Governments make us sick!

Yet another boring report on a boring topic sounds pretty boring. But the World Health Organization's study of drug patents distracts from the real health problems of the poor and will lead to yet more pointless rules and initiatives. For the poor, the real barriers to medicines and treatment are tariffs, bad infrastructure, government meddling and poverty.

The WHO, however, has a culprit for poor healthcare: the drug companies that invent new cures and that protect those discoveries with patents to cover their (gigantic) costs. The forthcoming report by its Commission on Intellectual Property Rights, Innovations and Health (CIPIH) hopes to alter that with some vague notion of government intervention.

This meddling is not just irrelevant, it is damaging to medical research and therefore damaging to the poor. Worse, it gives incompetent and corrupt governments an excuse to point the finger elsewhere.

In fact, even if all medicines were free, most poor people would still be denied them. As for patents themselves, just 2% of the WHO's own list of essential medicines are still under patent.

The truth is that up to 50% of people in parts of Africa and Asia have no access to medicines because of bad official policies described in the international “Civil Society Report on Intellectual Property, Innovation and Health”, published by 15 organizations. The real problem is getting many cheap and available medicines to the people who need them: it is the problem of under-development, roads, educations (health staff), communications (health campaigns) and government (corruption, inefficiency and tariffs). The real cure is prosperity.

Intellectual property is the wrong battle: patented medicines affect a tiny number of diseases of the poor. The biggest killers such as diarrhoea and lung infections are a question of education and way of life: no drug can prevent infection if you drink downstream from a village that chucks its waste in the river; no drug prevents you inhaling smoke from the dung or wood that you have to use for cooking.

When it is not your way of life killing you, it is your government: malaria is hard to fight in a country where the government (under the influence of the WHO) has refused to use DDT for decades; cures are complicated and, unbelievably, most governments tax those medicines.

Tariffs and taxes on medicines in Congo-Kinshasa, Morocco and Zimbabwe, for instance, are 39.5%, 18.3% and 22.5% respectively, as listed in the American Enterprise Institute's recent "Taxed To Death." Brazil levies nearly 30% on imported medicines and South Africa slaps 14% sales tax even on AIDS drugs. These costs drive many to traditional quack cures or to cheap counterfeits.

On top of that, inefficient and corrupt countries make registration of new drugs lengthy and expensive, so that some companies just do not bother trying.

Another barrier is good intentions. Price controls on drugs are alleged to help the poor but in reality, they restrict supply by making it uneconomical for pharmacies to stock them. Even in relatively well-off South Africa, price controls have closed scores of rural pharmacies, leaving thousands with no supply of medicines at all.

Last year, AIDS campaigner and former president, Bill Clinton, underscored the reality of aid to poor countries: “You just can‟t get the medicine, ship it into a country and drop it from the sky. If it is going to save people‟s lives, the medicine must be accompanied by instructions, monitoring, by follow-up and changing the medicine if necessary.”

But Sub-Saharan Africa averages 12.5 doctors per 100,000 people, with dilapidated or non-existent health structures in most countries. Tanzania would have to find nearly 10,000 more workers to address the rising needs of HIV/AIDS patients and three times that number to meet the UN‟s Millennium Development Goals.

In Malawi, there are only three for every 100,000 people. Bad roads prevent the delivery of medicines to rural areas and there is inadequate storage and refrigeration for drugs.

As for the cost of patented drugs, most patent-holders already operate “differential pricing”. Abbott offers the AIDS retroviral, Kaletra, for US$1.17 in Brazil but US$4 in the USA. But Brazil still threatens to break the patent, saying it can copy it for US$0.41: maybe it can, but who will then invest hundreds of millions of dollars in researching the next anti-retroviral when the virus becomes immune to Kaletra?

Without that research, everyone will suffer, and as ever, the poor will suffer most. Pressure at the WHO and the World Trade Organisation to break the patents on drugs deemed “essential” has serious repercussions for poor people. It does not just undermine research in the future, but also boosts the market for fake drugs right now. Counterfeits already threaten all poor countries, reaching 50% of the market in Nigeria.

Counterfeits, quack remedies and trafficking in expired drugs thrive where there is disregard for the rule of law. That disregard is part of what keeps people poor. To really tackle disease, Africans need to become richer because wealth and health are directly linked.

But that cannot happen without freeing them to plant, manufacture, trade and innovate freely under the protection of the law. Prosperity would then become the bulwark against disease.

Without those changes in the oppressively bureaucratic and corrupt regimes of poor countries, health aid can only remain permanent emergency assistance, keeping Africans reliant on handouts while stifling our self-reliance.