AIDS, Tuberculosis and Malaria, so it desperately needs to show some good-faith efforts on AIDS to help its application. That money is in part earmarked for dealing with AIDS in rural China, including "cocktail" therapy for AIDS sufferers, said someone who has seen an early draft of the proposal.
China's first application to the fund, seeking money for AIDS prevention and treatment among drug addicts, was rejected earlier this year partly because of the government's closed attitude about the problem, leading to unreliable statistics and other shortcomings.
Mr. Qi said that "drugs and other medicine are especially needed in places where there is a large concentration" of AIDS patients. He was referring to poor villages in Henan Province in central China, where many farmers contracted H.I.V., the virus that causes AIDS, through unsanitary practices by blood-buying operations.
Last week, China licensed its first domestically produced anti-AIDS medication, a version of the drug AZT. Mr. Qi said a shipment had already gone off to Henan, where it was being used by patients, although he did not say how many had access to the drug.
To advocates for AIDS patients here, poor access to medicines has been particularly galling, since China has a strong pharmaceutical manufacturing industry - one that is known, in fact, for its expertise in Western medicine.
One company in Shanghai, Desano, already legally makes the raw ingredients for many of the pills in the so-called AIDS cocktail, which it ships overseas to be transformed into generic pills. Aside from AZT, generic AIDS drugs are not available in China.
Dr. Wan, the AIDS activist who has been detained by security officials, posted a classified document prepared by the Henan Health Bureau on the Internet in late August, showing that officials there were well aware of a serious H.I.V. problem as early at 1995.
Selling blood was officially banned in that year, although the practice continued for several years in a number of villages, people from Henan say.
Dr. Wan, who was followed and harassed by security officials all summer, disappeared from a Beijing street on Aug. 24. He founded the AIDS Action Project, a small organization that ran a Web site and conducted AIDS advocacy work in China and was to receive a prestigious Canadian human rights award this month. On Thursday, officials of the State Security Bureau indicated to one of his colleagues that he was being held for disclosing the secret report, his wife reported.
"Finally someone admits that Wan is in their hand," his wife, Su Zhaosheng, who is studying in Los Angeles, wrote in an e-mail message.
The main focus of today's news conference was on the AIDS crisis among farmers in central China and on the need to provide patients with affordable drugs, two hard-to-solve problems that health officials had previously largely avoided addressing.
At the news conference, Mr. Qi emphasized that China was taking the epidemic seriously, calling the situation "very dangerous." He said the Communist Party's Central Committee had commissioned a special study of the epidemic, the first time it has lavished that kind of attention on a disease.
He added that the government had already earmarked 80 million yuan, about $10 million, to be directed toward Henan to combat AIDS.
But perhaps the biggest breakthrough was Mr. Qi's indication that China would consider bypassing patents to produce its own cheaper versions of AIDS drugs if the major Western pharmaceutical manufacturers did not reduce prices by the end of the year.
Until now China vehemently rejected that route, trying instead to get cheaper drugs by negotiating discounts from foreign manufacturers.
China maintained that position even as many other developing countries - including Thailand, India and Brazil - have started to produce or buy generic versions of the drugs. That has made effective treatment affordable for patients in those countries and has lengthened countless lives.
Earlier this year, the World Trade Organization basically granted countries the right to bypass drug patents if the medicines were declared essential to combating a national health emergency and were otherwise unaffordable.
To date, China's negotiations with drug companies have yielded only piecemeal results, bringing the price of the cocktail of expensive Western medicines used to treat AIDS from an exorbitant $8,000 a year in China to a merely unaffordable $3,000 to $4,000 - not including the testing that taking such drugs involves. The same medicines, in generic form, cost about $300 in Thailand.
As a result, Mr. Qi acknowledged, only about 100 patients in China are now on the AIDS cocktail, and most of those patients' drugs have been donated by foreign groups.
China's previous estimate of the number of people in the nation with H.I.V. was 850,000, but many experts say that even today's estimate of one million is very low.
"We are ready to negotiate with the pharmaceutical companies," Mr. Qi said, "but if affordable prices cannot be reached," they would take the other route." Asked how much longer the Chinese were willing to negotiate, he said, "Until the end of this year."
Anger over the lack of drugs to treat the epidemic has been generally mounting among China's experts.
"We need a group of drugs to treat patients now," Dr. Shao Yiming, one of China's leading AIDS specialists, said recently on China Central Television. "It's a dead end to wait for patents to expire. It's up to our government, under the appropriate circumstances, to invoke the W.T.O. clauses."
If Chinese manufacturers start producing generic medicines, it still remains unclear how much benefit patients will reap, since all of the manufacturers hope to profit from such a venture.
A spokesman for the Shenyang Dongbei Pharmaceutical Company, which is newly licensed to make AZT, refused to say how much the newly marketed generic version is selling for, calling that a "commercial secret."
At the news conference today, Mr. Qi also discussed in greater detail than ever before the rural AIDS epidemic that comes from practices used for buying blood.
Based on government statistics, he estimated that in one severely affected part of Henan, Shangcai County, about 10,000 people had contracted AIDS and 1,000 had died.
Poor farmers in central China sold their blood for about $5 a bag. The government-affiliated blood stations often harvested the fraction of blood used to make medicines and then pooled the rest of the blood and reinjected it into the sellers. This practice resulted in widespread H.I.V. infection among those who sold their blood.
But as before, the details provided are at best sketchy, and government estimates still seemed well below those suggested by the few independent experts who have quietly worked in the area. Those experts say that a majority of adults in some villages now carry H.I.V. and that more than a million people in the province may well be infected.
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