Los Angeles Times - August 19, 2009
Tom Hamburger, Reporting from Washington

In an unexpected spillover from the healthcare battle, activists in Washington, and Thailand and other developing countries are accusing the Obama administration of endangering access to affordable drugs to fight AIDS and other epidemic diseases.

And they say the problem may lie in the administration's reluctance to confront the giant pharmaceutical companies at a time when the companies are crucial allies in President Obama's struggle to revamp the U.S. healthcare system.

Organizations such as Doctors without Borders and OxFam International long accused U.S.-based pharmaceutical companies and the Bush administration of impeding their efforts to make generic drugs available to fight major diseases in poor countries. They say they expected Obama to take a less restrictive approach.

Now, many say those expectations have been disappointed.

"We had high hopes for change," says Rohit Malpani, a policy advisor to Oxfam, an international advocacy organization that opposed Bush-era trade policies as detrimental to public health.

"It appears that Obama appointees are continuing to work from the playbook of the last administration," he said.

Obama administration officials reject the claims of Malpani and half a dozen other health advocates interviewed by the Times/Tribune in the last two weeks, saying that the president remains committed to the international health goals he embraced during the campaign.

The administration has already initiated some changes, officials say.

The issue is expected to be discussed today at a meeting of the advocacy community and Obama administration officials from State Department, the U.S. trade representative and the Commerce Department.

Industry leaders support many programs for providing lower-cost drugs and note that they have contributed billions of dollars in medicines to poor countries.

But they say they press for aggressive enforcement of rules against copying their products so as to assure the quality and safety of drugs, as well as assuring economic incentives for developing new medicines.

Critics were especially unhappy with trade representative reports released this spring on intellectual property enforcement and with negotiations in Geneva over a treaty to set drug research and funding priorities to fight disease around the world.

To James Love, who will attend today's meeting and is an advocate for the distribution of lower-cost medicines to combat common diseases worldwide, the Obama administration made concessions that fit what he called an emerging pattern of cozying up to the drug industry.

"The substance of these reports read as if they were written by a lobbyist for the pharmaceutical industry," Love says. "It is appalling, coming as it does from the Obama White House."

The issue is enmeshed in long-standing, highly technical issues of trade, patent and intellectual property rules, but the end result can have serious consequences for ordinary victims of disease in less developed countries.

In general, pharmaceutical companies that develop new drugs are protected by patents that bar other companies from producing cheaper copies of the medications.

International treaties grant governments the right to over-ride these barriers when confronted with health emergencies. That exemption has been a key to obtaining generic copies of crucially needed drugs in Thailand and other countries, the activists say.

Governments in these countries are highly vulnerable to U.S. pressure, however, and activists say that tough talk from Washington about the importance of honoring drug patents can cause governments in the developing world to effectively curb access to lower-cost medicines.

In effect, that's what activists say the Obama administration has been doing, as the Bush administration did before it.

Every year, for instance, the U.S. trade representative produces a report on the state of intellectual property protection around the world. The report, required by an act of Congress and reviewed by the White House, can be couched in mind-numbingly technical language.

But seemingly unexceptionable sections placing Thailand on a "priority watch list" for poor patent enforcement and others urging its government to address "public health challenges while maintaining a stable patent system." can discourage poor countries from seeking lower-cost drugs, activists say.

Administration officials dispute the complaints, pointing out that the language in administration trade reports has been softened on drug policy issues, compared with reports issued during the Bush era.

"We approach our trading partners recognizing the public health needs in developing and least developed countries as well as promoting a thriving global environment for innovation. We don't see these as mutually exclusive," said Debbie Mesloh, a deputy assistant U.S. trade representative.

Administration officials point out that the most recent report focuses mostly on Thailand's breach of counterfeiting and digital piracy rules.

There is, however, a section urging Thailand "to consider ways of addressing its public health challenges while maintaining a stable patent system that promotes investment, research and innovation."

Activists say that language threatens to shake Thailand's continued support for drug initiatives that are considered models for fighting epidemics in the developing world.

"This policy got real results," said Kannikar Kijtiwatchakul, a university researcher in Bangkok who works with Doctors without Borders, the international medical relief organization.

She said that the number of Thai AIDS victims using a promising anti-retroviral drug trebled to more than 50,000 after the government made a cheaper generic version available.

Thailand's actions brought pressure from pharmaceutical companies and the Bush administration, which complained it undermined the international patent system.

"We had hoped for change," Kijtiwatchakul said of the Obama administration, "because Mr. Obama . . . expressed support for the use of generic drugs. However, we now view the Obama administration as no different from Bush. Access to treatment and essential medicines is not considered a high priority."

In Guatemala, international activists say they are concerned that access to life-saving AIDS drugs is becoming more limited. In the past, they say, these drugs were available through a government initiative to buy them at a reduced price from international organizations, a move opposed by drug companies and the U.S.

Recently, the government has begun to pay market price for AIDS drugs, they said.

"There really needs to be a course correction by the U.S," said Ellen R. Shaffer, a co-director of The Center for Policy Analysis, an international health advocacy organization that has been studying the situation in Guatemala.

She acknowledged that the Obama administration reduced criticism of the Guatemalan government in the latest report. But, she said, "that signal evidently hasn't been strong enough to stop the backwards slide in Guatemala at the expense of people's health. In effect, the Obama administration so far is stuck in the status quo."

tom.hamburger@latimes.com
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LT090803

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