Healthy Skepticism Library item: 7010

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Publication type: news

Cawthorne P, Dayal A.
Thailand still shows the way on HIV and AIDS
Bangkok's Independent Newspaper 2006 Dec 2

Abstract:

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.