But the shipment comes four years after Canada launched its Access to Medicines Regime, and the reaction has been far from positive.
Generic companies say the four-year delay, caused by excessive bureaucracy, means the first shipment may also be the last.
The Canadian HIV/AIDS Legal Network was relived that the shipment was finally sent but called on the new federal government to amend the Regime after the elections next month.
"The delivery of these medicines is way past due," said the Network's executive director Richard Elliott. "It's taken more than four years to get to this point. People are dying because they can't pay high prices for patented, brand-name drugs - they can't afford such delays."
On November 6 2003, Canada became the first country to begin implementation of the WTO Decision regarding the Doha Declaration. The Decision implements paragraph 6 of the Doha Declaration on the TRIPs Agreement and Public Health and waives countries' obligations under Article 31(f) of the TRIPs Agreement.
Article 31(f) of TRIPs limits the ability of countries that cannot make pharmaceutical products to import generic products from countries where pharmaceuticals are patented.
The Decision therefore allows any member country to export pharmaceutical products made under compulsory licences within the terms set out in the Decision.
Canada's Access to Medicines Regime was created in May 2004 and its main aim was "to facilitate access to pharmaceutical products to address public health problems afflicting many developing and least-developed countries, especially those resulting from HIV/AIDS, tuberculosis, malaria and other epidemics".
In simple terms it permits the government to declare a compulsory licence to manufacture and export a generic copy of a drug to a less-developed country that cannot make the drug itself and which has a public health crisis.
After some tender offers, the government of Rwanda decided to buy a low-cost AIDS drug, Apo-TriAvir, from Ontario generic pharmaceutical manufacturer Apotex. The drug is a combination of three patented drugs and is produced under a compulsory licence. It has received WHO approval.
Apotex claims it is making the drug available at cost price and is shipping enough medicine to Rwanda to treat 21,000 people for a year at a cost of 39 cents per daily dose.
It is not permitted to sell the drug in Canada.
But Jack Kay, president of Apotex, warned that the Regime needs to be changed. "While we are extremely pleased to be able to make this important and historic contribution, there is a reason no other company has tried to provide medicines under this regime. It is too complex and has to be repeated for every request that comes in from a country. For Canada to truly be able to provide help, the regime must be changed. Apo-TriAvir will save lives the moment the patients have access to it but it is now up to the federal government to fix CAMR," he said.
Elliot warned this might the first and last shipment. "The Regime risks becoming a one-hit wonder if Parliament doesn't cut through the unnecessary red tape. Canadian generic drug makers and people who do drug procurement in developing countries are saying it's unlikely that they will try to use it again because it's too cumbersome."
Once Apotex agreed to send the drugs all the parties were embroiled in red tape followed by four years of delays and negotiations.
