When thinking about trade policy, tariffs and quotas may be what typically comes to mind. The truth is multilateral trade agreements have affected people in numerous ways, including impeding on access to HIV medications.
As the U.S. Congress prepares to vote on a very important trade bill in the coming weeks, I hope our elected officials deeply consider the policy failures of the past so as not to repeat the trading of HIV-positive lives away.
The World Health Organization (WHO) currently estimates there are 35 million people living with HIV, myself included. Since 1981, the WHO has recorded 39 million AIDS-related deaths. These numbers would unquestionably be much higher were it not for health programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the U.S. Ryan White program.
PEPFAR has been heralded as among the most successful global health programs, but this program also exposed a trade policy failure often referred to as a death by patent. The announcement of PEPFAR’s creation was delivered during President Bush’s State of the Union in 2003. During this speech, the president called on Congress to commit $15 billion to address the growing global AIDS pandemic, citing the cost effectiveness of allocating funds for HIV medications.
At the time, the president stated the cost of treatment for one person had dropped from $10,000 per year to $300. He was accurate about the cost, but he hadn’t factored in the Pharmaceutical Research and Manufacturers of America (PhRMA) factor. The $300 was for generic HIV medications manufactured in India, but $10,000 was the patent protected price in the United States.
Following the State of the Union speech, PhRMA moved quickly to ensure PEPFAR would not purchase India’s generics. Pharmaceutical companies and policy makers used patent and intellectual property terms in the U.S.–backed World Trade Organization (WTO) to restrict access to generic treatments. This resulted in the first years of PEPFAR characterized by the program paying $10,000 per year for medication for one person, which was not what the president initially intended.
It would take years of advocacy from groups such as TAG, ACT UP and Doctors Without Borders before the WTO eased restrictions allowing generic HIV medications to flow to people in need. During this struggle, at least 10 million needlessly died. This easing of the WTO’s trade barriers for HIV medications has translated into 12 million people who are currently receiving medicines through global health programs. Over 80 percent of PEPFAR’s medications are currently being purchased from India at a price of less than $100 per year. The $100 cost likely sounds very refreshing to Americans living with HIV who, like me, would have to pay $3,400 per month or more for our lifesaving medication without insurance.
It is with both PEPFAR’s success and the WTO’s failures in mind that I am deeply concerned there may be a repeat of death by patent coming. Right now, the United States is negotiating a massive free trade agreement between 11 countries throughout the Pacific Rim and Southeast Asia. This deal, known as the Trans Pacific Partnership (TPP), has sparked widespread outrage over potential implications.
In referring to the TPP, the director of the WHO recently stated, “If these agreements open trade yet close access to affordable medicines, we have to ask: Is this really progress at all, especially with the costs of care soaring everywhere?” The terms of this trade agreement, like previous ones including the WTO, have been negotiated in secret with the public and even members of the U.S. Congress barred from knowing the full extent of what is being negotiated on our behalf.
What is known is the terms are being written by 600 negotiators, the vast majority of whom represent U.S. multinational corporations with PhRMA as the TPP’s chief lobbyist. Through leaked copies of the TPP text by Wikileaks, people have been provided information on the trade agreement’s terms. One of the terms authorizes corporations to sue sovereign governments over laws passed to protect public health. This provision is tragically similar to the one used to restrict access to medicines under the WTO previously.
In the coming weeks, the U.S. Congress will be voting on a Fast Track bill designed to quickly pass the terms of the TPP through Congress. If Congress passes Fast Track, it will mean the TPP will come before Congress for a simple yay or nay vote devoid of substantive debate or amendments. This would provide a narrow opportunity to ensure the TPP doesn’t repeat the faults of the WTO.
I assume most members of Congress would characterize the previous death by patent situation as having been a tragedy we could have prevented. I hope, when our elected officials cast their votes on Fast Track, all of the implications of their decisions are deeply considered.
Benjamin Gerritz is a coordinator of the Prevention with Positives program at Cascade AIDS Project and a board member with Oregon Fair Trade Campaign, a statewide grassroots organization. Gerritz was on the 2013 POZ 100 list and was recognized as a 2014 Queer Hero NW.