WASHINGTON — This week, the unthinkable happened in Africa: The world's biggest pharmaceutical companies were forced into a painful negotiation over patent rights and the price of AIDS medicines.
Suddenly, the question is no longer whether Africans will get life-saving drug cocktails but how.
That question lacks a simple answer; merely slashing prices will not automatically get drugs to patients. Many African nations are too poor to afford the medicines, even at rock-bottom prices, and some lack the infrastructure to deliver the pills and educate patients about how to use them.
Still, with the international spotlight now shining on the millions of Africans — many of them babies — dying for lack of drugs routinely available in the United States, world health officials, patient advocates and the manufacturers themselves say the situation can no longer be ignored.
"I think, really, things are changing," said Awa-Marie Coll-Seck, head of research and policy for UNAids, the United Nations agency that is fighting the disease. "Before, nobody was complaining. It was as if this were normal. People are now putting this issue on the table."
Over the past several days, several developments have pushed the issue onto the table.
In South Africa, 39 foreign drug companies went to court to challenge a law that would allow that country to buy cheap, generic substitutes for patented AIDS drugs — even as thousands of protesters marched in the streets demanding drug price cuts.
Cipla, an Indian manufacturer of generic medicines, asked the South African government for permission to sell inexpensive knockoff versions of eight of the 15 anti-HIV drugs that, in varying combinations, are used to create the cocktails. Cipla has said it could offer an AIDS regimen, which typically consists of three drugs, for $600 per year per patient — a small fraction of the $10,000 to $15,000 Americans pay.
And Merck, which makes two of the most widely used AIDS medicines, announced it would offer those drugs to a number of countries at cost: $600 per patient per year for the protease inhibitor Crixivan and $500 per patient per year for another anti-retroviral, Sustiva.
"I think that the companies have probably started to understand that, from a public relations standpoint, they were doing their best to shoot themselves in the foot without going forward with announcements of this type," said Dr. Mark A. Wainberg, past president of the International AIDS Society, a scientists' group. "They are starting to wake up."
In making its offer, Merck challenged other pharmaceutical companies, which will inevitably come under pressure to match it, and also issued a challenge to the governments of wealthy nations, which must now confront the thorny issue of how to help Africa pay for the drugs.