E-drug: US pressure on Thailand
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The Lancet, Vol 358, July 20, 2001
US pressure on less-developed countries
Sir--What makes the conflict between the US and Brazil reported in
your Feb 10 news item1 noteworthy is the fact that Brazil is trying
to resist the pressure.
Thailand has been subjected to trade pressure from the US
government for increased intellectual property protection of
pharmaceuticals since 1985.2 By contrast with Brazil, the Thai
government has not felt able to resist or undo the damage. Thai
patent law was amended to include pharmaceutical product
protection in 1992, when Thailand came under threats of trade
sanctions by the US Trade Representative after a complaint by the
US Pharmaceutical Manufacturers Association, underline if present.
The Thai Safety Monitoring Programme (SMP), a postmarketing
surveillance system, has been abused to provide protection and
thereby monopolies to drug companies. In 1989, an interim
measure was applied to allow 2 years monopoly for all new drugs
entering under the SMP, which was extended to 5-6 years in 1993
after further US pressure. Thailand was not required to provide
patent protection before 2000 and is not required to provide
exclusive marketing rights for non-patented drugs at all.
The SMP system has led to substantial delay in generic availability
for drugs such as antiretrovirals, and many others, although none of
these drugs are patented in Thailand. Some drugs have completed
the SMP and have become affordable thanks to generic production.
Such falls in price can mean life or death in a country still in the
aftermath of the economic crisis and the highest number of AIDS
deaths in Asia.
Thailand has done little to undo the damage of US pressure. The
SMP was revised only in January, 2001: market exclusivity was
removed and safety monitoring strengthened. However, market
exclusivity is abolished only for drugs already covered by the 1992
patent law, and is preserved for drugs patented abroad between
1986 and 1991 that the US government has sought to protect.
WHO and UNAIDS had supported a more decisive amendment but
Thailand did not question the concessions made under US pressure
in 1992.
Another disturbing experience was the failed attempt to issue a
compulsory licence for the formulation patent of didanosine in early
2000. Despite the US government's promise in December, 1999,
for a more flexible trade and patent policy for medicines, they
continued to warn the Thai government against the use of
compulsory licence. Eventually, demonstrations in Bangkok and in
the US forced them to relent. But the initial warnings were hard to
forget and the Ministry of Public Health rejected activist calls for
compulsory licence.
Solutions must come from both sides. The USA and other western
governments should commit to a moratorium on World Trade
Organisation disputes that affect access to medicines.
Less-developed countries should follow the example of Brazil in
resisting the pressure and make maximum use of available
safeguards to protect the health of their people.
*Tido von Schoen-Angerer, Jiraporn Limpananont
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*Medecins sans Frontieres
311 Ladphrao soi 101, Bangkok 10240, Thailand;
and Faculty of Pharmaceutical Sciences, Chulalongkorn University,
Thailand
e-mail: msfdrugs@asianct.co.th
1. Ahmad K. Brazil and USA at loggerheads over production of
generic antiretrovirals. Lancet 2001; 357: 453.
2. Wilson D, Cawthorne P, Ford N, Aongsonwang S. Global trade
and access to medicines: AIDS treatments in Thailand. Lancet
1999; 354: 1893-95.
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