A Turning Point That Left Millions Behind

The number of patients treated will increase eightfold, he said. That five-year goal will add between 420 and 889 patients to the rolls of the privileged, depending on whose figures are used. There are an estimated 79,000 Senegalese men, women and children infected with the AIDS virus. Because that number continues to grow, the target rate of coverage in 2006 is, at best, under 1 percent.

Other countries in sub-Saharan Africa, which generally have a much higher prevalence of AIDS and less effective efforts to fight it, are likely to fall short of that mark.

Setting Conditions

The pharmaceutical industry began 2000 on the defensive. For a decade, makers of AIDS medicines had rejected the idea of lowering prices in poor countries for fear of eroding profits in rich ones. The position required a balancing act, because the companies had to deflect attacks on the global reach of their patents, which granted exclusive marketing rights for antiretroviral drugs.

The industry argued that the real obstacles to AIDS treatment in Africa and other poor regions were not drug prices but social, managerial and political barriers, the absence of roads and records, shortages of caregivers and "the lack of resources to provide even rudimentary health care to many citizens," as the International Federation of Pharmaceutical Manufacturers Associations put it this year.

At the same time, the drug makers justified high profits as vital for underwriting the costs of research and development--work that leads to most medical innovations. The return on their investment did that and more. Even after plowing $ 21 billion back into R&D, the 10 largest U.S. drug makers had $ 100 billion more in sales than manufacturing costs over the 12 months ending in November, Forbes magazine calculated. On June 22, the New England Journal of Medicine described the rate of return on assets as the highest of any industry.

In the late 1990s, an unexpected synergy between AIDS activists and critics of globalization started eating away at the political framework that supported the boom. AIDS organizers tormented Vice President Gore's presidential campaign and chained themselves to desks in Trade Representative Charlene Barshefsky's office, pressing the Clinton administration to stop backing the industry against generic competitors. The slogans of the activists--"Pfizer's Greed Kills," "Death Under Patent," "Medical Apartheid"--sliced into the industry's long-standing efforts "to portray itself as being driven by improving the human condition," said Michael Artinger of Decision Resources, a pharmaceutical research firm.

On Dec. 1, 1999, President Clinton announced a new trade and patent policy "flexible enough" that "people in the poorest countries won't have to go without medicine they so desperately need."

Pharmaceutical executives anticipated further setbacks at a May 15 gathering of health ministers in Geneva, and at July's international AIDS conference in Durban, South Africa. As U.N. Deputy Secretary General Louise Frechette said in an interview, AIDS had "gone up quite a bit in the cosmic scale of priorities."

By Dec. 6, 1999, after an AIDS summit in New York in which U.N. Secretary General Kofi Annan called for new public-private partnerships, the industry decided to act. Vice Chairman Kenneth E. Weg of Bristol-Myers Squibb and Glaxo Wellcome Chairman Richard Sykes pulled Harvey E. Bale Jr. aside as they left U.N. headquarters. A former U.S. trade official, Bale ran the global umbrella group of pharmaceutical lobbies.

The two executives asked: Would Bale make a few discreet calls and find out which AIDS drug makers might be interested in joining a counteroffensive?

Six companies took part in Bale's first conference call six weeks later, on Jan. 20. Mid-level executives at Glaxo and Bristol-Myers volunteered to draft a set of principles that could guide an AIDS treatment initiative. One paper would set down the rationale for intellectual property protections, while the other would lay out conditions for price discounts.