Inter Press Service - December 26, 2001
Mario Osava

Investment in research on an HIV/AIDS vaccine has been "limited" in comparison to the funding that has gone into producing other pharmaceuticals, and increasing that share must become a top priority of the global health agenda, the assistant coordinator of Brazil's anti-HIV/AIDS programme, Alexandre Granjeiro, told IPS.

In 2002, Brazil will put a greater emphasis on research and development of a vaccine, and on foreign cooperation, especially with Africa, after gaining international recognition this year for its anti-HIV/AIDS programme and new victories for its contention that drug patents can be waived in cases of public health emergencies.

By supplying anti-retroviral drugs to nearly 105,000 HIV/AIDS patients, Brazil has cut mortality among AIDS victims in half, and hospital admissions by 80 percent, since 1996. Due to the programme's marked success, it will be expanded next year.

The goal of health authorities for the year 2002 is to expand coverage in regions where care continues to fall short, like the impoverished north and northeast, said Granjeiro.

The programme will also attempt to improve the quality of services offered to HIV/AIDS patients by providing comprehensive treatment of the diseases that take advantage of the patients' weakened immune systems, with special attention given to women.

Another objective is to improve the early diagnosis system. Most of the 597,000 people living with HIV or full-blown AIDS in Brazil - as estimated by local health authorities - are unaware that they are infected, or only realise it once the symptoms appear, which favours the spread of the disease.

Brazil will also continue standing out in the production of cheap generic versions of anti-retroviral drugs, in order to provide the so-called combination or cocktail therapies free of charge to a steadily growing number of patients at a cost that does not overstress the budget.

The Health Ministry is preparing an even more ambitious plan, the goal of which is to make free drugs available to all patients attended by the public health system's network of hospitals and clinics, in order to favour the poor, who are unable to afford private health care.

The anti-HIV/AIDS programme has brought about a "change in paradigm" that has benefited all of the country's health services, said Eloan Pinheiro, director of the Manguinhos Institute of Pharmaceutical Technology (Far-Manguinhos). The Far-Manguinhos Institute is the main government-owned drug- producing factory, and has links to the Oswaldo Cruz Foundation, a leading Rio de Janeiro biomedical research centre.

Brazil's anti-AIDS programme was a pioneer in incorporating the health reforms designed in the 1980s, aimed at extending health care and prevention to the entire population, with social participation and oversight and a decisive role reserved for non- governmental organisations, said Granjeiro.

Far-Manguinhos plays a key role in Brazil's fight against AIDS, by developing the technological know-how that provides the country with low-cost anti-retroviral drugs - something that has irked the transnational pharmaceutical industry.

The institute already produces, or provides the technology to produce, seven of the 15 medicines used in the anti-retroviral cocktail treatment offered in Brazil.

"Three other drugs are being developed," but the most outstanding aspect of the programme is the fact that the accumulated know-how is leading to innovations, said Pinheiro.

He reported that two "new families of molecules" that could improve treatment - one of them especially useful in cases of resistant viruses - were created and are undergoing trials. If they are found to be effective, the patents will be public in nature, and drug industries in any country will be able to freely produce them.

However, that will take at least five years, because the process is a slow one, and new research and more expensive testing are needed before the new drugs can be approved, he said.

The research and development carried out in Far-Manguinhos puts Brazil's Health Ministry in a strong bargaining position for negotiating a reduction in the prices of pharmaceuticals, even in cases in which patents are respected. Health Minister Jos Serra threatened to ignore several patents, in order to overcome the resistance put up by several laboratories to lowering their prices.

Brazilian law allows "compulsory licensing", which permits the manufacture and use of generic drugs without the agreement of the patent holder in cases of public health emergencies like the AIDS epidemic.

Compulsory licensing was given the green light at the November World Trade Organisation (WTO) ministerial meeting in Doha, the capital of Qatar, which represented a triumph for Brazil's position.

However, compulsory licensing is only possible for countries that have the necessary know-how to produce the drugs in question. In this South American country of 170 million, Far-Manguinhos provides that know-how.

The health minister's threat paved the way for negotiations that led to a 40 to 70 percent reduction in the prices of two anti- retroviral drugs this year. A third anti-AIDS drug, Kaletra, produced by the transnational giant Abbot, is the new target of the same strategy.

Another novel development this year was the announcement by drug giant Glaxo that it would voluntarily license three medicines, said Pinheiro. Far-Manguinhos also plays a key role in the international cooperation strategy of Brazil, which offers technology and training to countries interested in manufacturing their own anti- AIDS drugs.

Angola, for example, will expand its production thanks to the construction of a pharmaceutical factory built with aid from Brazil. This country has also provided assistance to other parts of Africa, especially Portuguese-speaking nations.

Brazil is intensifying another kind of cooperation with India, which does yet recognise patents, and thus produces generic medicines and many chemical substances at a low cost.

The association with India could also give a boost to Brazil's efforts in seeking a similar bilateral agreement with China, said Pinheiro. (END/IPS/LA/HE/TRA-SO SW/MO/DM/01)
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