Poverty, Not Patents
It's time for a reassessment of public policy on medicine access.


The 57th meeting of the Geneva World Health Assembly began on Monday, May 17. Inevitably the focus of activist groups has been on the role that drug patents play in blocking access to essential medicines in the world’s poorest countries. Big pharma, on the other hand, is highlighting the importance of drug patents to ongoing research into cures for diseases. Both positions are exaggerated and draw attention away from the real and pressing issues that lead to poverty, disease, and death for billions of people.

In October 2001 it became obvious that drug patents for anti-retroviral drugs (used to treat AIDS patients) were rarely on file in African countries and could therefore not be the major barrier to drug access. This research has now been extended by Dr. Amir Attaran of the Royal Institute of International Affairs in London. Attaran examined the degree of drug patenting for the entire World Health Organization list of essential medicines in 65 diverse countries (including all of Africa, major developing countries such as Brazil and China, and some middle-income countries).

The analysis (published in Health Affairs last week) measures the extent of patenting of 319 essential drugs in the countries selected, together home to over four billion people or around two thirds of the world’s population. This research is the first of its kind to quantify the degree to which the protection of intellectual property denies people access to medicines that could save their lives. In line with Attaran’s previous research on HIV/AIDS drugs, the results show that drug patents hardly matter at all for most drugs, in most countries, most of the time.

Only 17 of the 319 items could be effectively patented, and the typical developing country is likely to have far fewer essential medicines under patent or pending patent application than that. In fact, the median number of drug patents in these countries is only four; and it remains four even if one removes those countries that have no drug-patent legislation and could therefore possibly lower the median figure.

Drug companies usually do not seek to patent their medicines in most poor countries, even if patenting laws allow them to do so. The reasons for this are pretty clear. There is little incentive to go to the trouble and expense of filing a patent application in a country where the annual per-capita health expenditure is less than $2 and the demand for the drug will be negligible.

In only 1.4 percent of cases (or 300 out of 20,735 combinations of essential medicines and countries) did patents or patent applications exist for essential medicines. This means that in 98.6 percent of cases there are no patent barriers blocking access to these medicines. Of course this does not mean that we can dismiss the importance of drug-patent barriers when they do occur.

The analysis should introduce some balance to the ongoing and acrimonious debate surrounding the role of intellectual-property protection and access to medicines. Drug activists should now recognize that their view that drug patents block access to drugs has been greatly exaggerated. And drug companies–because they so rarely seek patent protection in so many countries–should recognize that their insistence on universal drug-patent protection is not entirely essential to ongoing research and development.

Activist campaigns against drug companies have probably contributed to reduced research and development in some key areas, most notably HIV/AIDS. At the same time, the drug industry has ignored mechanisms that could allow it to increase drug access in the rare cases where patents actually do act as a barrier to access. Out-licensing is one such tool-i.e., granting voluntary licences to generic drug companies to produce medicines for use only in poor, developing countries.

The publication of this data showing the minor role that drug patents play in reducing access to drugs should focus attention on the real, far more fundamental barriers to access. Poverty, poor medical infrastructure, paltry funding, and a lack of political will are all issues that need urgent attention. The narrow focus on drug patents has diverted attention away from these issues and acted as a “red herring” at WTO negations, in the words of Ugandan President Museveni. Resolving trade issues and removing the highly damaging agricultural subsidies in place in wealthy countries would have gone much further in creating wealth and improving drug access than the campaign against drug patents has done.

Amir Attaran’s research justifies an urgent reassessment of public policy on medicine access. Failure to focus on the real barriers to access will have catastrophic results, amounting to a suicide pact with epidemic disease.

Dr. Roger Bate is a visiting fellow of the American Enterprise Institute and a director of Africa Fighting Malaria.