[Ip-health] Financial Times on generic ARVs in Thailand

[Mike Palmedo]

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Thailand's cheap Aids drugs revive patients' hope

By Amy Kazmin
July 9 2004 17:43
Financial Times

The modest house in the middle-class Bangkok neighbourhood bears no sign
of its use as headquarters of the Thai Network of People Living with
HIV/Aids, an anonymity reflecting Thai society's persistent discomfort
in dealing with those infected with HIV.

But the dedicated activists of the network - which represents many of
the 700,000 Thais living with HIV - have pressed hard for the government
to recognise Aids patients' needs - none more urgent than the need for
affordable anti-retroviral drugs (ARVs).

In early 2002, Aod, a 31-year-old activist who discovered in 1996 she
was infected with HIV, entered the early stages of full-blown Aids,
suffering from weight loss, exhaustion, lesions and other infections.
The only anti-retroviral drugs then available in Thailand were expensive
foreign-made drugs - all out of reach on her Bt9,000 ($220, =80180, =A3120)
monthly salary. "I was so depressed," she said. "I thought my time was
coming."

Aod - who asked to be identified only by her nickname - and several HIV
positive friends decided to smuggle anti-retroviral drugs from India,
where generics were more widely available. The scheme lasted only a few
months. On the second trip, Aod's friend - carrying a three-month supply
of drugs for nearly 100 people - was arrested and jailed for two days.

But hope was at hand. In May 2002, Thailand's state-owned Government
Pharmaceutical Organisation (GPO) began production of its own cocktail
therapy, GPO-VIR, a three-in-one, fixed-dose combination made up of
three anti-retroviral drugs whose patents in Thailand had expired or
been relinquished.

Today, health officials are building up distribution of GPO-VIR, which
costs just Bt1,260 a month, and is free through public hospitals for
those who need it. Around 36,000 people are now taking it, and by the
end of the year, Thai authorities hope to have around 70,000 people
under treatment, rising in the years to follow.

But Aod and other activists are already looking ahead. Patients can take
GPO-VIR for three to five years before resistance develops, when they
need to switch to a different drug regimen. However, the GPO's cupboard
has little to offer by way of second line treatment. Many of the key
newer drugs are still under patent, and cost around Bt15,000 to Bt20,000
a month.

While the World Trade Organisation's Doha Declaration gives developing
countries the right to compulsorily license patented drugs in a public
health emergency, activists say Bangkok is unlikely to take any action
that could upset Washington, its closest ally.

"America is the big brother - and Thailand must obey," Aod said. "We are
afraid of anything that will affect this relationship."

Thailand has embarked on negotiations about a trade agreement with the
US, which is pressing for stronger protection for its drug
manufacturers, especially for their clinical test data. That data is
also used by generic drug-makers seeking approval for their copies of
the medicines developed by others, and restrictions on the use of data
could delay the introduction of generic copies of drugs.

If Thailand agrees to that and other US demands, activists fear
important drugs are likely to remain out of reach for the majority of
Thai Aids patients for a long time to come.

Thongchai Tavichachart, managing director of the GPO, insists that
Bangkok will not simply trade away the futures of Thai Aids patients and
is working with US health and drug officials to evaluate what patented
drugs Thailand most urgently needs.

"We are working . . . to consider the items that are important for our
people to announce for compulsory licensing," he said, citing Lopinavir
- a second-line drug included in Abbott Laboratories' combo pill Kaletra
- as one possible example. He said if any compulsory licensing does take
place, the GPO, as a state company, will take "full responsibility" for
production.

By distributing GPO-VIR, he said, Thailand is demonstrating that its
public health system has both the necessary doctors and equipment to
properly prescribe ARVs and treat Aids patients.

"Access to ARV is not only production," he said. "Most important is
readiness of health personnel. We are well known on prevention but now
we are also a good example of caring for Aids patients . . . If we had
announced compulsory licensing two years ago but no doctors knew how to
care [for patients], it would be useless."