There is no lock on the door, no phalanx of guards, no visible impediment to the drugs leaving the glass chamber that the laboratory technicians call a ”stability room”. The pills come in little white boxes with labels such as lamivudine, zidovudine and efavirenz, technical names disguising the fact that these tablets are the stuff of life.
Take them together and if you have HIV you can stave off death for years. Millions in Africa have the virus but not the pills. A stone’s throw from the laboratory, Aids is wiping out communities, yet these pills cannot leave the stability room.
This is Nairobi and the factory is Kenyan, but a web of influence spun by the world’s pharmaceutical giants encloses these laboratories, ensuring the Aids drugs stay inside. For Africa, getting them out would be a milestone in controlling the pandemic.
Two things are happening that could untangle the web: activists are preparing a legal challenge to allow Kenya to make and import generic Aids drugs, and Nairobi’s factories are ramping up their capacity to make their own cheap drugs in expectation of that court victory.
For decades African companies have produced generic copies of antibiotics and other drugs, paying royalties to those Western companies that developed and patented the formulas. Prices tumbled, making them affordable to the poor.
But that has not happened with Aids. The Western companies, protecting their profits and market share, have refused permission for generic versions of anti-retrovirals (ARVs).
But in the labs of Nairobi manufacturers such as Cosmos they sense change coming. Following World Health Organisation guidelines, they have successfully copied branded Aids drugs, registered them with health authorities, printed labels for the boxes and stored them in the stability room. Under international patent law, there they must stay unless the makers obtain a licence.
”There is nothing preventing me mass producing. We have the expertise, the access to raw materials, the registration,” said Prakash Patel, Cosmos’s chairperson and managing director. ”By the end of the year we will be producing. I think we will be the first to produce ARVs in Africa.”
Patel’s boast reflects swelling confidence that the multinationals will not block African generics. Another Nairobi company, Laboratory & Allied, said it could also switch to ARVs within weeks.
That optimism stems from a series of victories in recent years that asserted the right of countries facing public health emergencies in the developing world to override intellectual property rights by issuing what is called a compulsory licence to make or import generic drugs.
Countries such as Britain issue compulsory licences occasionally, giving the United Kingdom health service cheaper drugs, but African states have hesitated: the drug giants have friends in Washington and other capitals who can withdraw investment and trade concessions from uppity African states.
This threat has now receded. The World Trade Organisation’s Doha declaration said developing world countries could make or import generics.
Yet the drug industry is fighting back by cutting prices of branded drugs, warning health ministers that national treatment programmes would bankrupt their budgets and depicting generics as unsafe.
John Musunga, commercial director of GlaxoSmithKline’s Nairobi office, said the company had no plan to stop generics, yet pinned on his wall was a strategy apparently advocating the ”promotion of doubt” about generics. Musunga rejected claims that the industry exerted improper influence over the Kenyan government.
Two years ago an amendment protecting patents was slipped into Kenyan legislation. It was removed after an outcry, but this correspondent has seen a letter from Kaplan & Stratton, a Nairobi legal firm, to the Kenya industrial property office requesting an amendment for an unnamed client.
Still, the momentum towards African generics is growing. The Consumer Project on Technology (CPTech), a not-for-profit group started by the radical United States campaigner Ralph Nader, is coaching groups in South Africa, Ghana, Uganda and Kenya to mount legal bids for compulsory licences.
The plan is to reassure African governments that the international climate has changed. The prize is not just lower prices, but more sustainable supplies suited to Africa, such as all-in-one pills. Kenya seems to be moving fastest, with some government officials enthusiastically backing the initiative.
”The first case you get in Africa is going to have a huge effect on other African countries. If it’s a positive decision they’ll look to that, it’ll have a domino effect,” said James Love, of CPTech. ”We should succeed in Kenya. It would be a crime against patients if we don’t succeed.” — Â