By David Usborne in New York
Published: 10 May 2007
The former US president Bill Clinton has unveiled an ambitious programme to provide generic versions of Aids drugs for patients in developing countries at greatly reduced prices.
The initiative is a challenge to many US-based manufacturers who have balked at relaxing patent protections and cutting prices for poorer countries.
Mr Clinton has also endorsed decisions by Brazil and Thailand to override patents on the drugs and to pursue the manufacture of generic versions after negotiations with the manufacturers failed. "I strongly support the position of the governments of Thailand and Brazil and their decision after futile negotiations to break these patents," he said.
In a direct attack on American drugs companies, he said: "No company will live or die because of high price premiums for Aids drugs in middle-income countries, but patients may."
Mr Clinton's foundation has been working since 2002 to broker deals to increase the availability of Aids medicines. Approximately 750,000 people are believed to have had access to them for the first time through his work. Aids/HIV affects some 39 million people, and almost 95 per cent are in developing countries.
This time, his foundation has negotiated with two manufacturers in India - Cipla and Matrix Laboratories - to produce generic versions of second-line medicines for when patients develop resistance to the treatment they are originally prescribed, as well as one-tablet-a-day first-line drugs that are less toxic.
Paying for second-line drugs is threatening to overwhelm the healthcare budgets of many governments as more long-term patients begin to develop resistance. They are generally 10-times more expensive. "That's a very great strain on countries' healthcare budgets," Mr Clinton said.
Helping to buy the second-line drugs from the companies will be a group of countries that have together raised $100m (£50m), led by France. The French ambassador to the US joined Mr Clinton for the announcement.
Under the programme, the once-daily first-line pills will become available for about $1 a day. They will combine the drugs Tenofovir, Lamivudine and Efavirenz. "This drug represents the best chance that science has to offer," Mr Clinton said. Money for the drugs will come largely from donor groups including the Global Fund to Fight Aids, Tuberculosis and Malaria.
The initiative means that the second-line drugs will be made available with average savings over current prices of about 25 per cent for low-income countries and 50 per cent in middle-income countries.
That Mr Clinton is willing to take the side of foreign governments against US companies is troubling news for the big American manufacturers. He said that the US manufacturer Abbott had "been almost alone in its hardline position here over what I consider to be a life and death matter".
The life-saving effect of antiretrovirals
* Drugs have transformed Aids from a killer disease to a chronic condition that people can live with
* Those lucky enough to have access to highly active antiretroviral therapy (HAART) can look forward to a near normal lifespan. But that takes careful monitoring and a healthy lifestyle to boost the immune system and ward off infection
* In developing countries, new and better drugs in simpler combinations have brought new hope. Combined with quicker, simpler diagnostic tests they are bringing treatment to more people and improving compliance, which is crucial to preventing drug resistance
* Increasing access to treatment is the key to successful prevention. Once drugs are available, people have a reason to go and get tested and can then be counselled to avoid further spread.