[Ip-health] Thais locked in a battle for life

[James Love]

http://www.theage.com.au/news/world/thais-locked-in-a-battle-for-life/
2006/12/25/1166895240786.html

Thais locked in a battle for life

Connie Levett, Bangkok
December 26, 2006
Wary Christmas: bar hostesses dress as Santa's helpers in a nation in
which AIDS if rife.

Wary Christmas: bar hostesses dress as Santa's helpers in a nation in
which AIDS if rife.
Photo: AP
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APIWAT Kwangkaew can still remember the day nearly five years ago
when Thailand began producing nevirapine, a generic anti-retroviral
drug.

Within an hour of the announcement, hospital wards across the country
were packed with people who knew they were sick but could not afford
treatment.

With a population of 64 million, Thailand has more than a million
living with HIV/AIDS. Some believe the figure is much higher.

Nevirapine helped save Mr Epiwat's life. Now he is fighting to save
others, taking on US pharmaceutical giant Merck for the right to
break the patent on the anti-retroviral drug Efavirenz, and produce
another generic HIV-AIDS treatment. So far he is winning.

When 32-year-old Mr Apiwat found he was HIV-positive 10 years ago,
treatment was so expensive it may as well not have existed. At 10,000
baht a month, it was double the monthly salary of a shop assistant.
Seven years ago he came to the Mercy Centre, an AIDS hospice, run by
Father Joe Maier in the slums of Klong Toey, to die among friends.

"When I came here, I couldn't help myself," he said this week as he
walked through the cool, basic cement-floor ward where he once lay.
"I was being attacked by a fungus in my brain. I didn't have any
hope. I only wanted to die with people who sympathised with me, to
feel the warmth of brotherhood."

He is now the director of the hospice and an ardent advocate for
access to reasonably priced drugs.

The generic nevirapine still works for him, but for many of his
friends and patients at the hospice, there is a growing resistance to
the drug. The answer for them is Efavirenz, made by Merck, but it is
expensive, and supplies have been unreliable.

Mr Apiwat said the Government and the company blamed each other for
the problem. The Government says the company does not have enough
stocks to supply the drug and the company says "we have the medicine
but your Government has not paid for it".

"We don't know who is telling the truth, but we know Merck has the
medicine to sell to others but not to the Thai Government," Mr Apiwat
said.

Before it was ousted by the military in September, the business-
oriented Thaksin Shinawatra government was pushing for a free trade
agreement with the United States, which included extension of drug
patent rights to 25 years and protection of intellectual property
rights for pharmaceutical companies.

Mr Apiwat said the agreement, if passed, would have overridden World
Trade Organisation rules that allow a country to issue a compulsory
licence to make a patented product without the consent of the patent
owner in the event of a public health crisis =97 a clause seen as
referring to the HIV-AIDS pandemic.

Fierce protests by health activists in the northern city of Chiang
Mai in January 2006 forced the government to put the negotiations on
hold.

This month the breakthrough came. At the urging of AIDS activists,
the military-appointed interim Government has issued a compulsory
licence for the generic production of Efavirenz.

The Health Ministry says it can have the generic Efavirenz on the
market within six months, increasing access to the treatment from the
present 20,000 patients up to 100,000.

Father Maier, the founder of the Mercy Centre AIDS hospice, said
Efavirenz cost 2700 baht ($A96) a month, while the generic version
would cost 600 baht.

Merck has reportedly asked the United States to pressure the Thai
Government to rescind the decision.

Mr Apiwat said AIDS activists in Thailand acknowledged the amount of
research and funds that went into developing a drug, "but we see they
have reasonable profits already, and to prolong the life of people is
perhaps more worthy than making profit for a company".