Poor countries that fought to be able to import generic prescription drugs have failed to use changes to the WTO rules on intellectual property rights, reviving a row over who is to blame for the lack of treatment for millions of AIDS sufferers.
According to Daniela Bagozzi, spokeswoman for the World Health Organisation in Geneva, "nothing much has changed since August," when a compromise between the 146 members of the World Trade Organisation broke an eight-month deadlock over the changes.
"From what we know and what we've heard, no country has issued a demand for a compulsory licence as authorised within the agreement," she said.
An official of the UN joint programme on HIV/AIDS (UNAIDS), who asked not to be quoted by name, said the complexity of the WTO agreement was partly to blame for discouraging potential beneficiary countries.
But he also accused the United States of "protecting its pharmaceutical industry by putting pressure of various kinds on small countries such as Morocco and those in Central America not to take advantage of the agreement."
International drug companies have been on the defensive since 2001, when 39 firms buckled in the face of world-wide outrage and abandoned a lawsuit against the South African government for importing generic versions of patented anti-retroviral drugs.
A spokesman for the European Federation of Pharmaceutical Industries and Associations (EFPIA) suggested that the industry's defensiveness was misplaced.
"Ninety-five percent of the 305 drugs classified as essential by the WTO are no longer protected by patent and can be freely copied," he said. "Whether there is a WTO agreement or not, the poor countries have no money and usually have no hospitals, doctors, dispensaries or drinking water."
An executive of a European drug company added: "We are the ideal scapegoat, the excuse for governments not to pay for health care."
Whoever is to blame, in the opinion of Oxfam International, the poor countries' failure to use their new-found rights plays into the hands of the drug firms.
"The pharmaceuticals don't suffer from the current situation," said Jennifer Bryant, Oxfam's spokeswoman in Geneva. "That's why we want the WTO agreement to be rewritten," she added, because "only competition with generic producers can lead to a significant fall" in drug prices.
Bagozzi, referring respectively to the lawsuit and to the current round of WTO talks, said: "Something has changed in the atmosphere since Pretoria and Doha. WHO and UNAIDS are moving forward to make it better, but the pharmaceuticals did not move much."
The EFPIA insisted, however, that "our attitude has changed" and said the firms were making costly drugs available in poor countries through private-public partnerships.
There is evidence that the various programmes had brought down the price and improved the quality of life-saving drugs in countries such as Cameroon, Chad, Gabon, Kenya and Rwanda.
Progress remains very limited, however, when compared to the terrible fact that 14,000 people are infected with HIV every day in Africa and that a child dies of malaria every 30 seconds.
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