ACCRA, Ghana -- Should poor governments be allowed to break drug patents for humanitarian reasons?

That question is front-and-center at a major public health conference sponsored by the World Health Organization that started on 28 April in Geneva.

Top-notch policy experts from around the world have gathered to make formal policy recommendations about patents to Third World governments struggling with disease. Many will claim that patents allow Western drug companies to keep drug prices artificially high, and that patent-breaking is a cheap and easy way to get poor patients the drugs they need.

They’re wrong on both counts.

For starters, the drugs needed in the developing world aren’t patent protected. A 2004 study published in the journal Health Affairs showed that less than 2 percent of the 319 prescription drugs on the WHO’s Model List of Essential Medicines are actually under patent.

What patients in the Third World need aren’t patent-busting bureaucrats, but more roads, doctors, hospitals, nutritious food, and good sanitation. When roads are in disrepair, it can be particularly difficult to reach rural populations, where disease burden is highest. In places with no electricity, temperature-sensitive pills often go bad before anyone can benefit from them. Refrigerated Coca-Cola vans have been shipping polio vaccines to the hinterlands of Cameroon, because most roads are unmotorable. Even if roads were available and medicines were donated, they must be prescribed by qualified medical staff. Patients will also need good drinking water and a good meal to enhance recovery from disease. However, the doctor-patient ratio is abysmally low and close to 60 percent of Africans do not have access to good sanitation and many subsist on less than a dollar a day.

Patents are actually a critical part of the solution. They protect the financial incentives that drive pharmaceutical companies to create innovative medications in the first place.

It takes an average of US$800 million and 10-15 years to bring a new drug to the market. Patents ensure that pharmaceutical companies can recoup that enormous investment.

If countries start breaking patents, though, firms lose out on sales. And they’re less able to finance the development of new cures. That’s a blow to the public health efforts of all countries, rich and poor. Ghana’s health Minister told me that he fails to see how people could hold antagonistic positions against pharmaceutical companies, because in his own words "if drugs are being made, then people must be sick somewhere-it is not for charity".

Poor patent enforcement also gives rise to potentially harmful copycats.

The generic pharmaceuticals manufactured in the developing world often don’t comply with international safety regulations. Low-quality and counterfeit drugs are common.

The WHO estimates that 10 percent of the world’s drugs are counterfeit. Patent-theft is making the problem worse.

It’s also important to realize that drug companies are not as blindly self-serving as many anti-patent groups portray them to be. Global pharmaceutical companies have worked for years with groups like the WHO and the UN Children’s Fund to lead the fight against HIV/AIDS, malaria, tuberculosis, and other diseases plaguing the developing world.

Just a few months ago, Pfizer, GlaxoSmithKline, and Merck donated $450 million in medicines to Burkina Faso, one of the poorest countries in the world. These sorts of philanthropic efforts are less likely if drug companies start struggling just to break even.

Many important steps need to be to taken to improve medical care in the Third World. Despite what the health activists are saying, stealing drug patents and stifling the creation of life-saving medicines is not one of them. It seems that a sensible route to take would be dialogue with pharmaceutical companies for differential pricing for developing world markets while making every effort to improve the well being of citizens. Open, decentralized and transparent government, lower trade tariffs, free speech, the rule of law, relaxed business entry and exit rules, property rights, and freedom to contract and freedom from contract would be important to help poor citizens buy their own health insurance against diseases.

Franklin Cudjoe is executive director of IMANI Center for Policy and Education, a think-tank located in Accra, Ghana. He spoke at the IGWG conference in Geneva on 28-29 April, 2008.