Of the 42 million people with HIV worldwide, only 1 million are receiving drug treatment. At the same time, worldwide infection rates are rising; 14,000 people are newly infected with the virus each day. There is an urgent need to develop more powerful and more affordable drugs to treat the disease, and to continue to work on a cure.

 

Yet many drug companies, especially the smaller ones that made many of the past breakthroughs, are leaving the field. In 1997, there were 83 companies working on AIDS research. In 2003 the number had dropped to 60. Over the same period the number of compounds under development fell from 128 to 83.

 

You can hardly blame the drug companies for running. AIDS drugs yield low returns when compared with drugs for cancer, hypertension, heart disease or even erectile dysfunction. Among people who have money and insurance, millions more suffer from those ailments than from AIDS.

 

Moreover, as populists push to lower AIDS drug prices and restrict patents around the world, drugmakers can expect profits from HIV medications to fall even further. Says one industry executive: "We have lost the battle with the activists, and now the market is less profitable. The result is that we are spending less R&D time on antiretrovirals. Why bother to innovate these products when any advance will not be profitable?" Yes, some important large players like Merck and Pfizer remain. But if you were a venture capitalist, you would have little incentive to invest in HIV research.

 

So what to do?

 

An unconventional answer: a combination of patent extensions and guaranteed markets. Here's how patent extensions would work: If a company were to develop a new HIV drug, it would give up the patent voluntarily in the developing world, or perhaps worldwide. As a quid pro quo, the government would grant it an extension on the patent of any drug of its choice in the U.S. for a set period of time. For instance, Pfizer could choose to lengthen its patent on Viagra. A two-year patent extension on a blockbuster drug like this could earn Pfizer enough to make it profitable to spend scarce R&D time on developing a new HIV medication.

 

While this is an elegant solution to the HIV drug development problem, it's doubtful that it will fly in an election year, when high U.S. drug prices, made even higher by other kinds of patent extensions, are toward the top of the political agenda. But when the election dust settles, this solution should be considered in earnest.

 

The other option is guaranteed markets. President Bush's $15 billion Emergency Plan for AIDS Relief, announced in January 2003, calls for spending a significant sum buying HIV drugs that the plan will then distribute in developing countries. The Administration should only buy drugs from pharmaceutical companies that are investing a certain amount in original research on new HIV medications. That would guarantee a multimillion-dollar market for new AIDS drugs. Congress should pass legislation mandating that this guaranteed market extend for at least a decade, given the long time it takes to develop new drugs.

 

The Administration should pressure other countries to follow suit. It should demand, for instance, that the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, which purchases drugs for poor countries and is funded 36% by the U.S., only buy HIV drugs from companies engaged in original AIDS research.

 

Beyond those two ideas, we should, as others have suggested, cut taxes for companies working in the HIV field and lower the cost of testing new drugs. But with the virus rapidly developing resistance to existing drugs, it is vital that researchers discover new therapies. If researchers are to develop new drugs, it is essential that companies be able to utter "profit" and "AIDS" in the same sentence. If not, the sentence future AIDS patients will face is death.