Toby Kasper, the head of the Access to Essential Medicines Program for Doctors Without Borders who worked with Kapczynski in her fight, said, "The developments at Yale could not have happened without Amy Kapczynski. She was driving things there and did a great job just getting out there and talking to the right people." Speaking from his office in Cape Town, he hailed the decision as "historic. A company has never given up its patent for a drug like this. Universities make a lot of money on these patents, so they're hesitant to give up their right. But Yale acted out of fear of public relations and the fear of a student uprising. Besides, AIDS is a graveyard for corporate P.R., and it's an area that could cause potential harm to a university's P.R." With her close-cropped brown hair, pierced eyebrow and penchant for wearing Carharrts and T-shirts, Kapczynski looks more like a prototypical activist than a lawyer. But it was her research ability, media savvy and negotiating skills that helped broker the deal. Kapczynski is no newcomer to the field of AIDS-related legal issues -- she worked for an AIDS organization in London after studying at Cambridge as a Marshall scholar and worked as a researcher on a CBS "60 Minutes II" special on the AIDS epidemic in Africa. She had seen the devastation AIDS has wrought in South Africa during a trip there on behalf of a human rights organization at Bard College.

Doctors Without Borders' Kasper met Kapczynski at the AIDS conference in Durban. His organization had sought permission from patent holders of AIDS drugs for South Africa to import or produce generic versions, using Brazil as a model. In Brazil, less restrictive intellectual property laws allow for the generic production of HIV drugs: More than 100,000 patients there are being treated with a generic cocktail manufactured by Brazilian companies. The Indian generic drug manufacturer Cipla has said it could produce a three-drug cocktail for $1 a day per patient in South Africa. The cocktail, which is made up of a generic version of Zerit and two other anti-retroviral drugs, would cost $350 a year per patient -- a fraction of the $10,000 to $15,000 that patients in the United States or Europe must pay for the treatment. DWB's strategy was to press its case directly with the universities and corporations that hold the key-use patents for the drugs it needed.

Kasper learned that Kapczynski was in law school and was interested in working with the organization on legal issues that people with HIV or AIDS face -- family law, rights, access to healthcare, intellectual property and other problems. After Kapczynski returned to New Haven, Kasper contacted her and another Yale student he knew from his undergrad days at Harvard, Marco Simons, by e-mail, alerting them that he planned to send a letter to Yale requesting that they grant a d4T license to his organization. He asked them to help mobilize faculty and students.

Kapczynski's first move was to identify potential university allies. Of these, the most crucial proved to be the compound's inventor, Dr. William Prusoff. Going into the meeting with him, she had no reason to be wildly optimistic. The 80-year-old pharmacologist, who had discovered that d4T was an effective AIDS medicine in the 1980s, had made millions off the patent, and often scientists are unwilling to pressure pharmaceutical companies, which provide them with funding and revenue opportunities. "We didn't expect him to be as friendly and receptive as he was," she recalls. But Prusoff turned out to be not only receptive but downright outspoken in his support of the students.

Meanwhile, Yale had rebuffed Doctors Without Borders' request. Jon Soderstrom, managing director of the Yale Office of Cooperative Research, which manages patents held by the university, sent a Feb. 28 letter to the group stating, "Yale has granted an exclusive license to Bristol-Myers Squibb, under the terms of which only that entity may respond to a request." The d4T patent has been a cash cow for Yale, which nets about $40 million a year from its licensing agreement -- almost all of that money coming from developed nations like Germany, the United States and France.

Kapczynski began doing legal research, trying to find out the terms of Yale's licensing agreement with Bristol-Myers Squibb. She met with School of Public Health dean Michael Merson, who formerly headed the AIDS program of the World Health Organization and, Kapczynski believed, would be sympathetic to DWB's request. Through another professor, Kapczynski requested a copy of the contract the university had with Bristol-Myers Squibb, which officials declined to release. At the same time, she put reporters at the Yale Daily News on the trail of the story. The student paper published its first story on the subject on March 2. "The story had a strong mobilizing effect," says Kapczynski. A group of students in the Graduate Student Union -- which had already been campaigning against Yale's relationship with corporate sponsors -- circulated a petition calling on the school to ease its patent. They managed to collect 600 signatures from students, professors and researchers on campus. The students also assailed Yale for its close ties with BMS -- the company donated $250,000 to the school in 1999.

Looking back, Kapczynski says that she didn't realize in the middle of the struggle just how big the stakes were. "[At first], the project just felt like something on our task list. It absorbed lots and lots of time. We were just trying to figure out how to make things happen, and we were doing it on the fly," she says. "We didn't realize how big of a deal it could potentially be."

On March 9, armed with Kapczynski's research into the licensing contract and with help from members of the Yale AIDS Action Coalition (of which Kapczynski is a member), Kasper wrote back to the university, arguing that the deal violated Yale's own licensing provisions, which require that such deals "benefit society in general" and that they "protect against the failure of the licensee to carry out effective development and marketing within a specified time period." By ignoring 90 percent of the market for d4T, Kasper argued, the university was not serving the public interest.

As the negotiations between the university and Bristol-Myers Squibb continued, Prusoff jumped into the fracas, telling a New York Times reporter in an interview on March 11 that he would "strongly support" the campaign by students to relax the patent in order to enable wider distribution in South Africa. "I wish they would either supply the drug for free or allow India or Brazil to produce it cheaply for underdeveloped countries," he told the Times. "But the problem is, the big drug houses are not altruistic organizations. Their only purpose is to make money."

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