Hands off generics

The humanitarian organization Doctors Without Borders (MSF) sources 80 percent of the anti-retroviral drugs (ARVs) it uses to treat HIV/AIDs in the developing world from India. India has become known as "the pharmacy of the developing world" for producing affordable, generic drugs. But some activists warn that a proposed free-trade agreement between the European Union and India could lead to tougher intellectual property regulations that could hamper access to cheap, generic Indian medicines.

MSF recently launched the 'Europe! HANDS OFF Our Medicine' campaign to pressure the 27-member bloc into halting measures it says would substantially restrict access to inexpensive medicines for people in developing countries.

Last week, in an open letter to European Trade Commissioner Karel de Gucht, MSF warned that if the European Commission pursues the trade deal "people who rely on these medicines to stay alive will be left without a lifeline and many are likely to die."

Deutsche Welle talked to MSF's international president, Dr. Unni Karunakara, about the campaign, as EU-India negotiations on the proposed free-trade agreement progress.

Deutsche Welle: MSF has accused the EU of trying to "shut off the tap of affordable medicines." Why is India so important in the context of generic drugs globally?

Dr. Unni Karunakara: We have 160,000 HIV/AIDS patients now on treatment in Africa alone, and 80 percent of the drugs that we use to treat our patients come from India. So India is for us the pharmacy of the world. This is where the drugs come from that allow us to treat so many patients. It is very important that this space exists in India for us to be able to continue to produce generic medications and our ability to actually use them as well.

The other concern is that increasingly the industry and other governments are characterizing generic drugs as counterfeit drugs. That's absolutely not the case. Generic drugs work as well as branded drugs, it's just that they are not made by a company. Characterising generic drugs as fake, counterfeit or substandard is actually doing a disservice, and it's going to affect our ability to treat patients in Africa big time. And that's why we are concerned, and that's why we have launched this campaign.

The campaign slogan leaves little doubt that you're suggesting interference by Europe in the production and distribution of various life-saving drugs. But can MSF and others push their argument forward using a rights perspective?

I think the big victory in the Doha rounds was that intellectual property rights are in opposition to large public health concerns; the government has the right to overturn the pattern. I think we need to keep that; we can't afford to lose that. What governments are trying to do is to enter into bilateral agreements to undermine this sort of international agreement [Doha Declaration] and, by underhand methods, trying to again shut down the production of generics. For us this is a huge problem.

Europe and other Western governments are trying to bind India to a deal that will hit the production of generics and you say deprive millions of patients of affordable drugs. How can countries that are often seen as benign donors justify this?

I think it's a question of "does the right hand know what the left hand is doing." I think there are different parts of the government or different parts of the European Union that are engaged in negotiations. The European Commission Humanitarian Aid and Civil Protection, as we know, is trying to promote humanitarian action, has a large amount of funding for humanitarian work that is going on. At the same time, the trade and commerce people are, of course, interested in protecting their interests, whether it's in Europe or in America.

I think sometimes these things come in to competition, and we are relying on the good will of the public to tell their politicians what matters most. We've had great successes in the past, and we hope that this campaign will also help get our concerns heard, and that the citizens will also express their opinion on this matter, and force their governments to back down.

Based on developments so far, is it realistic to expect that the two sides can modify the proposed EU-India free-trade agreement enough to dispel your concerns?

We always put the pressure on the European governments; I think the Indian government also needs to live up to its role as an aspiring superpower. I don't think many people in India fully realize the impact of the Indian drug industry on the lives of people outside India. And I think this is something they need to know. They need to know that they are serving a larger purpose. The government needs to take a firm stand and it can do it. I'm personally hopeful that the negotiations will go in the right direction. I think India should step up to addressing this problem and consider the lives of so many - 4 million people on treatment in Africa alone - and that is not just MSF but all patients, and many of them rely on Indian drugs.

MSF also claims that the European Commission is attacking not only the production of generic medicines, but also their registration, transportation and export.

As far as I understand, any drug that passes through a European port, the consignment can be confiscated and even destroyed. So that's also a very important part of the problem. We want the EU to not enforce this very arbitrary kind of decision that they have made.

MSF has said the EU-India deal is only a fraction of the attacks on the generic medicine industry. Where else are the obstacles being placed and what kind of an impact are they going to have?

The US and the pharmaceutical industry are right now in India, challenging patents that are being granted by the Indian government or trying to gain patents for certain drugs which the Indian government has deemed not worthy of patent. The efforts are going on in many different forums, so I think this is a multi-pronged attack from the industry and governments to address this issue once and for all. And we just can't let that happen.

Apart from the HIV/AIDS medicines you are distributing, what other diseases and health conditions are we talking about when we refer to generics from India?

As far as other diseases are concerned, a lot of those we treat - neglected tropical diseases like sleeping sickness [which is endemic to sub-Saharan Africa], [the tropical parasitic] chagas disease - by and large a lot of diseases that are being treated by drugs that have been in existence for a long time and there are no patent issues there.

In the future, of course, our ability to get new forms of antibiotics or to be able to treat hyper-tension with new classes of drugs or our ability to treat diabetes, I think they all will be affected by the kind of decisions governments are making today.

Interview: Ranjitha Balasubramanyam
Editor: Sean Sinico