Veena Panchal, from a suburb of Mumbai, found out in 2002 that she was HIV positive. She has been taking generic, domestically-produced medicine for treatment since. (Photo courtesy of Médecins Sans Frontières)
Compared to a number of other nations, India has done an incredible job of keeping medicine cheap enough that its citizens can afford to buy whatever it is that they need. Most importantly, it avoids handing out patents for drugs unless they're completely new or have some sort of therapeutic advantage over already-available treatments, meaning that the vast majority of life-saving medicines are free to be replicated and sold by any company that wishes to do so.
For example, in 2012, German Big Pharma company Bayer were charging $4,500 (£2,780) per month for a kidney and liver cancer medicine. Deeming that a little too pricey in a country where the average yearly wage is around a quarter of that number, the Indian government granted a license to manufacturer Natco to produce a generic alternative to the branded medicine, as long as they paid some royalties to Bayer. As a result, the price of the medicine decreased by a massive 97 percent.
However, aggressive lobbying from US pharmaceutical companies is set to change all that. America's pharmaceutical plutocrats are attempting to revise intellectual property laws in India, meaning that many people seeking treatment will be forced to buy expensive US imports instead of domestically produced replicas. Which obviously isn't great news for the 96.9 percent of citizens living with less than $5 (£3) a day.
In most drug-producing countries that aren't India, once a drug has been developed and a first patent filed and granted, pharmaceutical companies then engage in a practice called "evergreening". That practice basically involves undermining access to affordable medicines by using a variety of tactics to extend the company's monopoly on the drug past its initial 20-year patent period. By obtaining multiple secondary patents, often for trivial modifications to the original, companies are able to protect their product for decades, preventing production of cheaper generic replicas.
Because Indian patent law forbids evergreening, the country's generic pharmaceutical companies have been able to produce affordable versions of foreign medicines to suit their nation's income. But it's that law that's coming under pressure from the US government and international drug companies, with both institutions wanting India to allow evergreening, therefore further tightening the companies' grasp on drug monopolies. That, of course, means that low-cost generic medicines will simply disappear, leaving India's sick the choice of whether to submit to severe poverty in order to raise the cash for US imports, or forego treatment altogether. Either way, India loses.
Nolitha Tsilana, a Médecins Sans Frontières nurse, delivers TB pills to a patient in Khayelitsha township, Cape Town. (Photo courtesy of Médecins Sans Frontières)
And it's just not those needing medical treatment in India who should be worried about the lobbying. India has been referred to as "the pharmacy of the developing world", exporting more than half of its generic medicine to the world's poorest countries every year. And the exports include more than just paracetamol and basic painkillers; the Indian pharmaceutical industry produces treatments for life-threatening diseases, like hepatitis C and HIV – treatments that the countries importing them don't have the resources to make themselves.
In fact, speaking to Rohit Malpani from Médecins Sans Frontières (an organisation that relies heavily on affordable generic drugs), he stressed that even a tiny alteration in the law "would have enormous impacts on public health systems in sub-Saharan Africa, Latin America and Southeast Asia".
The crushing irony of the whole thing is that the vast majority of medicines taken in the US – and those distributed by US aid programmes – are of the generic variety, many of which are developed by Indian manufacturers. So that's Indians, US aid agencies, Médecins Sans Frontières, the world's poor and vulnerable and US citizens that US pharmaceutical companies could be screwing over with the proposed change in law.
According to the letter sent to President Obama that outlines the proposals to force India into buying American-made medicine, Representatives Erik Paulsen, John Larson and 170 other members of Congress are "deeply concerned about the growing trade imbalance between the United States and India". The lobbyists claim that India is "harming" US industry by "jeopardising jobs and innovation here at home" and having "a negative impact on […] investment in the United States".
You'd been forgiven for thinking that these were the words of a right-wing venture capitalist with no ability to value human life over the prospect of making a little more money. But Rohit pointed out that the support is "decidedly non-partisan", saying that "we don't see any empathy or understanding of the measures that the Indian government or other governments are taking to ensure affordable medicine prices. In some ways, we often see very little space between the approaches of either political party".
Medicine distributed in Kenya by Médecins Sans Frontières. (Photo courtesy of Sven Torfinn / Médecins Sans Frontières)
Paulsen and his patriotic friends are also worried that other countries may take up India's abhorrent stance on producing medicine domestically for the benefit of its own people and join the attack on America's economy, because "[India] is a thought leader among emerging countries".
The justification the lobbyists have provided for their attack is that the Indian government's attitude towards producing affordable alternatives is illegal – that they're breaking intellectual property laws by replicating branded drugs. However, Rohit told me that "every sort of impartial legal expert has validated India's measures as being consistent with global trade rules".
Rather than just take Rohit’s word for it, I consulted a report from the World Health Organisation (WHO). The report explained that member states should "consider, whenever necessary, adapting national legislation in order to use to the full the flexibilities contained in the Agreement on Trade-Related Aspects of Intellectual Property Rights". These flexibilities in the law include compulsory licenses, just like the one awarded to Natco to produce a cheaper alternative to the kidney and liver cancer medication that Bayer were trying to peddle for almost 100 times more.
After approaching Pfizer – one of the main pharmaceutical companies behind the lobbying – and being bounced between multiple media departments, I wasn't provided any comment. Instead, I was forwarded testimony that Chief Intellectual Property Counsel Roy Waldron delivered to the House of Representatives back in June. He stated that India's actions lower their ability to "provide faster access to life-saving medicines", and that the country was a "hostile innovation and investment environment".
Which basically translates to: "Because Indians have made their own medicine that people there can actually afford, nobody wants to waste thousands of dollars on the stuff we make that does exactly the same thing. Which is a mean and selfish thing to do to America's billionaire pharmaceutical bosses."
A Pfizer booth at a medical trade show. (Photo via)
After reading through Waldron's novel take on how India looking after their sick is a direct attack on the US economy, I was kindly directed to some of the many think-tank websites that have been set up to push the anti-India initiative. The "Alliance for Fair Trade with India", for example – which isn't just concerned with the pharmaceutical industry, but also technology and other sectors – is full of incisive information detailing how India is being "unfair" and is practising "discrimination" against US traders.
When I asked Rohit how the Indian government should go about countering all this political pressure and PR hot air, he said they should continue doing what they've always done, which is to "very carefully and continually defend these measures they have taken as legal".
Continuing, Rohit said that the Indian government should collaborate with other pressured countries to fight back, and emphasised how crucial it is that the government spreads "knowledge and understanding amongst people in the country, [so they] understand how these very technical changes to the patent law will have an impact on their lives, as well as the lives of others".
If Paulsen and the other Congressmen get their way, it would undoubtedly sound the death knell for the generic medicine trade in general. Which wouldn't only affect those in India and the rest of the developing world, but countless others around the globe; as Dr Margaret Chan, Director General of the World Health Organisation, said earlier this year: "The costs of many new medical products are becoming unsustainable for even the wealthiest countries in the world. [Of the 12 cancer drugs approved last year], 11 were priced above the $100,000 per patient per year. This price is unaffordable, for most patients, most health budgets and most insurance companies. These are problems for all countries, not just the developing world."
Follow Joseph on Twitter: @josephfcox
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