On World AIDS Day, the media was filled with images of Premier Wen Jiabao and Health Minister Wu Yi visiting AIDS patients. A few weeks later Wu Yi visited the so-called "AIDS villages" in Central China's Henan Province, some of which have an infection rates as high as in sub-Saharan Africa.

Last week, we heard about a series of tough new measures being put in place by the new State Council Co-ordinating Committee on HIV/AIDS, measures aimed at preventing the spread of HIV, as well as providing care and treatment for those already infected.

These are powerful statements from the leadership.

As one health official in Beijing put it: "This is what we have all been waiting for."

The government's new attitude is more than just symbolic. Wen and senior health officials announced a "Four Free" policy in poor and rural areas: free testing; free treatment; free school for "AIDS orphans;" and free treatment to prevent mother-to-child transmission of HIV.

If this new policy can be enacted, China will go from having one of the most closed HIV/AIDS policies in Asia to having one of the best such policies in the world.

The big question now is not whether Chinese leaders want to implement these changes - they clearly do - but how to make them a reality.

They face huge problems. China's healthcare system is inadequate, and the marketization of healthcare over the past two decades means doctors and hospitals now largely rely on drug sales for their livelihood. No money, no treatment.

If HIV/AIDS treatment is to be different, doctors will have to be convinced to put the health of AIDS patients before their own profits, and to overcome their fear of treating AIDS patients.

But one of the greatest obstacles China is facing - and one you rarely see mentioned in the headlines - is the stubborn refusal of foreign pharmaceutical companies to make anti-retroviral drugs available at an affordable price in China.

For example, GSK has patented and registered its drug Epivir (r) (also known as Lamivudine or 3TC) in China, but does not actually market it. (3TC is cheap and has far fewer side-effects than other treatments, and for this reason is the backbone of the WHO's "first-line" HIV/AIDS treatment plan worldwide.) GSK doesn't sell Epivir(r), but does sell the same chemical component in a different dosage under the name Heptodin (r) (to treat hepatitis), but at a very high price.

It sells a combination pill, Combivir(r) (3TC plus another drug, AZT), but at almost US$250 per month, so very few Chinese can afford it. Indeed, US$250 would buy more than a year's supply of an equivalent generic in India.

Why is GSK so reluctant? Market surveys show that Heptodin (r) is GSK's best selling drug in China, accounting for somewhere between US$60-80 million in annual sales. But this is business, and it would be unrealistic to expect companies not to make a profit. Still, what multinational pharmaceutical companies are doing in China is anything but healthy competition. Even if the companies lower their prices for anti-AIDS drugs - something they've been talking about for years now - there are likely to be many restrictions on those "discount" prices.

There is a better solution, however. Under the World Trade Organization (WTO) rules, China has the legal right to issue a compulsory licence and produce copies of GSK's patented medicine. They may fear this would be seen as just another case of the Chinese Government failing to respect patents, and that trade officials from Washington and London would protest strongly. On the contrary, in the words of a WHO report on the subject: "If China chooses to proceed with the issuance of compulsory licenses for some essential medicines, it will be showing its commitment to the patent system...rather than ignoring patents or engaging in underground counterfeiting..."

China should now go ahead with such a decision, and set a bold precedent in international trade. China has the technical capacity to supply not only the domestic market but the world's developing countries with cheap, life-saving AIDS drugs.

For years people have spoken of the time when China takes its rightful place in the world of trading nations.

Now it's time for that to become a reality.

(China Daily May 18, 2004)