Published: 30 November, 2001
UNAIDS Sponsored Talks Result in ARV
Price Cuts in Honduras
By Richard Stern*
Significant price reductions for anti-retroviral
treatment have been achieved in poverty stricken Honduras as a result of
negotiations carried out by UNAIDS and the Honduran government with
multi-national pharmaceutical companies.
The negotiations, part of the UNAIDS "accelerated
access" program took place November 22nd and 23rd in Honduras's capital
GlaxoSmithKline and Boehringer-Ingelheim
offered significant price reductions, which, when combined with those
previously offered by Merck and Co. would reduce the cost of the triple
therapy cocktail to about $1340. per year for some combinations of anti-retroviral
drugs and about $1450. per year for others. Of the companies involved in
the negotiations, only Bristol-Myers Squibb refused to lower prices of
its products in Central America. Badara Samb, of UNAIDS, who had
previously negotiated price reductions in other countries, was in
Tegucigalpa for the second time in two months to direct the negotiations.
These reductions represent a
significant breakthrough in Central America, where triple therapy prices
were previously hovering around $4000 per year. However, at $1340 per
year, the cost is still significantly higher than the figure of about
$800 per year which was achieved in similar negotiations in Africa last
Generic producers do not participate in
UNAIDS accelerated access negotiations. The Indian company CIPLA is in
process of registering its products in Honduras, but product
registration is expected to take at least four more months, according to
a CIPLA spokesperson in Honduras. CIPLA offers some triple therapy
combinations at less than $400 yearly.
The Honduran government recently
approved an emergency allocation of $190,000 for anti-retroviral
purchase and, according to National AIDS program director Marco Antonio
Alvarenga, the government expects to begin purchase of anti-retroviral
medications in December. Alvarenga pointed out that with the prices
negotiated, the government will be able to purchase medications for
approximately 160 people for one year. At prices offered by Indian
generic companies, up to about 500 people could receive triple therapy
It is estimated that as many as 5000
People Living with AIDS in Honduras currently need retroviral treatment.
Honduras's population is 6.5 million. The government has not decided how
it will choose the first 160 people. A budget of an additional 22
million Honduran lempiras (US $1,400,000) has tentatively been approved
and funds are to become available sometime around June of 2002.
During the negotiations, Honduran
Health Minister Plutarco Castellanos indicated to participants that he
expected that the price reductions offered would be applicable in
Nicaragua, El Salvador, Guatemala and Belize, as well. It is estimated
that an additional 8000 people are awaiting anti-retroviral treatment in
Samb, of UNAIDS, told participants in
the negotiations, which included Doctors without Borders, as well as
representatives from the Pan American Health Organization, government,
and civil society, that he had recently negotiated prices of about
$1,200 per year in Trinidad and Chile, and hoped that more movement was
still possible in Honduras as well.
Olaf Valverde Coordinator of Doctors
without Borders Access to Essential Medicines Campaign in Central
America commented that "Big Pharma should arrive at these negotiations
with clear ideas and appropriate offers. They know that there are many
countries still waiting to participate in similar negotiations and they
have to become more organized. While blasting Bristol-Myers Squibb, ("They
should be ashamed of the attitude they have taken in Honduras") Valverde
praised Merck and Company for "taking a serious and completely
transparent approach on a world wide level."
Valverde also criticized Boehringer-Ingelheim.
"They have offered prices up to three times lower for Nevirapine in
other countries," he said referring to the price offered by the company
in Tegucigalpa of $657. per year. Boehringer does offer Nevaripine free
only to pregnant HIV+ women, an offer that has been extended to Central
Valverde also questioned the lack of
participation of Abbot Laboratories and Hoffman La-Roche in the
These results represent significant
progress in the struggle for treatment access in Central America.
Hopefully the Honduran government will follow through on its part of the
bargain and immediately begin purchasing medications and saving lives.
It remains to be seen if Guatemala, El Salvador, Nicaragua and Belize
can immediately take advantage of prices obtained in Honduras.
The results are encouraging and
worrisome at the same time. In poverty stricken Latin America, the
UNAIDS accelerated access program which resulted in these price drops
has apparently only reached Trinidad, Chile, and now Honduras. The
process, appears to be slow, cumbersome and random. UNAIDS indicates
that government interest as well a budgetary commitment to medication
purchase are required for a country's participation, but it is also
clear that UNAIDS plays a great role in stimulating a country's
motivation to be involved. Two UNAIDS staffers, Mary Guinn-Delaney and
Juan Ramon Gradehly, worked full time for a year in Honduras paving the
way for these negotiations.
In other countries in Latin America and
the Caribbean this is not the case.In the Dominican Republic 8000 people
have no access to ARV treatment and in Peru, perhaps as many as 10,000.
But there is no movement towards accelerating access and prices remain
in the $4000 - $5000 yearly range, for people just as poor as those who
will now benefit in Honduras and Trinidad. UNAIDS must find ways to "accelerate"
its own "accelerating access" program.
CIPLA, Rambaxi, and other generic
producers could also be negotiating directly with poor governments in
Latin America, but they have been slow to register their products.
Except in Panamá there is no patent protection on anti-retrovirales in
*Richard Stern, Ph.D.
Director, Agua Buena Human Rights
San José, Costa Rica