Global Policy Forum

By Mamphela Ramphele and Nicholas Stern

Money is vital in combating the global AIDS epidemic, but diplomacy is key as well. Many lives hang in the balance as the world's trade ministers debate allowing poor countries continued access to cheap generic drugs. Last month, officials left a meeting in Tokyo without resolving the issue, and the stalemate has continued at talks in Geneva. President Bush's request for an additional $10 billion over the next five years to fight AIDS in Africa is great news, but the money will go much farther if poor countries can get affordable drugs.

This is the problem: Patent rules adopted by the World Trade Organization in 1996 and set to come into effect gradually over the next decade will limit trade of generic drugs that compete with patented products.

Under the new laws, poor countries that are able to manufacture the generics themselves will continue to be able to market them domestically. However, these tend to be the larger and (relatively) better-off states like Brazil, India and Thailand. Countries that can't manufacturing their own - typically the poorest and most disease-ravaged places - could be barred from importing generic versions of patented drugs. Thus a poor person in Brazil would legally be able to obtain treatment with generic versions of a new AIDS drug, while a much poorer person in Bolivia, Cambodia or Uganda would not.

One day's supply of patented antiretrovirals for an AIDS patient typically costs $30. This is of course out of the question for the nearly three billion people who live on less than $2 a day. Generics are usually much cheaper than patented drugs, and the threat of competition has reduced prices of both in some places. Hetero, a manufacturer of generics in India, offers H.I.V. drugs for just 55 cents a day.

The United States is right to point out that pharmaceutical companies have a legitimate interest in protecting their patents. Because patents give temporary monopolies on new drugs, they are the main incentives for new research. However, allowing these very poor countries to import generics would hardly erode incentives for Western conglomerates.

These poor states form only a tiny portion - likely less than 1 percent - of the global pharmaceuticals market. They are so insignificant to the bottom line that some companies, acting out of compassion, are selling their H.I.V. drugs in such countries at or near the cost of production; some important drugs are even being provided free.

America also has a reasonable concern that generics produced in developing countries could be smuggled into rich countries, undermining patent protection in the drug companies' most lucrative markets. But there are other ways to guard against illegal trade, such as prohibiting generic manufacturers from mimicking the packaging of patented drugs.

In principle, Washington has endorsed loosening some rules on importing drugs to help poor countries. Unfortunately, it wants to limit any trade in generics to treatments for a selected list of infectious diseases like H.I.V., malaria and tuberculosis.

These limits may seem reasonable, but developing countries see them as a retreat from the rich countries' promises that trade talks would address their needs. After all, half of the premature deaths in poor countries are from noninfectious causes like heart attacks and cancer. Does a child dying of leukemia have less right to low-cost medicine than a child with AIDS?

To be sure, an agreement on generics would not solve these countries' health problems. In many places poor roads, inadequate clinics and a lack of doctors and nurses are greater barriers than the costs of pills.

But ensuring continued legal access to generics for the poorest countries is vital to improving their health care systems, and the lack of an agreement is becoming a serious impediment to the success of the broader trade talks. American leadership in resolving the issue would be a fitting complement to President Bush's generous pledge.

Mamphela Ramphele and Nicholas Stern are, respectively, a managing director and the chief economist of the World Bank.

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