Inter Press Service - December 1, 2000
Ranjit Deuraj

Pharmaceutical drugs are high on the list of contraband goods regularly smuggled to neighbouring Pakistan, but most ordinary Indians are so poor that they cannot afford them.

"India produces and sells drugs at the lowest prices anywhere in the world but the levels of poverty are such that less than 25 percent of India's one billion people can afford medicines," says Mira Shiva, leading public health analyst.

"Liberalisation has only widened the gap," she adds.

Drug prices in this country have been soaring steadily since India passed legislation to comply with Trade Related Intellectual Property Rights (TRIPS) rules last year.

"India is still battling vector and water-borne diseases but no pharmaceutical company is interested in producing or marketing drugs against these because of the low profit margins while there is competition for diseases such as diabetes and heart problems which mostly affect the affluent," Shiva points out.

The leading U.S. economist, Jeffrey Sachs, who toured India in April as chairman of the World Health Organisation's (WHOs) 'Commission on Macroeconomics and Health', reported a tremendous unmet health demand in this country.

"It is a paradox that while democracy is more likely to allow poor people better access to health, many dictatorships were doing far better than India in health delivery -- too many people are spending far more than they can afford on health care," he noted in his report.

In contrast, India's four-billion dollar pharmaceutical industry is enjoying booming health as it produces and aggressively markets a range of 'life-style' medications, 'mood elevators', vitamins, tonics and other over-the-counter preparations.

Shiva said she was particularly concerned about what all this means for women's health in the country. "Seventy five percent of Indian women are anaemic and which multinational is going to be concerned with them?" she asks

"There is now a concerted attempt to impose the U.S. system over the whole world although different countries have different needs. For example, it may be fine for a woman to be infertile in the U.S. but here here she could be thrown out with the garbage for it," Shiva said.

Shiva's fears are not without basis. A few months ago, despite years of campaigning by women's rights groups against the contraceptive method, Indian courts allowed a trans-national corporation (TNC) to market an injectable contraceptive.

"The existing health infrastructure is simply not capable of providing the kind of counselling and follow-up that is mandatory for long- acting contraceptives," says C. Satyamala, a leading women's health researcher.

Not only did the government permit the marketing of the injectable contraceptive without a public debate on the controversial method, several state governments made this part of their birth control programmes.

"What is really galling is that the government actually left the job of safety certification to the concerned drug company, when it has its own fine research institutions which are capable of doing the job," says N.B. Sarojini of 'SAMA', a leading women's rights group.

"Naturally, the company cleared its own product," she says.

While economic liberalisation has put many ordinary drugs out of the reach of the poor, the pharmaceutical industry in India, far from collapsing as predicted, has been doing particularly well through favourable government policies.

The incomes of 11 leading drug companies showed a phenomenal 23 percent increase last year.

According to a business analysis of the industry, the profits of two companies, 'Rhone Poulenc' and 'Novartis' grew by 134 percent and 95 percent respectively as a result of price escalations on drugs, which were 'decontrolled' by the government.

The industry is now clamouring for more drugs to be put on the decontrolled list.

Rather than worry about existing price controls at home, the Indian pharmaceutical industry is now trying to earn profits in the international market by investing in research and development and falling in line with international practices.

Others are entering into licensing deals with TNCs to manufacture and market life-style drugs, including 'hormone replacement therapy' which are in increasing demand by the affluent.

Even as fears are being expressed that ordinary people in this country cannot afford treatment against emerging diseases such as HIV/AIDS, several Indian companies are doing a roaring business exporting such medication.

Says Homi Khusrokhan, President of the Organisation of Pharmaceutical Producers of India: "Even if we can manufacture anti-retrovirals at prices affordable by ordinary Indians, the question remains as to who is going to take care of delivery, maintenance and follow-up of these drugs which need utmost care in handling." (END/IPS/ap-he-dv/rdr/mu/00).
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