Bitter Pills

The AIDS drug Ziagen has brought healthy windfalls to the University of Minnesota and GlaxoSmithKline. But it isn't doing anything at all for the millions who are dying of the disease in Africa.

Critics argue that there is another, unspoken reason for universities' reticence: Defying drug companies could have a chilling effect on corporate funding.

Still, the debate over Ziagen has inspired some institutional soul-searching: For the past few months, Mark Rotenberg has been meeting quietly with GlaxoSmithKline officials to discuss the university's options. The talks, he says, are partly concerned with protecting Glaxo's trade secrets from public scrutiny. But he says he has also questioned company representatives about Ziagen's affordability and availability in Africa.

Rotenberg believes the experience may lead to changes in the way the university licenses its inventions. "There needs to be a clause in these agreements to deal with public-health crises," he says, describing a loophole that might give the university some leeway to sublicense to a generic manufacturer if its patent comes into conflict with efforts to distribute affordable drugs in the developing world. "We don't want to be frozen into a market structure that's keeping affordable drugs off the market. It would be very worthwhile to explore that in the future."

Swarr and her fellow activists want the school to act now. If the university were to waive its patent rights in the developing world or sublicense to a generic manufacturer, she suggests that the impact could be enormous. Swarr points to the example of Brazil, which has used compulsory licensing and government-produced generic AIDS drugs to drastically cut both death and infection rates. Because Ziagen is now sold almost exclusively in North America and Europe, she notes, the school wouldn't suffer any drop in royalty revenue by allowing it to be produced generically for use in Africa.

If nothing else, Swarr adds, it would set a powerful precedent: namely, that universities are willing to stand up to industry when monopolies restrict access to essential medicines. "It's one of those rare moments when doing the profitable thing and doing the morally courageous thing aren't in conflict," she says. "The worst tragedy I can imagine would be to look back after millions of people have died and realize we could have done something more."

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