An Interview with Cipla's Yusuf Hamied—Indian Drug-Maker Leads the Charge for Low-Cost AIDS Drugs
Dr. Yusuf K. Hamied
March 2003—Dr. Yusuf K. Hamied burst onto the world stage in February 2001 when his company, Mumbai-based Cipla Ltd., offered a three-drug anti-HIV regimen to poor African countries and aid groups like Médecins Sans Frontières for $350 a year-one thirtieth of the standard price. After receiving his Ph.D. in organic chemistry from Cambridge University at the age of 23, Dr. Hamied joined Cipla as a research officer in 1960. He has been Managing Director of the company since 1972 and Chairman since 1989. Dr. Hamied agreed to be interviewed for this first issue of the TREAT Asia Report.
TREAT Asia Report: Can you tell us about Cipla?
Dr. Yusuf Hamied: Cipla was founded in 1935. From our inception, our whole philosophy has been based on self-reliance and self- sufficiency. Post-independence, in the 60s, we fought very hard to have our patent laws changed. The basic principle was that we were not against patents; we were against monopoly. Since 1972, Indian Government policy has dictated that, in two areas—food and health—you cannot patent a product; you can only patent a process. And for a period of just seven years. When this policy was initiated in 1972, the multinationals controlled 85 percent of the Indian pharma business. Today, Indian companies control 85 percent of it. We are now a large exporter of pharmaceuticals.
TA Report: What are Cipla's annual revenues?
Hamied: Our total revenues are about U.S. $350 million. Sixty-five percent of this is from sales in India and 35 percent from exports. We produce at least 30 times the volume that figure would represent in America because the medicines we sell in India for a dollar cost between $20 and $30 in the U.S.
TA Report: How large is the pharmaceutical market in India today?
Hamied: Domestically, it's about $4 billion, and exports total about $2 billion. In terms of HIV, we produce antiretrovirals for about 20,000 patients. Of these, 5,000 to 10,000 are in India. So our total HIV business is about $6 to $7 million a year and growing.
TA Report:That's comparatively low, considering all the publicity you've gotten. Do you expect this number to increase significantly?
Hamied: I'm preparing for that. We have four criteria for HIV drugs. They must be effective, affordable, production must be sustainable, and we must be able to predict demand. If I had to supply two million people with HIV drugs at $300 a year, I would need at least a year to build up the capacity, and it would also require considerable financing. We need to partner with governments to do this.
TA Report: Which drugs do you produce?
Hamied: AZT, d4T, 3TC, ddI, nevirapine, and efavirenz. We have the know-how to produce others like abacavir. We make and also buy some of these from other countries. For example, the Koreans and the Chinese are extremely good in their manufacture of AZT. There is room for everybody in responding to HIV. It has to be a team effort between the multinationals and the so-called generic companies. We are now producing a combination of three drugs, called "Triomune," which includes d4T, 3TC, and nevirapine as two tablets a day—one in the morning and one in the evening.
TA Report: This is a combination you can't get in North America or Europe?
Hamied: That's right. Legally, I can produce all three as each individual drug comes from a different company.
TA Report: So you might be in the unusual situation of having a higher standard of care in a developing country than in rich countries?
Hamied: Exactly. That's what the multinationals don't like, and they oppose us like mad. All of Cipla's factories have been inspected and approved by the World Health Organization, and that's very important because nobody can point a finger at us and say that our drugs are not on par with what's available abroad. Last week we introduced a combination kit of two tablets and a capsule, to be taken simultaneously once a day under the name Odivir. These three contain 3TC, efavirenz, and sustained-release ddI. Now, that combination is more expensive—just under $3 a day. But we will introduce Triomune as a once-a-day combination kit for just over $1 a day.
TA Report: About 4 to 5 million people are infected with HIV in India, but only 5,000 to 10,000 people are being treated. Why the gap?
Hamied: Do you know that 90 percent of cancers in India are detected in the last stage of the disease? HIV is also not detected in most people. Here, it is detected by way of the opportunistic infections that the virus causes. A close friend of mine died of AIDS and never even knew he had HIV until he got sick from tuberculosis. In India, we don't even know how many TB patients have HIV. Detection is not done until it's too late. So HIV is still a silent killer, like breast or prostate cancer.
TA Report: What needs to be done in countries like India to significantly increase the number of people getting treatment?
Hamied: Increasing awareness, counseling, and testing are vital.
TA Report: But why would people get tested when there is no assurance, if they're HIV-positive, that they're going to get access to treatment?
Hamied: Because you are going to infect others. Any person who enrolls in a hospital or goes to a doctor should be tested. To get a driving license or a passport, you should be tested. In countries like Singapore, when you apply for a visa, you have to have an HIV test. Many things can be done when you're waging war against a pandemic that affects humanity.
TA Report: That's pretty controversial.
