The Pill Machine.(AIDS drugs in Africa)(Brief Article)

Twenty years ago, a scientist discovered that a drug being tested for heartworm in dogs was also a miracle cure for river blindness in humans. That was big news, and a bigger dilemma for the scientist's bosses at Merck pharmaceuticals. As a veterinary medicine, the drug would be a big moneymaker. As an antidote to river blindness, a deadly scourge to millions of people in West Africa, it would be a sure loser. Merck is a business, not a charity. Yet it would be uncomfortable, at best, to sit on an antidote to this horrific disease, borne by parasites that attack the eyeball and cause an itch that can drive victims to suicide.

Merck wasted no time in making its choice. It launched a seven-year clinical trial to prove the drug safe for humans, then began distributing it free under the name Mectizan. Working with aid groups, Merck now treats 25 million people per year in 31 countries. Since 1987, the company has given away more than 600 million tablets of Mectizan, which it figures is worth $1.50 a pill. Merck says it has no estimate of how much the effort has cost, but the United Nations says river blindness may be eradicated by 2007. "Merck is really the pioneer," says Jordan Kassalow, former director of river-blindness programs for Helen Keller Worldwide. "They did it because it was the right thing to do."

Now, the dilemma Merck once confronted behind closed doors confronts the entire drug industry. For years, the growing anti-globalization movement has attacked drug companies for doing too little for the poor, while building fat profit margins on concerns of the rich: heart disease, obesity, erectile dysfunction. In recent months, however, poor nations began pressuring Western pharmaceutical firms to drop prices for AIDS drugs, and join the nonprofit fight against this deadly epidemic. Now developing nations are pushing this case even further, saying that Big Pharma should battle all life-threatening diseases in the Third World, a category that could cover everything from malaria to leprosy as well as river blindness. Drug companies are no longer under pressure to perform isolated acts of philanthropy. They are under pressure to be philanthropies.

Those are the stakes of the debate coming out of the World Trade Organization summit just finishing up in Doha, Qatar. The immediate issue is how to interpret a 1994 trade rule that allows countries to ignore drug patents in "a health-care crisis." The poor nations want to broaden that language, which would free them to develop cheap generic versions of the expensive "AIDS cocktail." In Doha, they are fighting efforts by the United States and Europe to broaden patent protection. But in a controversial new study, Harvard researcher Amir Attaran says patents aren't blocking the poor from access to affordable drugs. In fact, companies rarely even bother to seek patents in Africa, so they can't be a real obstacle. The reason Africans can't buy drugs, says Attaran, is much more profound, and simple: "a lack of money."

The drug industry is on the defensive. Under pressure from protesters, Western companies started last summer to back off efforts to defend patents in the Third World. Now it's even tougher. In the wake of anthrax attacks in the United States, Canada and the United States threatened to violate patents themselves on an anthrax antidote in order to get an affordable price. For those same countries to continue defending patents on treatment for AIDS--which has killed far more than anthrax--looks to advocates for the poor like utter hypocrisy. In Doha last week, WTO Director-General Mike ...