Today or Tomorrow? HIV Policy Involves Complex Issues

Your recent headline article on the problems faced by HIV-positive Singaporeans (Today, 4 May 2001) misrepresents or inadequately addresses many of the key issues involved in the HIV debate. Although the article raised a very valid concern, the tone as well as content of the article did not give justice to the complex considerations involved in the treatment and care of HIV.

HIV is indeed one of the major health concerns of the world today. However, it is no longer simply a health concern, as its ability to extinguish the lives of people - often in their prime - has led to very real economic and political impacts as well. As the crisis has reached epidemic proportions, especially in Africa and many parts of Asia, there is a need for governments to act to protect not just their short-run interests in controlling the disease, but also for them to deal with the long-run issues. It is this fact - that HIV is now pervasive in almost all spheres of life and is likely to remain a problem in the future - that necessitates decisive action on the part of policymakers, and Singapore is no exception.

The article has concentrated on the plight of HIV-infected patients in Singapore, and how they are worse off due to the double whammy of a stringent government policy to uphold intellectual property rights and yet not provide adequate aid in the form of financial aid. This stands in contrast to other regional countries, which have allowed generic forms of patented drugs to be reproduced and sold cheaply, and the response of first-world nations, that have provided generous health subsidies to assist HIV-infected patients. Yet this distinction draws too clear a line between the possible alternatives and glosses over more subtle issues involved.

First, even if cheap medication were made available through compromising the intellectual property system, the ability of the poorer patients to maintain a treatment course is questionable. Recent studies have warned that strict adherence to the medical therapy programme is essential, as anything less than 95% compliance to the strict regimen can result in significant increases in the chances of the treatment failing, leading to complications that would undermine the entire endeavour to begin with. Unfortunately, this serious responsibility on the part of the patient has been ignored in the article, which only emphasises the role of the government in nannying the patient.

Second, there is a very strong economic argument for why differential pricing in different markets is necessary. In the absence of a reliable patent system, there would be little incentive for pharmaceutical companies to develop superior drugs to the ones currently available, since they have little hope of recovering their initial outlays. Whilst the greater good of man is a laudable goal, at end of the day, corporations require a profit to remain in the business. True, certain very low-income countries may be exempted purely on humanitarian grounds, but for Singapore - which has the highest per capita income in Asia and one of the highest in the world - not to offer proper patent protection to pharmaceutical firms is a supreme act of hypocrisy. Do we want the benefits of a high standard of living without the attendant costs?

Third, to suggest that governments should shoulder the costs of such major patient expenses - $15,000 a year according to the article - misplaces the onus of responsibility. Why should taxpayers subsidise what is essentially a private cause? This has the possibility of opening the floodgates to all sorts of calls for welfare support for medical treatment, which would place undue strain on limited resources, especially with a rapidly ageing population. In addition, there is little reason to believe that private-sector solutions, such as medical insurance and private charities, cannot take up much of the slack in the absence of government subsidies.

Last, money paid for these medications are eventually channelled back the pharmaceutical companies. These funds could then have the potential to be used for research and development efforts, and these efforts may one day produce superior cures or perhaps even a cure for the disease. To exploit loopholes in drug payment today would only serve to weaken the chances of better solutions in the future. As stated earlier, we should not just be concerned with short-run measures, but also be aware of the long run implications of our policies. Therefore, far from being malicious or uncompassionate, the absence of action may actually be the best course of action.


'Patent or Patient', Today, 4th May 2001

This article first appeared in the Today newspaper on the 10th May 2001.