Hamied: Maybe. But I believe every avenue has to be looked at. I'm not saying done, but looked at. When I enter a country like Mauritius, my blood is checked for malaria. Every time I go there from India, the next day the man from the Ministry of Health comes to my door and tests me for malaria. So I asked the Deputy Prime Minister of Mauritius, "If you're testing me for malaria, why don't you also test the same blood sample for HIV?" I'm just throwing ideas at you—I'm not saying it should or should not be done. We need a brainstorming debate on this issue.
TA Report: Is there the capacity in India to deliver AIDS drugs in a knowledgeable way?
Hamied: Cipla is running workshops for doctors and nurses. We are teaching the doctors what to look out for. When a patient is detected as being HIV positive, counseling is essential. We urgently need initiatives like TREAT Asia to develop guidelines for treatment and to provide training for health care workers. We have done it in our workshops with doctors. But these are our guidelines.
TA Report: Are you concerned that if these drugs are not used properly, widespread drug resistance will emerge?
Hamied: There's a Jewish phrase that says, "If you can save one life, you've saved the world." But we do believe that these drugs need to be used properly, and that's why we desperately need to train and educate people about how to use them. I say that a person should do what he does best. We are best at producing medicines at affordable prices. Let us do our job—let others do theirs.
TA Report: What do you think of what the WTO is doing on compulsory licensing?
Hamied: In November 2001, the WTO agreed on two things. One, every country can decide for itself what is a national crisis or national emergency. And two, every country has the right to grant compulsory licenses. In India, we have 80 million cardiac patients, 60 million with diabetes, and 50 million people who suffer from hepatitis B. We could have 35 million people infected with HIV by 2010. And one in three Indians has latent TB. Because of this, health care is a permanent crisis in India. It is not an emergency; it is a permanent crisis. So we need permanent compulsory licensing laws. Which means what? It means we respect patents. and we will pay royalties to the patent holders for all drugs. In India, with a population exceeding 1.2 billion, we simply cannot allow companies a monopoly.
WTO also declared 49 countries to be "least-developed countries." But they have no definition of what a least-developed country is. The UN looks at it as gross national product per capita. According to the UN, no country with a population exceeding 75 million can be classified as least developed. Can you believe that? Today, only six percent of Indians finish high school. India has only 0.4 to 0.5 percent of world trade, and by 2012 that may reach one percent. Ninety percent of the country is least developed. Just because ten percent is super-developed doesn't mean that India is a developed country. We are a continent, not a country.
TA Report: Why not have different rules for AIDS drugs and so-called "lifestyle drugs" like Viagra?
Hamied: It's not about Viagra per se. It's what it costs to make a pill of Viagra and what price is being charged. Do you know what the price of a Viagra equivalent is in India today? About twelve cents per tablet, against $10 in Europe or the United States.
TA Report: The multinationals say that they are investing a significant amount of money in R&D to develop new, better HIV therapies. Why shouldn't they be able to profit from this?
Hamied: Much of their investment is not in really new types of drugs. For the really innovative, risky, conceptual research, they need to make a reasonable return and that needs to be protected. I agree with this, but 90 percent of all so-called pharmaceutical research is in "me too" drugs, and if there is a blockbuster, every effort goes into protecting it indefinitely.
TA Report: But should developing countries like Brazil and Thailand that are comparatively better off get what some might call a "free ride" in terms of these drugs?
Hamied: But many of the HIV drugs—AZT, d4T, 3TC—were not developed by the big companies. If you look at the world's top 50 drugs, more than half of them are not original products of the companies marketing them. They are all licensed. When it comes to diseases like HIV, we are willing to pay the inventors a royalty. I cannot accept a monopoly situation for these drugs in the context of a health crisis.
AZT was invented in 1963. It is covered under patent in the U.S. until 2005. Now it is used mainly in combination with lamivudine. Do you know when the combination patent of lamivudine with AZT expires? In 2017. Protection for 54 years—is that what intellectual property is all about? And then the companies sometimes go to court to extend the patent or to add new, extremely technical patents to extend their rights by way of analogues, enantiomorphs, newer polymorphs, or salts, etcetera.
TA Report: What should governments in Asia be doing to provide greater access to HIV treatments?
Hamied: What has happened in the two years since Cipla first announced a price of $300 per year, per patient? Very little. WHO and UNAIDS haven't done much. Even MSF [Médecins Sans Frontières] and the big activists—what have they really done? One or two countries have acted, like Malawi, Senegal, Cameroon, Zambia, Nigeria, and maybe Namibia and Botswana, in their own limited way. By and large, very little has been done—unlike in Brazil.
TA Report: Three years from now, how many people in developing countries will be getting effective treatment for HIV?
Hamied: I would say one to three million people in developing countries worldwide. That's the upper extreme figure. And the could be 60 million people living with HIV by 2010, so only 5 percent of that.
TA Report: Dr. Hamied, thank you for your time.