A UNAIDS official is calling for a review of the World Trade Organization (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, labelling it an unjust health practice.

According to Dr Richard Amenyah, director of UNAIDS Multi-County Office in the Caribbean, such agreements drive up the cost of care in poorer economies, making it harder to treat chronic conditions like HIV.

Under TRIPS, drug manufacturers have intellectual property rights to pharmaceuticals for 20 years, prohibiting generic forms from being developed.

In an exclusive interview with the Jamaica Observer, Dr Amenyah said these agreements have caused the region’s expenditure on HIV drugs to be significantly higher than in other parts of the world.

“One of the critical pathways to achieve universal health coverage and to end AIDS as a public health threat by 2030 is for governments to take advantage of the latest scientific innovations in medical technology and ensure these technologies are affordable, available and accessible to all,” Dr Amenyah said.

“Importantly, this includes access to essential medicines for public good. However, this pathway is proving very difficult and painful for people living with HIV in the Caribbean and Latin America regions because their governments are using their scarce resources to pay more for essential HIV medicines to keep them alive than governments in other regions,” he added.

The 2023 Global AIDS update highlighted that the average price per patient per year for durable antiretroviral drugs in the Caribbean and Latin America is US$160, while the average price in West and Central Africa is just US$67.

Dr Amenyah said this raises the question of fairness among people living with HIV as to why countries in the Caribbean and Latin America are paying such a high price for life-saving medicines.

“It is necessary to highlight this disparity because several Latin America and Caribbean countries are saddled with high debt and are sacrificing investment in social programmes for their people for debt servicing as stated in the recent report, A world of debt: A growing burden to global prosperity by the UN Global Crisis Response Group,” Dr Amenyah said.

“The report puts the global public debt at US$92 trillion, 30 per cent of which is owed by developing countries. To manage this unfair and unfortunate situation, it is important to explore potential strategies that Caribbean and Latin American countries could use to negotiate lower prices for essential HIV medicines and to ensure better access to life-saving treatments for their people, as governments work out more sustainable ways of dealing with inequalities in the international financial architecture to tackle the high cost of debt and mitigate the risk of external shocks and further debt distress, as well as long-term development financing opportunities,” he added.

Further, the obligations countries have to enforce patents of pharmaceutical products — as per their commitments as WTO members for a period of 20 years for the lifespan of patents — can restrict the production and importation of generic drugs, thereby limiting competition and driving up prices.

“These obligations most times lead to limited competition in the pharmaceutical market in the region, leading to higher prices for some essential medicines. The effect of these patent monopolies and stringent intellectual property laws is the lack of access to more affordable generic versions of antiretroviral drugs,” Dr Amenyah said.

“The patent for Dolutegravir would expire around 2026, which means that countries cannot purchase generic versions of the products while the patent from the originator is still valid. It is therefore not surprising that Latin America and Caribbean countries pay US$160 per patient per year for Dolutegravir-containing antiretroviral regimen than any other region,” he explained.

However, he said utilising flexibilities in intellectual property laws to navigate strict TRIPS rules such as compulsory or voluntary licensing and parallel importation, so as to promote the production and importation of affordable generic drugs, has resulted in steep price reductions.

He further made reference to the Strategic Fund of the Pan American Health Organization as a good example of how to lower drug prices for essential medicines, as it involves pooling the procurement of essential medicines and strategic health supplies for countries that qualify.

In the meantime, Dr Amenyah challenged governments in the Caribbean and Latin America to begin local manufacturing of antiretroviral drugs, and advocates price reduction to make these essential medicines affordable and accessible to their people.

“As governments in the region consider local production in the long term they must, in the meantime, increase their negotiating power with pooled procurement and the leverage flexibilities in the TRIPS to make sure their HIV programmes are high-quality with improved health outcomes,” he told the Observer. “It requires strong collaborative partnerships to support efforts to lower the prices of HIV drugs in the Caribbean and Latin America. Together, we can make a difference in the lives of people living with HIV in the region.”