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Drug Wars

Why the force should be with Indian pharma

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It is important not just for the developing world but also for rich nations to pray for the good health of India’s generic drugs industry.

Over a 100 countries, mostly in the developing world, depend on India for affordable and quality essential medicines, vaccines and medical supplies, earning India the title 'pharmacy of the developing world'. Every fifth generic drug and every third HIV drug consumed anywhere in the world, mostly in the developing world - home to over 80 per cent of the world's population - is manufactured in India.

Some of the largest non-profit drug procurers of the world who work to make medicines accessible to the poorest people in the world depend on India for a substantial proportion of their total procurement. This includes Unicef, United Nations Population Fund (UNFPA), the Presidents Emergency Plan for AIDS Relief (PEPFAR of the US), the Clinton Foundation, Mêdecins Sans Frontieres or Doctors Without Borders (MSF) and the International Dispensary Association (IDA), world's largest non-profit supplier of high-quality, low-cost generic drugs and medical supplies.

According to Unicef's 2011 annual report on supply, India is its largest supplier. A quarter of its procurement budget, about $467 million, is spent in India. Of this, about 94 per cent is spent on purchasing vaccines, medicines, medical consumables and diagnostic reagents and kits from Indian companies.

Talking to TOI-Crest, Crest Edwin de Voogd, managing director of IDA said that over the past five years, over 70 per cent of all the pharmaceuticals it bought were procured from Indian companies, 20 per cent from Europe and 10 per cent from China.

"When it comes to paediatric and second line anti retrovirals (ARVs) for HIV 100 per cent of all those medicines are from Indian manufacturers. The ARV treatment for one person per year used to cost $10, 000 in Europe. Medicines from Indian manufacturers has brought it down to just $95 per patient per year, 100 times less, " says Voogd about the price advantage of buying from India. IDA supplies medicines to 130 low and medium income countries on a regular basis. It also supplies to many international NGOs and foundations in the US and Europe, such as USAID, the Clinton Foundation, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Global Drug Facility (GDF) involved in TB treatment, MSF and the International Red Cross.

India is the largest supplier of generic ARVs to low- and middle- income countries, providing 80 per cent of donor-funded ARVs to low- and middleincome countries. According to a report, A lifeline to treatment, published by the Journal of the International AIDS Society in 2008, Indian-produced generics accounted for 91 per cent of antiretroviral drugs meant to treat children with HIV.

Developing nations have a big stake in ensuring that the supply of Indian generic drugs continues unimpeded. When the Thai government issued compulsory licences that allowed generic manufacture of patented medicines essential for public health, India offered critical help in finding alternative affordable, quality, generic supplies of vital medicines to treat HIV, heart disease and cancers, points out Paul Cawthome, MSF Access Campaign Coordinator-Asia.

"Although most generic supply is produced locally, in recent years newer generics are being imported from India. The Thai National Health Security Scheme would face major financial constraints if the supply line of Indian generic medicines is disrupted due to the Indian government accepting the conditions stricter than the WTO's agreement on Traderelated Aspect of Intellectual Property Rights, " says Kannikar Kijtiwatchakul, a Thai health activist. "It comes as a great relief to millions around the world who depend on a continuous supply of Indian generic medicines that the Indian Supreme Court has ruled against Novartis, " adds Cawthome.

In 2001, when the South African government was threatened with legal action by 39 major pharmaceutical companies, the Indian company Cipla offered to supply a three-drug cocktail for treating HIV at just $350 per patient per year. Even after price reduction by pharmaceutical multinationals, the cheapest they could offer came to around $3, 617 per patient per year. Before price reduction, the typical annual cost for the AIDS-drug cocktails in the US and Europe was $10, 000 to $15, 000 per patient.

Cipla's offer exposed how the multinational drug companies were abusing their market monopoly to profiteer in the face of a catastrophic health disaster. It was the biggest public relations disaster for Big Pharma which led to a global outcry that forced the companies to drop the case against South Africa. This ushered in affordable HIV treatment which meant that the number of people receiving treatment for HIV/AIDS in sub-Saharan Africa increased from a pitiful 8, 000 in 2001 to 810, 000 people by 2005.

India also exports generic drugs to the developed world. The US is India's largest export market, at 27 per cent of the trade. The UK, including NHS purchases, is India's third largest customer, although it constitutes barely one-sixth of the US volume. Given that rising healthcare costs are plaguing even the rich governments of the world, the good health and development of the Indian pharmaceutical industry is a matter of concern not only for India but for the whole world.

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