Y K Hamied, chairman of Indian drug firm Cipla is upset there are few takers for his dirt-cheap triple drug cocktail to combat AIDS symptoms.
"The sad thing is that in 2001 there were 10,000 patients in Africa on the cocktail but two years later there are only 34,000...when there are millions suffering," the silver-haired Hamied said.
Hamied rocked the pharma world in February 2001, when he started offering a cocktail of anti-AIDS drugs called anti-retrovirals (ARVs) for less than $1 a day.
But there is little demand. The drugs, which don't cure the disease but slow down its progress, are too expensive for most people to buy, particularly in badly-affected sub-Saharan Africa. And their governments are either too cash-strapped to organise mass treatment or lack the political will to do so.
"Countries simply do not have enough funds. There are many badly-affected countries whose drug budgets are less than $2 per head per year," said Hans Hogerzeil, co-ordinator of medicines policy in the World Health Organisation's department of essential medicines in Geneva.
At the same time, AIDS patients in rich countries can't buy the generic drugs as their governments uphold patent rights of the global drug giants that invented the anti-AIDs cocktail's ingredients.
Still, other Indian generic drug firms are working on getting their plants approved by international drug authorities. And Indian drugmakers such as Ranbaxy Laboratories, Aurobindo Pharma and Hetero Drugs already supply anti-AIDS drugs at similar low prices as Cipla.
Patents hold back growth
The patents for the drugs in Cipla's Triomune cocktail -- lamivudine, stavudine and nevirapine -- are controlled by GlaxoSmithKline, Bristol-Myers Squibb and Germany's Boehringer Ingelheim respectively, but Indian laws allow firms to produce them as long as they use different manufacturing processes.
Hamied's gesture of offering drugs at one-thirtieth the multinationals' prices has caused them to drop prices albeit reluctantly. The WHO estimates prices are down 95 per cent, but they are still nowhere near generic firms' prices.
Generic supplies are hindered in countries that uphold intellectual property rights if an innovator has registered patents for its drugs there.
A deal to let poor countries buy cut-price generic drugs for AIDS and malaria stalled late last year when the United States effectively blocked an agreement saying it would undermine patent protection for big drug firms.
"Indian pharma companies are well placed to manufacture most of the anti-retrovirals available in the international markets," said Lanka Srinivas, director at Aurobindo Pharma.
"But patents from originators are not allowing the supplies of generic anti-AIDS drugs in some highly HIV-prone countries."
A worldwide problem
Earlier this year the US government announced a surprise $15 billion package spread over five years to help treat AIDS in Africa and Haiti, including buying drugs from generic suppliers like Cipla.
There are roughly about 40 million AIDS patients in the world and about one-third of them need HIV treatment. Africa, with about 10 per cent of the world's population, accounts for nine out of every 10 new cases. India is catching up and is tipped to bear the unenviable title of AIDS-capital of the world in a few years.
The international community has set a target of treating just three million HIV-infected people with ARVs by 2005.
Late last month, the WHO and the United Nations met with generic firms around the world and the drug makers agreed to work on bringing down prices further, simplify dosages and keep up a sustainable supply of key medicines.
"The Global Fund for AIDS tries to supply to governments but much more effort is required from the richer nations," said the WHO's Hogerzeil. "Ideally some $10 billion is needed to do really effective work. But the global fund has only $2 billion."
Other Indian firms
Drugs from Cipla and Ranbaxy are already on the WHO's list of pre-qualified medicines and Hyderabad-based Aurobindo and Hetero are working on getting their facilities approved.
Anti-AIDS drugs make up less than 10 per cent of Cipla's estimated Rs 16 billion in revenue this year.
Ranbaxy's ARV's are presently sold in 13 countries including Brazil, Cameroon, Nigeria, Ethiopia, Cambodia, Zambia and India and the company is gearing up to treat 500,000 to one million AIDS patients over the next 18-24 months.
Hetero, which has the capacity to manufacture 10 million tablets and 20 million capsules of anti-AIDS drugs per month, started producing them four years ago, and exports them to Brazil, Argentina and some African countries.
Cipla has enough capacity to produce the anti-AIDS drugs, but Hamied says he has shifted production to other drugs today because of lack of demand.
"What we are saying is that unless the governments take part and there is guaranteed predictability (of demand), there is no incentive to produce and supply these drugs," Hamied said. "If I am giving it at a humanitarian price, then we should have guaranteed predictability, and payment."