[Ip-health] Interview of João Sanche, Communication director of Me rck on the Brazilian Move towards CL

Thu Apr 26 14:08:01 2007

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Agência de Notícias da AIDS

Editoria:

Pág.

Dia / Mês/Ano:

26/ABRIL/07

For Merck, patients and the country lose with de declaration of "public
interest" of efavirenz

25/4/2007 – 19h20

In an exclusive interview to Agência de Notícias da Aids, the corporative
communication director of Merck Sharp & Dohme João Sanches affirmed that
"not only the pharmaceutical industry or Merck lose" with the declaration of
public interest of efavirenz done by the Ministry of Health, through the
decree published in this Wednesday, 25, in the Official Union Diary. "I
think that everybody loses. Patients and the country as well" said the
executive. He comments that the news was a surprise for the company, because
they were in the middle of a negotiation process with the Brazilian
government and reaffirmed the "unequivocal" commitment of Merck to try to
find a solution for AIDS. However, he highlights that to keep doing research
"is important to have a safe environment for investment and a return for the
shareholders and for the people who are investing in this way". Read the
full interview.

Agência Aids: What is Merck' position about the decree published today in
the Official Diary declaring the "public interest" of efavirenz?

João Sanches:It was a surprise for us because we are still in a process, and
we understand that we are in the middle of a negotiation process. I don´t
have a lot to say because we are exactly in the middle of the process.  From
our point of view, we are sure and expect that the Brazilian government does
not issue the compulsory license because we do not believe that this is a
solution neither for patients, nor society,and  neither for the country nor
for the pharmaceutical industry as a whole.

Agência Aids: According to the decree, one of the reasons for the government
taking this action was the fact that no agreement was achieved with Merck
for the price. The government proposal was the adoption of the price set in
Thailand, of US$ 0,65, and the Merck' proposal was a discount of 2% of the
current price, which is US$1,59. Why such a small reduction? Why the
industry is so intransigent in the negotiations?

João Sanches: I think it is important to look at the historical process of
this discussion. In 2003, we gave two discounts to the Ministry: a discount
of 17% and, right after, because of a negotiation, we gave an additional
discount of 25%, as we recognize that Brazil is a country with an excellent
treatment AIDS program and that give access to all patients, because all our
policy is corporate, it is global, and based on access.  As a result of
these two discounts, the efavirenz's price in Brazil is the lowest in the
world and is still currently the lowest all over the world, for countries
which have medium HDI (Human Develoment Index) and prevalence lower than 1%,
which is the case of Brazil, that is classified in the global access policy
established by Merck together with other pharmaceutical companies and the
United Nations, World Health Organization and World Bank. These criteria
were not set by us; it is a criteria of common agreement.

The second thing I can tell you is that the price of efavirenz in Brazil,
since it was launched in 1999, had a reduction of 78%. So, I think that when
you ask me this question, we are looking at a certain time, isolating it
from the historical fact.  Efavirenz's price is today the lowest among the
other anti-retrovirals bought by the National STD/AIDS Program, 34% of the
patients use Stocrin {brand name for efavirenz}, but it represents only 17%
of the total cost of the Program.

Agência Aids: In an interview to the Agência, an activist said that
pharmaceutical industry should be more transparent, should show their real
costs for medicines. He said that if companies spent less money with
marketing and publicity, it would be possible to reduce the medicines prices
and make it affordable for those who need. Why the industry does do that?

João Sanches: I don´t have any comment to make about this declaration
because the figures of pharmaceutical companies, such as Merck, are
published and are public. And the balance  follows the parameters of sound
accountancy. What I think people usually forget, for example, is the
commitment that we have had for 21 years to research innovative medicines
and that the first anti-retroviral comes from Merck Sharp & Dohme
researches. Research is in the long term, and we keeping researching
vaccines until now. We have two candidates in trials for a vaccine against
HIV/AIDS. Our commitment is to undoubtly find a solution for this disease.
But to keep doing this research it is important that we have a safety
environment for investment and have a return for shareholders and for people
that, in any way, are investing for that.

Agência Aids: Considering what AIDS represents today in the world, don't you
think that it is the moment for pharmaceutical companies have a different
policy for AIDS medicines?

João Sanches: Do you know our global access policy? It already does that. I
will summarize it for you. The global access policy set together with World
Bank, United Nations Organization, UNAIDS, WHO and some pharmaceutical
companies, established two criterias: HDI and prevalence of adult
population. Among that, there are three categories of countries. The first
one, which usually are developed countries, have high HDI and prevalence
lower than 1%. There is a second group, where Brazil is included, which are
countries with medium HDI and prevalence lower than 1% for adult population.
In this price range, Brazil has the lowest price. And the third range, which
include all Subsaarian African countries, which have the low HDI and
prevalence more than 1%. Why the prevalence? Because it means the cost for
society and for health systems of these countries  to treat HIV/AIDS. In the
case of Botswana, 40% of the adult population are infected by HIV/AIDS. It
is impossible to compare Botswana and Brazil, where the prevalence of the
lattest is of 0,85%. And the HDI are totally different. So, according to
these categories, we have a global price policy. For example, in countries
with medium HDI and prevalence below 1%, such as Brazil, efavirenz's price
is US$1,80. In Brazil, the price is US$ 1,57.

Agência Aids:Up to where does Merck intend to go in the negotiation with the
Government so that it doesn´t bear the burden of the responsibility for the
issuance of a compulsory license:?

João Sanches: Usually we understand that we are committed and will keep
negotiating with the Brazilian government. We believe that the compulsory
license is not the best solution. Now, what I would like to contribute is
that all this discussion is always looking from one side, which is from the
pharmaceutical industry. It is not only pharmaceutical industry or Merck
those who lose. I think everybody lose. Patients lose, and the country also
lose, because – coming back to what I have said in the beginning – efavirenz
is today the most economical solution among other medicines for the cocktail
government has.

Maurício Barreira

Free translation: Gabriela Chaves

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Hoje milhões de pessoas em todo o mundo dependem dos medicamentos vendidos a
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