There are tens of thousands of lawyers working for the pharmaceutical industry around the world. Along with general counsel-type duties, they are managing regulatory filings, filing patent claims, challenging and litigating patent claims, lobbying Congress and state legislatures and governments around the world, influencing intellectual property treaty negotiations, defending claims of negligence and much more. These attorneys are generously compensated and those at the top of the field, working as chief legal counsels for Big Pharma companies, are exceptionally well paid.
Unfortunately, representing the interests of Big Pharma often puts you on the wrong side of public health debates.
A public interest career offers a different pathway.
Consider the case of global access to HIV/AIDS drugs. In this story, a very small number of advocates (including me) overcame the monopoly-protecting efforts of the legions of Big Pharma lawyers. These advocates weren’t paid particularly well for this work, at least not by the standards of industry lawyers or big firm jobs, but they did manage to facilitate global access to life-saving treatments that have saved nearly 20 million lives.
Here’s the thumbnail version of this history.
In 1987, the U.S. Food and Drug Administration approved the first antiretroviral drug to treat HIV/AIDS. By the mid-1990s, people with HIV/AIDS in the United States were able to begin taking combination therapies that achieved remarkable results. People with HIV/AIDS – mostly gay men, at the time – talked of the “Lazarus effect,” as patients came back from the brink of death and were able to resume normal lives.
At the same time that these treatments were achieving miracles in the United States, HIV/AIDS was fast spreading across the developing world and especially in Africa. By 1999, there were more than 33 million infections worldwide, more than two-thirds of them in Africa – and the epidemic was gaining steam. There were just shy of 6 million new infections that year, with roughly two-thirds in Africa. The disease was reversing gains in life expectancy and child mortality.
The world had the treatment to stop people from dying (and to help stop the spread of the disease, because treatment reduced viral loads and transmission). But people in Africa and across the developing world weren’t getting them. The reason was simple: price.
Thanks to patent and monopoly protections, antiretroviral treatment in the United States and rich countries cost $10,000 or more a year per person – and drug companies imposed the same charges in poor countries. In nations with per capita incomes of, say, $800, $10,000/year drug treatments were simply out of reach for all but the tiniest fraction of elites. So, lots of people died.
My colleague Jamie Love – an economist and something of a self-trained lawyer – was probably the first to recognize that the problem wasn’t really poverty, it was the monopoly prices imposed by Big Pharma companies.
A small cadre of allied advocates (me among them) started talking about “compulsory licensing” – a legal means for governments to compel patents holders to issue licenses to patented technologies. In short, what compulsory licensing offered was a way to introduce generic competition while drugs were still patent protected. We joined forces with AIDS activists in the United States, outraged that the medicines keeping them alive were not available to everyone. Soon, we linked up with allies and activists around the world, including international organizations like Doctors Without Borders and awe-inspiring patient groups like the Treatment Action Campaign in South Africa.
Yet even as an international movement developed, there remained only a few dozen lawyers and experts providing the technical underpinning of the global demand for treatment access.
In 2001, Jamie, a few others and I met with Dr. Yusuf Hamied, the head of a high-quality generics manufacturer in India called Cipla. Hamied confirmed for us that the cost of manufacture of HIV/AIDS drugs was trivial compared to what Big Pharma was charging. Soon after, Cipla announced that it would make treatment drugs available for less than a dollar a day. Today, generic HIV/AIDS treatment cost $100/year or less.
The Cipla announcement spurred changes across the world. At a dollar a day, donors believed that they could start to provide funding for scaled up treatment. The United States created the President’s Emergency Plan for AIDS Relief (PEPFAR) and countries around the world created the Global Fund to Fight AIDS, Tuberculosis and Malaria. Over nearly two decades, these funds have channeled tens of billions into HIV/AIDS treatment. Developing countries found ways to work around patent barriers, though compulsory licensing or other means, and found the political spine to stand up to Big Pharma’s intimidation tactics.
These things weren’t simple and they didn’t happen overnight – though, looking back, things did move fast after the breakthrough Cipla announcement. All along the way, it was a small band of advocates that drove the policy changes, in the United States and around the world.
Something like a quarter century after we began these advocacy efforts, the results are clear: 20 million are receiving life-saving treatment, the vast majority of whom would have been denied that care if Big Pharma monopoly protections remained in place.
That’s the reward for public interest lawyering.
Robert Weissman is the President of Public Citizen.