In a dramatic speech screened at yesterday’s plenary, Zackie Achmat, the ailing South African AIDS activist, called for the proprietary drug companies to waive patent restrictions and throw open the doors to a competitive market in generic drugs throughout the developing world.

“The partial price reductions and insufficient donations by drug companies will not assist in the long term to deal with the epidemic in a sustainable and an effective manner,” said Achmat, who in 1998 was one of the founders of South Africa’s Treatment Action Campaign.

“What is required is generic competition, and therefore we appeal to all the brand-name drug companies to issue non-restriction voluntary licenses at between 3-4% royalty, to ensure that poor countries and communities have access to ARV therapy.”

He said this would eliminate the “unnecessary conflict” between the activist community, government and drug companies.

In recent years, major drug manufacturers have slashed their prices or agreed to give away HIV drug in low- and middle-income countries, but with few exceptions they have yet to surrender their patent rights.

This makes it illegal for domestic manufacturers to produce generic versions of brand-name drugs. Critics argue that by waiving patent rights and granting licences to generic manufacturers, the world’s largest drug companies would open the way for fierce competition and vastly open up access to antiretrovirals.

WHO estimates that 6 million people in the developing world are at risk of dying within two years if they do not receive antiretroviral therapy soon.

Drug companies deny that high prices are the main factor limiting access to HIV-drugs. Peter Hare, Vice President (HIV Business for the United States) at Glaxo Smith Kline told AIDS 2000 that lack of public health infrastructure, not drug pricing, is mainly to blame for the lack of access to treatment in poor countries.

“In India, for example, where the generic manufacturer Cipra is based, prices are the lowest in the world, yet how many Indians have access to antiretrovirals?” Hare said. “So patents are not the main issue: countries need doctors who know how to prescribe medicines, they need clinics, they need patient education programmes to ensure that people adhere to their regimens.”

Achmat said that pilot projects conducted by Médecins Sans Frontières in resource-poor settings, such as Khayelitsha, outside Cape Town, have clearly demonstrated that HIV drugs can be provided without sophisticated public health infrastructure. But he added that governments must demonstrate the political will to fight AIDS and to fund public health care systems.

Achmat, who has been living with HIV since the early 1990s, was unable to attend the Barcelona conference owing to a lung infection. In 1998, he declared that he would not take antiretroviral drugs until the South African government agreed to fund a national pilot project providing HIV treatment free of charge. This has yet to happen.

In January, he told a South African meeting that his CD4 cell count stood at 235.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team