But to many activists, the drug companies' gestures do not go far enough. Few African governments can afford brand-name AIDS drugs, even at bargain prices. And the industry's zealous defense of its patent rights has emboldened foes even more. Activists plan to turn up the heat this week in Pretoria, when South Africa's high court resumes hearings on a lawsuit filed by 39 pharmaceutical companies against a 1997 law that gives the Health Minister discretion to import cheap copies of patented drugs or authorize local labs to produce them without the consent of patent holders. The Pharmaceutical Manufacturers Association says the law is unconstitutional. But the industry faces clamorous opposition. Thousands of protesters have taken to South Africa's streets, and a petition signed by 160 organizations and 35 countries calls the lawsuit "morally reprehensible." The E.U. has called on the drug companies to drop it. "This is the first time," says Zackie Achmat, leader of South Africa's Treatment Action Campaign, "that the pharmaceutical industry will have to justify to the world why their prices are so high and why patents should be so aggressively protected when cheaper drugs exist."
The message may be getting through. Last month Merck and Bristol-Myers Squibb slashed the price offered to African countries for anti-AIDS "cocktails" to a fraction of what's charged in industrialized countries. One Bristol-Myers AIDS drug, Zerit, now costs just $54 a year in Africa; in the U.S., patients pay $3,589. This month, six other firms assured U.N. Secretary-General Kofi Annan they too would continue lowering prices. But at a conference in Norway last week with officials from the World Health Organization and World Trade Organization, some industry leaders resisted calls for further discounts. Said Bill Fullagar, the president of the U.K.'s pharmaceutical trade association: "The industry can't be a health service to the world."
The big multinationals also have to contend with competition from generic drug makers. The Indian company Cipla plans to sell its versions of a triple-drug anti-AIDS cocktail to Médecins sans Frontières for $600 a year per patient — $200 cheaper than the least expensive brand-name cocktail. "We are offering the drugs at a humanitarian price," says Cipla chairman Yusuf K. Hamied. GlaxoSmithKline and Bristol-Myers have threatened to sue Cipla; they fear that a flood of cheap imitations in Africa could create a global black market for AIDS drugs that could undercut prices in the developed world.
For the poorest African nations, where annual per capita health care budgets are less than $10, even cheap generics aren't cheap enough. This month Mali closed a deal to buy drugs from four Western firms at a 90% discount; but the government said it can treat just 600 of the country's 130,000 AIDS patients. What more can be done?
A group of Harvard academics has proposed a treatment and prevention program — run by an international organization like the U.N. and funded by the the developed countries — that would buy AIDS drugs from major pharmaceuticals at deep discounts. Jeffrey Sachs, the economist who headed the study, says the initial cost for such a program would top $1 billion a year and would climb to $3 billion annually within five years; by comparison, Sachs says total annual U.S. aid to sub-Saharan African during the 1990s averaged just $150 million. But, Sachs points out, America's gross national product is now $10 trillion. So "each billion means one cent out of every $100 that America earns each year. We're advocating two cents to save 5 million lives." Given the stakes, it seems a small price to pay indeed.