[Ip-health] Nathan Ford in the Bangkok Post: Compulsory licensing seen crucial for treatment

[Thiru Balasubramaniam]

<SNIP>

Amid the cacophony of press conferences and ever mounting mass of
progress reports, statistics, and press clipping comes a report, ''The
Economics of Effective Aids Treatment: Evaluating Policy in Thailand'',
released by the World Bank, that sends a very clear wake-up call to the
Thai government.

<SNIP>

Action can be taken to reduce these costs. The World Bank report points
out that by exercising compulsory licensing to reduce the cost of
second-line therapy by 90%, the Thai government would reduce its future
expenditures by 127 billion baht up over the next two years. This is not
an unreasonable goal: thanks to generic competition, the cost of
first-line treatment has been pushed down from over 400,000 baht per
patient per year to around 14,400 baht _ a 97% reduction in price. But
doing so will provide strong political resolve, and it is not something
the pharmaceutical companies and the US government are keen to see
happen. The current US-Thai FTA negotiations threaten to seriously
hamper access to affordable generic versions of these drugs. In these
negotiations the US is pushing regulations that will limit the ability
of the Thai government to override patents _ the very mechanism that has
allowed Thailand to scale up treatment in the first place.

The World Bank has given Thailand a clear message that compulsory
licensing should be considered if long-term care for people with
HIV/Aids can be guaranteed. The recent removal of the WHO representative
in Thailand for suggesting that compulsory licensing should be
considered an option for securing affordable second-line medicines,
shows how little progress has been made at the international level to
confront these major political barriers. Thailand must show political
strength to follow the World Bank recommendations. We cannot afford to
do otherwise.

http://www.bangkokpost.com/News/17Aug2006_news23.php

------------

*FOCUS / TACKLING HIV/AIDS IN THAILAND*

*Compulsory licensing seen crucial for treatment*

*By NATHAN FORD*

The convention centre for the XVI International Aids Conference in
Toronto, Canada, looks like a giant shopping mall. Conveyor belts of
people stream from one session to another, with celebrity names pulling
the biggest crowds _ the two Bills (Clinton and Gates), Richard Gere _
as well as a whole host of UN acronyms and pharmaceutical companies. The
general message conveyed by most is that things are going well, we just
need more of the same. Activists and healthcare workers on the ground
are more cautious about the claimed successes. The title of the
conference, ''Time to Deliver'', appears to be directed at everything
and no one. Amid the cacophony of press conferences and ever mounting
mass of progress reports, statistics, and press clipping comes a report,
''The Economics of Effective Aids Treatment: Evaluating Policy in
Thailand'', released by the World Bank, that sends a very clear wake-up
call to the Thai government.

The report is the result of a three-year evaluation of the Ministry of
Public Health's efforts to expand access to anti-retroviral therapy. It
warns that unless urgent action is taken to ensure continued access to
newer medicines, the cost of treatment is going to rapidly rise to such
an extent that Thailand's treatment programme, hailed a success
worldwide, will begin to unravel.

Currently, over 80,000 people in Thailand are receiving treatment. This
achievement was only made possible because of the local production of
generic medicines by the Government Pharmaceutical Organisation, which
has allowed treatment costs to come down to around 1,200 baht per month.
According to the World Bank study, the treatment programme is highly
cost-effective.

HIV/Aids is a chronic disease requiring lifelong treatment. This means
ensuring access to a range of newer medicines to overcome side-effects
that some patients may experience over time and the problem of drug
resistance _ an inevitability in any HIV/Aids programme.

The problem is that these newer medicines are patent-protected, and much
more expensive than the standard treatment that people start out with.
Unless something is done to bring down the price of newer medicines, the
cost of the government programme will, according to the World Bank,
increase five-fold in the next 15 years.

Take the example of one key anti-retroviral medicine,
Lopinavir/ritonavir. Until recently, the price of Lopinavir/ritonavir, a
key medicine used in the developed world for patients who develop
resistance to the first line of treatment, was priced at around 125,000
baht per patient per year in Thailand. A group of Thai physicians and
academics, together with patient groups and also Medecins Sans
Frontieres (MSF), a non-governmental organisation which has been
supporting HIV/Aids programmes in Thailand since 1995, has been pushing
the manufacturer, Abbot, to lower the price of this drug since the
beginning of the year. In a move motivated more by good PR than concern
for public health, the company announced at the Toronto conference that
it would lower the price of this drug to 88,000 baht. But this is still
far too expensive for Thailand, meaning the drug remains out of reach.

Action can be taken to reduce these costs. The World Bank report points
out that by exercising compulsory licensing to reduce the cost of
second-line therapy by 90%, the Thai government would reduce its future
expenditures by 127 billion baht up over the next two years. This is not
an unreasonable goal: thanks to generic competition, the cost of
first-line treatment has been pushed down from over 400,000 baht per
patient per year to around 14,400 baht _ a 97% reduction in price. But
doing so will provide strong political resolve, and it is not something
the pharmaceutical companies and the US government are keen to see
happen. The current US-Thai FTA negotiations threaten to seriously
hamper access to affordable generic versions of these drugs. In these
negotiations the US is pushing regulations that will limit the ability
of the Thai government to override patents _ the very mechanism that has
allowed Thailand to scale up treatment in the first place.

The World Bank has given Thailand a clear message that compulsory
licensing should be considered if long-term care for people with
HIV/Aids can be guaranteed. The recent removal of the WHO representative
in Thailand for suggesting that compulsory licensing should be
considered an option for securing affordable second-line medicines,
shows how little progress has been made at the international level to
confront these major political barriers. Thailand must show political
strength to follow the World Bank recommendations. We cannot afford to
do otherwise.

Nathan Ford heads the Medecins Sans Frontieres' Manson Unit in London.