[Ip-health] Thailand: Bitter Medicine

[Stephanie Weinberg]

South China Morning Post - Wednesday, July 12, 2006

BITTER MEDICINE

SIMON MONTLAKE

When US negotiators arrived in Thailand in January for the sixth round of b=
ilateral talks with the country, up to 10,000 protesters were ready for the=
m. United by their opposition to the free-trade agreement being drafted beh=
ind closed doors, dozens of civil-society groups gathered outside the Shera=
ton Hotel in Chiang Mai, where the talks were being held.

Amid angry scenes, and despite a huge police presence, protesters broke int=
o the hotel and disrupted the trade talks, which were later moved outside t=
he city. It wasn't quite a knockout blow, but there was no ignoring the mes=
sage: the activists did not buy Prime Minister Thaksin Shinawatra's claim t=
hat the agreement would be a win-win deal for everyone.

Among the most vocal were representatives of HIV/Aids patients in Thailand.=
 US demands for tougher rules on patented drugs and controls on their compu=
lsory licensing - so-called generic copies - had serious implications for t=
heir care. Without low-cost alternatives to imported branded drugs, it was =
hard to imagine how Thailand could afford to treat its HIV-positive populat=
ion, now 600,000 and rising.

Into the fray stepped Dr William Aldis, the World Health Organisation repre=
sentative to Thailand.

A US physician who had spent the previous decade running the WHO's emergenc=
y response unit in Africa, Dr Aldis moved to Thailand in late 2004 to begin=
 the usual four-year posting. He quickly found himself in the thick of tsun=
ami relief and racing to stay on top of the unfolding bird-flu crisis. Dr A=
ldis was also keeping an eye on the US-Thailand trade talks.

He shared the concerns of international public health experts who had studi=
ed recent US trade pacts and concluded they hampered the ability of countri=
es to license lifesaving medicines, such as antiretroviral drugs to treat A=
ids patients. So he decided to speak out publicly on the issue.

It was a move that is said to have triggered his abrupt recall from Thailan=
d, after a rebuke by the US government, and sent shockwaves through the WHO=
 and other international agencies. Disgruntled WHO officials said the "puni=
shment" meted out to Dr Aldis smacked of political interference by the US p=
harmaceutical industry, which had lobbied for stricter intellectual-propert=
y rights.

The row came as the WHO was gearing up for a change of leadership after dir=
ector-general Lee Jong-wook died in May of a brain haemorrhage. While Lee w=
on plaudits for steering the WHO during high-profile crises, including the =
Sars outbreak in 2003, critics inside and outside the organisation faulted =
him for caving in to political pressure. A new director-general is due to b=
e selected in November.

"The greatest concern in the WHO under Lee was to ensure that certain membe=
r countries weren't upset," said a senior WHO official in Geneva. The treat=
ment of Dr Aldis "is a disturbing sign of things at the WHO".

What got Dr Aldis into trouble was an opinion piece published on January 9 =
in the Bangkok Post that described a US-Thailand free-trade agreement as a =
potential disaster for public health. Giving up Thailand's rights to waiver=
 pharmaceutical patents on lifesaving drugs "would put at risk the survival=
 of hundreds of thousands of Thai citizens", and could bankrupt Thailand's =
subsidised health-care system, he warned.

"Restrictive intellectual property rights will prevent Thailand from using =
locally produced affordable generic drugs ... the accumulated financial str=
ain on the national health budget would be untenable," he wrote.

Suspecting it would be watered down, Dr Aldis didn't clear the article with=
 his bosses in Geneva. On March 23, a US ambassador to the United Nations c=
omplained to then-director general Lee about the critical article and said =
the WHO should remain "neutral and objective".

The following month, Dr Aldis was recalled from his post in Bangkok and ass=
igned to a research position in New Delhi. WHO insiders said it was describ=
ed as a promotion, but immediately smelled fishy, given that Dr Aldis had c=
ompleted only 16 months in Thailand. Such a move was normally only initiate=
d on grounds of corruption or gross incompetence, insiders said.

Harsaran Pandey, a spokeswoman for the WHO in New Delhi, declined to give a=
 reason for the recall. "As international civil servants, all of our positi=
ons are transferable. William Aldis was transferred from the country office=
 to the regional office," she said.

In an e-mail, US Department of Health spokesman Bill Hall confirmed that th=
e US had objected to the Aldis editorial but denied any interference in the=
 WHO's affairs. "We made no suggestions or recommendations to Dr Lee or any=
 other WHO official on how the WHO might address the matter ... Whatever tr=
anspired afterwards was purely a matter internal to the WHO."

Dr Aldis, who joined the WHO in 1993, said he was still in the dark about h=
is recall. "I've been given no information about my removal and how it rela=
tes to the FTA," he said in an interview with the South China Morning Post.

Thai health activists urged the WHO to come clean on the reason behind the =
recall of its representative. "It's not only bad for him, it's bad for the =
Thai people," said Jiraporn Limpananont, professor of pharmacology at Bangk=
ok's Chulalongkorn University and a critic of the US-Thailand trade agreeme=
nt. "As a representative of the WHO it's his duty to make sure people are h=
ealthy and have access to medicine."

Negotiations on the agreement were suspended in March after Mr Thaksin diss=
olved parliament and called an election that was later annulled, leaving a =
political vacuum. US and Thai trade officials on Monday discussed plans to =
resume the talks.

