Abstract

Patents and access to antiretrovirals: the politics of AIDS treatment in Brazil

A. de Mello e Souza

Institute for Applied Economic Research, Directorate of Studies in International Economic and Political Relations, Brasília, Brazil

Brazil's widely recognized success in controlling AIDS resulted primarily from its provision of free and universal access to antiretroviral therapies since 1996. Yet, AIDS treatment in Brazil has, from the outset, been challenged by the high costs of patented antiretrovirals. Local pharmaceutical production has thus far ensured the affordability of such treatment both by offering cheaper generic anti-AIDS drugs and by enabling the government to make credible threats of compulsory licensing, thereby successfully negotiating considerable price discounts for patented antiretrovirals with brand-name pharmaceutical multinational companies. Domestic and transnational political support helped Brazil resist resulting pressures and retaliations from these multinationals and the US government. Yet, this paper provides qualitative and quantitative evidence, gathered through extensive field research in Brasilia, Rio de Janeiro and Geneva, that such strategy has ceased to be effective since 2005, when India and other suppliers of antiretroviral active ingredients to Brazil adopted stricter patent laws in accordance with the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). It argues that the legal and institutional reforms which enable pre-grant patent opposition by health authorities, more flexible and easier compulsory licensing and expedite post-patent generic entry, while important, remain unable to ensure the sustainability of AIDS treatment in Brazil. Rather, the paper concludes that such sustainability depends crucially on further technological capacitation of the Brazilian pharmaceutical industry, without which neither domestic political support nor lax domestic patent rules will suffice in the context of TRIPS. In particular, the command over all phases of antiretroviral production is key for Brazil to exercise bargaining and market power in face of global patent rules and strong external opposition. Such technological capacitation in Brazil may help increase access to antiretroviral therapies in other developing countries as well.