Are drug donations by pharmaceutical companies evidence of their social commitment or are they just another marketing technique?

In mid-2002, the German multinational Boehringer Ingelheim got much publicity following its announcement that it would donate the drug nevirapine to developing countries for programmes preventing maternal–foetal transmission of HIV. Company spokespeople stated that this donation was a response to the AIDS crisis in South Africa.

However, this donation was actually a clever response to growing global criticism of companies producing drugs for AIDS. These drugs are sold at exorbitant prices which deny life-saving treatment to the majority of those who need it. Further, multinational companies and the governments of developed countries have been accused of undermining the efforts made by developing countries to provide access to drugs through compulsory licensing and parallel imports.

Indeed, there are many strings attached to this offer:

• Though the drug can be used to treat adults, the company’s offer is limited to one-dose therapy at the time of delivery. So children who do not get infected will be orphans very soon as a result of this ‘free drug’ because their mothers will get no treatment.
• This offer is not available to countries implementing compulsory licensing and parallel imports—internationally accepted legal procedures by which countries may either manufacture life-saving drugs or import them at the best possible price, irrespective of their patent status. In this way, the company tries to restrict the rights of developing countries.
• The donation ends in 2006—the deadline the World Trade Organization has set in the TRIPS agreement for least developed countries to implement patents for drugs. It is hard to believe that this is a coincidence.

Further, the safety of nevirapine is not well-established. Though potentially useful, it can also have severe unwanted—sometimes lethal—effects. Nevirapine is not yet licensed in Europe and the USA for preventing mother-to-child-transmission of HIV. So the donation could also be interpreted as a large but not well-controlled trial of the drug.

Boehringer Ingelheim colluded with the German government by announcing a ‘public–private partnership’ for the mother-to-child HIV–transmission programme. According to the government’s calculations, the limited use of nevirapine in three African project areas will cost approximately six million German marks per year. The company contributes a fraction of the cost of the entire project, and receives a good deal of publicity for this. Buko Pharma–Kampagne, Germany (www.bukopharma.de), initiated a letter campaign against Boehringer Ingelheim and the German government telling them to stop this unhealthy donation.

It is difficult to convince the public—and even the medical profession–of the damage done by such donations. Most would say, ‘Let people have something; they are dying without medicines now.’ Often people are blinded to the politics behind drug donations—the Boehringer donation is one such example.

In general, drug donations are likely to create expensive interventions that are not integrated into healthcare systems and take money away from a comprehensive healthcare approach. Drug donations help corporates build their image, control the market, or get tax exemption from the government. They don’t help people.