International campaigners who monitor intellectual property rights in trade=
 agreements said Dr Aldis was simply echoing the general view among WHO mem=
ber countries on access to vital medicines. The fact that he was shot down =
for his comments signalled a retreat by the WHO in the face of US pressure =
and boded ill for future health emergencies, they said.

"It's quite unbelievable. What this article said was exactly in line with o=
fficial WHO policy on this issue. The WHO is advising countries to make use=
 of exclusions to patent laws," said Ellen `t Hoen, director of policy advo=
cacy at M=E9dicins San Fronti=E8res in Paris. She said the WHO should reaff=
irm its stance under its next leader and not be pushed around by the US or =
other member countries. "You need a leader who has the courage to stand up =
on this issue and be an advocate for public health, not sit on the fence," =
Ms `t Hoen said.

With the World Trade Organisation paralysed by divisions over rich-nation a=
gricultural subsidies, the US has pursued bilateral trade deals in Latin Am=
erica and Asia. Intellectual property rights, often among the most contenti=
ous negotiating points, are usually left until the final rounds of trade ta=
lks.

US negotiators said that without enforceable patents, its pharmaceutical in=
dustry would not have sufficient financial incentives to create drugs to tr=
eat HIV/Aids as well as other diseases such as tuberculosis and hepatitis.

As more patients become resistant to the latest medicines, such as retrovir=
al combinations, demand for newer drugs is increasing. That means more reso=
urces need to be committed to their development.

At a press conference after the Chiang Mai talks, assistant US trade repres=
entative Barbara Weisel denied that prices for HIV/Aids medicines would sky=
rocket under the proposed US trade terms. The big challenge now, she said, =
was to produce the next generation of drugs. "Clearly, having access to the=
 newest medicines is critical. But without any incentives to develop these =
medicines, there will be fewer new drugs to access. We believe we have stru=
ck a careful balance between these twin priorities," she said.

Critics contend this balance already exists. In 2001, the US was among 142 =
countries that signed the Doha Declaration, which confirmed the rights of p=
oor countries to override intellectual property laws for emergencies. Few c=
ountries have done so, but the declaration has often been used by governmen=
ts to persuade foreign drug companies to lower prices on their branded prod=
ucts.

Thailand is frequently cited by health officials as a country that has succ=
essfully developed low-cost alternatives to patented drugs. Until 2002, whe=
n the state-run Government Pharmaceutical Organisation began producing a si=
ngle-dose cocktail of antiretroviral drugs, it cost more than US$10,000 a y=
ear to treat one Aids patient with branded drugs. The generic version broug=
ht the price per person down to US$372.

The result is a massive expansion in coverage: Thailand now treats more tha=
n 80,000 HIV sufferers, a number forecast to rise to 150,000 by 2008.

"In order to make drugs accessible, the key is affordability. It's been sho=
wn that when there's competition in the market, especially with generic pro=
ducers, the price drops," said Matthew Coghlan, regional trade policy offic=
er for Oxfam America.

Thailand didn't need to override any patents because the drugs used in its =
generic version were invented before 1992, when its patents law was amended=
 to include such products. But procurement of newer, second-line Aids drugs=
 is constrained by patents that will be greatly enhanced under the proposed=
 US trade agreement. Unless they can be produced locally, or imported from =
other low-cost producers, Oxfam says fewer people will receive the drugs th=
ey need to stay alive.

Given that drug companies spend far more money on marketing and lobbying th=
an on research and development, the insistence on stricter patents on lucra=
tive Aids drugs leaves a nasty taste in the mouth of some health officials.=
 "The drug companies can have their 50 per cent margins," said a senior WHO=
 official. "Hell, they can have their 100 per cent. It's the 1,000 per cent=
 margins that get me angry."

(BOX)

TRADE PACTS THREATEN GENERIC DRUGS

In 2001, after years of fierce debate over the cost of drugs for treating H=
IV/Aids in the developing world, the World Trade Organisation adopted a res=
olution to allow poor countries to prioritise patients over patents in prov=
iding vital medicines.  Specifically, the WTO ruled at a meeting held in Do=
ha that governments can make or import copies of branded drugs, provided th=
ey compensate patent holders.

But health charities warn that the Doha Declaration is being undone by US t=
rade agreements that extend the term of patents and crimp the use of generi=
c drugs.  These include a recent US free trade pact signed with six countri=
es in Central America and the Caribbean.

A leaked document from the US-Thailand trade talks contains several demands=
 on intellectual-property rights (IPR) that critics say would tie Thailand'=
s hands in tackling HIV/Aids and diseases such as tuberculosis and malaria.=
  The closed-door talks were suspended in March.

One demand is for data exclusivity, which prevents generic producers from u=
sing test data from companies that hold drug patents.  Another would restri=
ct WTO-approved rights for breaking patents to a specific "national emergen=
cy" or for non-commercial uses.

Another clause allows pharmaceutical manufacturers to extend a standard 20-=
year patent by tinkering with the formula of its clinical applications.  Th=
is delays the introduction of generic copies that help bring down drug pric=
es.

"The US is ratcheting up [IPR] standards with each successive trade agreeme=
nt.  This is the strictest so far," said Matthew Coghlan, regional trade po=
licy officer for Oxfam America.

SIMON MONTLAKE