E-DRUG: Nation: Thailand still shows the way on HIV and AIDS
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Nation, December 2, 2006
Thailand still shows the way on HIV and AIDS
Paul Cawthorne and Ashvin Dayal
December 1 was World AIDS Day. Latest figures from the UN show that numbers
with HIV and AIDS continues to rise, with 39.5 million people currently living
with HIV and AIDS around the world.
AIDS is often thought of as a predominantly African problem, but still
around one in five people with HIV and AIDS - some 7.8 million - live in South
and Southeast Asia.
Thailand has led the fight against HIV and AIDS in the Asia region, first
through its successful prevention efforts then more recently through its
determination to provide treatment to all in need. Thailand can be proud of
the fact that it is the only country in Southeast Asia that has managed to
provide anti-retroviral therapy to over half the number of people on Aids
treatment who need it.
The cornerstone of Thailand's successful treatment programme is the local
production of affordable medicines. Before generic production, the cost of
standard HIV and AIDS treatment in Thailand using patented drugs was over
Bt33,330 per patient per month, and only 3,000 people were getting
treatment. In 2002, Thailand launched a generic version of HIV triple
therapy, resulting in an 18-fold drop in the cost of treatment. Thanks to
this, over 85,000 people with HIV are today receiving treatment.
While international and Thai law both allow for the use of compulsory
licensing and other measures to override patents whenever needed, the
pharmaceutical industry, backed by the US government, has made numerous
attempts to prevent this from happening
When the Thai government first took steps to produce generic medicines in
1999, the US ambassador in Bangkok wrote a letter to the US trade
representative saying that "the Thai government certainly don't want to be
the cause of a trade dispute - which is what we have always told them would
happen if compulsary [sic] licensing clause [of the World Trade Organisation
Agreement] should be invoked". The US stated concern that this would "set a
worrisome precedent the rest of the drug industry".
A senior official at the Commerce Ministry expressed concern at the time,
saying: "If a compulsory license were to be issued, just one million people
will benefit, while the rest of the country's 61 million people will have to
pay the price if the US retaliates."
In spite of these pressures, Thailand continues to show its commitment to
putting the lives of its citizens before the interests of multinational
companies.
On Wednesday the Thai government announced that it would issue a government
compulsory licence to improve access to a key HIV medicine, efavirenz,
by producing a generic version of the drug locally. It took this step both
to improve supply and reduce the cost.
Merck, the pharmaceutical company holding the patent on the drug, has been
unable to supply the drug reliably, and as a result several hospitals have
run out of the drug and been forced to give patients sub-optimal treatment.
To prevent this from happening, Thailand needs to find alternative sources
of the drug.
Around 12,000 people are estimated to need efavirenz in the country, but
because of its high cost the number of people actually getting the drug is
significantly less. Merck currently charges Bt1,400 per month for the drug
in Thailand. This is almost double what Indian generic manufacturers charge
for the drug, and what the locally produced version will cost (Bt800/month).
Elsewhere in the region the drug is even more expensive: in China, Merck
charges Bt2,400 per month.
Thailand is demonstrating that the lives of patients have to come before the
profits of drug companies, and this policy needs to be expanded to other
essential drugs that are expensive and in short supply. One example is the
drug lopinavir/ritonavir, another HIV medicine, which currently costs
over Bt7,000 a month - far too expensive for Thailand.
As has been the case in the past, Thailand is likely to come under severe
pressure, in particular through the current US-Thai free trade negotiations,
to protect patents at the expense of improving access to medicines.
Recent evaluations by both the World Health Organisation and the World Bank
show that Thailand cannot afford to pay the high prices charged by the
multinationals. Their estimates forecast dramatically rising drug costs in
Thailand due to the fact that patients need to switch to newer and more
expensive drugs in cases of resistance and toxicity. Both the WHO and the
World Bank recommend the use of public health safeguards such as compulsory
licensing to override patents.
Therefore, Thailand's issuing of a compulsory license this week is in
keeping with international and domestic law, and follows recommendations
from major multilateral institutes. As international organisations working
to support HIV and AIDS programmes in the region and across the developing
world, we fully support this important step. It is the first time such
measures have been used in Thailand but it should not be the last.
Paul Cawthorne is head of mission for Medecins Sans Frontieres, Thailand.
Ashvin Dayal is regional director of Oxfam East Asia.
© 2006 www.nationmultimedia.com
Nathan Ford <nathan.ford@london.msf.org>