[Ip-health] MSF letter to Rice and Schwab on Thai CL

[Kris TORGESON]

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http://www.doctorswithoutborders.org/publications/openletters/torice_12-29-=
2006.cfm=0D
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=0D
Honorable Condoleezza Rice, Secretary of State=0D
U.S. Department of State=0D
2201 C Street NW=0D
Washington, DC 20520=0D
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Ambassador Susan Schwab, United States Trade Representative=0D
600 17th Street, N.W.=0D
Washington, DC 20508=0D
United States of America=0D
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New York, December 29, 2006=0D
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Dear Secretary Rice and Ambassador Schwab:=0D
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I am writing to express Doctors Without Borders/M=C3=A9decins Sans Fronti=
=C3=A8res=0D
(MSF)=E2=80=99s concern that the United States Department of State and the =
United=0D
States Trade Representative have intervened in the decision by the=0D
government of Thailand to issue a compulsory license on patents for the=0D
AIDS drug efavirenz, and to explain why the US government should refrain=0D
from such actions.=0D
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The US government is reportedly asking the Thai government to engage in=0D
prior negotiation with patent owners before issuing compulsory licenses.=0D
Not only is this not required under the World Trade Organization (WTO)=0D
rules when the compulsory license is for government use, it is not=0D
required under US law.  What the WTO does require is that Thailand=0D
"promptly" notify the patent owner when it issues a compulsory license.=0D
Thailand has clearly done this.  The US government should not be=0D
overseeing the management of Thailand's dealing with the patent owners as=
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long as Thailand abides by its WTO TRIPS obligations.=0D
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In 2001, the United States government and every other member of the World=
=0D
Trade Organization (WTO) announced the signing of the Doha Declaration on=
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TRIPS (Trade-related Aspects of Intellectual Property Rights) and Public=0D
Health.  This historic agreement said:=0D
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<start quote>=0D
We agree that the TRIPS Agreement does not and should not prevent members=
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from taking measures to protect public health. Accordingly, while=0D
reiterating our commitment to the TRIPS Agreement, we affirm that the=0D
Agreement can and should be interpreted and implemented in a manner=0D
supportive of WTO members' right to protect public health and, in=0D
particular, to promote access to medicines for all.=0D
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In this connection, we reaffirm the right of WTO members to use, to the=0D
full, the provisions in the TRIPS Agreement, which provide flexibility for=
=0D
this purpose.=0D
</end quote>=0D
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Thailand is obviously trying to do exactly what the Doha Declaration=0D
promised it could. Respecting Thailand's decision to exercise its right=0D
under the Doha declaration is a matter of urgent concern for Thai patients=
=0D
in need of affordable AIDS treatment.=0D
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The drug efavirenz, which is recommended by the World Health Organization=
=0D
(WHO) for HIV/AIDS treatment, is currently patent protected in Thailand,=0D
and the monopolistic situation has affected both supply and affordability=
=0D
in the country. The price the patent holder Merck charges in Thailand=0D
(1,400 baht/month =E2=80=94 US $39) is double of what Indian generic manufa=
cturers=0D
charge for the drug (650 baht/month =E2=80=94 US $18). In addition, on seve=
ral=0D
occasions, Merck has been unable to supply the drug in Thailand. It is=0D
estimated that at least 12,000 people in Thailand currently need=0D
efavirenz, but that due to cost and supply difficulties, the number=0D
receiving the drug is significantly lower.=0D
=0D
MSF has worked in Thailand since 1976. The organization began providing=0D
ARV treatment to people with HIV/AIDS in 2000 and we have witnessed the=0D
development of the Thai AIDS treatment program. Generic production is the=
=0D
cornerstone of Thailand=E2=80=99s universal HIV/AIDS treatment program. Bef=
ore=0D
generic production, the cost of standard HIV/AIDS treatment in Thailand=0D
was over 33,330 baht per patient per month (US $924), and only 3,000=0D
people were getting treatment. In 2002, Thailand launched a generic=0D
version of HIV/AIDS triple therapy, resulting in an 18-fold drop in the=0D
cost of treatment. Thanks to this, over 85,000 people with HIV/AIDS are=0D
today receiving treatment. UNAIDS reports that Thailand is the only=0D
Southeast Asian country to have over half of the total number of people on=
=0D
AIDS treatment who need it.=0D
=0D
Both the WHO (in August 2005) and the World Bank (in August 2006) have=0D
predicted dramatically rising drug costs in Thailand due to the fact that=
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patients need to switch to newer and more expensive drugs in cases of=0D
resistance and toxicity. Both organizations recommend the use of public=0D
health safeguards enshrined in the Doha Declaration on TRIPS and Public=0D
Health.=0D
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Issuing and executing a compulsory license, allowing both importation and=
=0D
local production, will increase supply and affordability of efavirenz to=0D
the benefit of Thai patients. Creating a competitive generics market for=0D
efavirenz and other newer AIDS drugs that are patented in Thailand and=0D
other markets is critical to maintaining patients under treatment as=0D
natural resistance to first-line ARV therapy increases, as well as to=0D
scaling up ARV treatment.=0D
=0D
Thailand's decision will have important consequences, not only for=0D
Thailand, but for any developing country that needs to obtain low-cost=0D
generic products.  If Thailand follows through and begins to buy from=0D
generic suppliers, it will create a larger global market for generic=0D
products, stimulate competition, and lower prices everywhere for the newer=
=0D
products.=0D
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While the benefits of expanded generic competition are widely appreciated,=
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many developing countries have been reluctant to issue compulsory licenses=
=0D
because of fears that the United States government will oppose such=0D
actions and exert pressure.=0D
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We ask that the United States government refrain from any opposition or=0D
interference with the Thai efforts to use WTO flexibilities to buy generic=
=0D
AIDS medicines -- including pressuring or otherwise seeking to persuade=0D
Thailand to engage in negotiations with Merck rather than proceed to=0D
execute the compulsory license it has issued.=0D
=0D
Sincerely,=0D
=0D
Nicolas de Torrente=0D
Executive Director=0D
Doctors Without Borders/M=C3=A9decins Sans Fronti=C3=A8res (MSF-USA)=0D
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=0D
Paul Cawthorne=0D
Head of Mission, MSF-Thailand=0D
=0D