THAILAND: Holding Big Pharma's feet to the fire

For nearly a week, the advertising pages of Thai- and English-language dailies have been the stage for debates on Thailand's decision to break patents on anti-AIDS drugs in the interest of public health.

A lobby championing the cause of the powerful pharmaceutical companies ran full-page spreads in the morning newspapers with an eye-catching warning in large, bold text, which said: "The Wrong Prescription for Thailand".

The charge was supported by allegations that Bangkok's decision was fraught with errors, such as, "Thailand is refusing American and European medical technology at the expense of the poor and sick of Thailand." Another leveled by "USA for Innovation", the organization leading this pro-pharmaceutical-company drive, declared: "Most of Thailand's AIDS patients will not have access to the world's best medicines."

But if those warnings were meant to trouble men like Boripat Dornmon, a 40-year-old who has been living with the human immunodeficiency virus (HIV) for 11 years, they have made little headway. "I disagree with this group, USA for Innovation. It shows that the big drug companies do not care about people like me," he said.

Boripat echoes the views of the group he belongs to, the Thai Network of People Living With HIV/AIDS, when he says Bangkok was correct in issuing compulsory licenses to secure cheaper generic drugs. "We need the new, cheap drugs to live longer."

It was a sentiment conveyed in the full-page advertisements taken out by a coalition of AIDS activists, humanitarian groups and a university to hit back at the pro-pharmaceutical lobby's campaign. The generic anti-retroviral (ARV) drug produced by the state's pharmaceutical body has "made a phenomenal contribution in reducing the number of deaths among Thai AIDS patients from an average of 7,282 per year between 2001 [and] 2004 to 3,862 in 2005 and to 1,613 in 2006", states the advertisement.

And a meeting this week between officials from Abbott Laboratories and Thai officials from the Food and Drug Administration (FDA) confirmed that Bangkok has not caved in to pressure from the pharmaceutical lobby and the US government over a groundbreaking move to secure cheaper drugs.

In fact, a Health Ministry official was quoted in the local media hinting that Bangkok may not have finished issuing compulsory licenses for ARVs produced by Abbott, given that a significantly lower-priced generic version of Aluvia, a second-line anti-AIDS drug, is being offered by an Indian company.

"If the Public Health Ministry chose to buy drugs at prices higher than offered by other sources, it must be able to give the public a good reason to justify its decision," Vichai Chokewiwat, head of the Public Health Ministry's panel on compulsory licensing, said in Tuesday's Bangkok Post newspaper.

Thailand's efforts have also received a boost at the ongoing World Health Assembly in Geneva, where Health Minister Dr Mongkol Na Songkhla is defending his country's case. "International supporters have entered the debate, saying that they will support Thailand on the issue in every way," he told the state-run Thai News Agency (TNA).

"International organizations belonging to the Third World Network, as well as national groups from Brazil, Germany, India, Malaysia and the Philippines, had met with him and praised Thailand on the issue," added TNA.

Mongkol now is reported to be planning to enforce compulsory licensing for cancer drugs. The pros and cons are being studied of issuing licenses for a group of cancer drugs that are still under patent in Thailand.

Thailand's determination to use available provisions in international trade to break patents emerged late last year, when Bangkok broke the patent on the ARV Efavirenz, produced by the US pharmaceutical giant Merck Sharp and Dhome. That was followed by a compulsory license issued here for Kaletra, another ARV produced by the US pharma multinational Abbott Laboratories. In January, the patent for Plavix, a blood-thinner made by Sanofi-Aventis, was broken.

But it was only Abbott that hit back at Thailand's use of the special provisions under the World Trade Organization (WTO) for developing countries to break patents on drugs when faced with a public-health emergency. In March the US multinational refused to register seven new drugs here, including Aluvia, a drug that can be easily stored in tropical climates.

Abbott's hopes of steamrolling over Thailand were dealt a blow last week from a quarter close to home - the foundation of former US president Bill Clinton. At a ceremony in New York, with the Thai health minister Mongkol by his side, Clinton endorsed Bangkok's decision to break the patents on the life-prolonging ARVs.

"No company will live or die because of high-price premiums for AIDS drugs in middle-income countries, but patients may," Clinton said during an event that announced the foundation's success at further slashing the price of second-line drugs, such as Abbott's Kaletra and Aluvia.

While last month Abbott announced that it had reduced the price of Kaletra in Thailand to US$1,000 for an annual course per patient, from the $2,200 for the same course it had charged a month before, the Clinton Foundation announced that it had an even cheaper offer. Matrix Laboratories, an Indian drug maker, was producing the generic version of Aluvia for $695 for a one-year course.

Thailand's leadership in securing better care for its HIV and AIDS patients is in keeping with other pioneering efforts it has embraced to deal with the killer disease. The Southeast Asian country has more than 600,000 people infected with HIV and has recorded 300,000 deaths due to AIDS, the disease HIV causes.

"We have to stand up to the pressure from the pharmaceutical companies and the US," said Jiraporn Limpananont, associate professor in the pharmaceutical science faculty at Bangkok's Chulalongkorn University. "If more countries issue compulsory licenses, it will get the point across that this is the right tool for developing countries."

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