[Ip-health] Thailand's Dr. Suwit on Efavirenz Compulsory License (MSF interview)

[robert weissman]

http://www.accessmed-msf.org/prod/publications.asp?scntid=3D30112006143362&=
contenttype=3DPARA&

Interview with Dr. Suwit Wibulpolprasert
Senior Advisor on Health Economics, Ministry of Public Health, Thailand
30 November, 2006

Interview with Dr. Suwit Wibulpolprasert
Senior Advisor on Health Economics, Ministry of Public Health, Thailand
President of Intergovernmental Forum on Chemical Safety (IFCS)


What was the reason for issuing this compulsory license?
We have around 120 000 people on ARVs in Thailand. The first formulation
that we use is the nevirapine-based, triple therapy, but about 20 to 25%
of patients cannot really take these drugs, due to side effects, some of
which are even fatal. These patients have to be switched to efavirenz,
which is three times more expensive. So we need a cheaper drug because
we cannot afford it. Since October 2003, the Thai government has had a
policy of universal access to ARVs for all HIV positive patients who
need it. Patients under the scheme get their drugs for free.

But why issue the compulsory license now?
For good reason, because after three years we have learnt a lot. At
first we didn=92t have much experience now we=92ve done intense research an=
d
have found that the nevirapine-based formulation has about four times
more serious side effects than the efavirenz one. And if possible, if we
can afford it, we would hope that in the future we will be able to
replace the nevirapine-based formulation with the efavirenz-based one.

What will be the impact of this compulsory license on your national
policy of universal access to ARVs?
We will start by expanding the number of patients on the efavirenz-based
ARV formulation and if we have a bigger budget and a further reduction
in price, we should be able to cover all our patients. After the
compulsory license, the price of efavirenz will be reduced by around
half. Right now, it is only when patients can=92t tolerate nevirapine that
we switch them to efavirenz. But if the price of efavirenz goes down
thanks to compulsory licensing, we will not have to subject these
patients to the risk of nevirapine-based products in the near future. We
will be able to start patients on the efavirenz-based formulation
straight away.

How many patients will benefit from this compulsory license?
We have issued a compulsory license by the state which starts
immediately and lasts for five years for up to 200 000 patients per year.

Is the compulsory license for both local production and import?
At first, we will import from India and at the same time our Government
Pharmaceutical Organisation (GPO) has just finished the development of
the efavirenz formulation. They are in the process of testing the
product, and if the production price is cheaper or at least not more
expensive than the Indian product, we will shift to local production.

What kind of price reduction do you foresee?
The Government Pharmaceutical Organisation estimates this will result in
a 50 % reduction in price. The current price from the originator company
is around 1400 Bath per month which is almost US $40.