[Ip-health] BBC on Thai CLs

[ben.krohmal@keionline.org]

http://news.bbc.co.uk/2/hi/asia-pacific/6587379.stm

Thailand takes on drugs giants
by Jonathan Head
BBC News, Bangkok

The Thai government's decision to break the patents on two Aids drugs and
one heart drug, so it can offer them to all Thai citizens, is a bold move,
which has put the country on a collision course with the big
pharmaceutical firms.

Six years ago I visited a clinic outside Bangkok, where a locally-made
pill, called V1 Immunitor, was being distributed.

The claim that it could treat HIV/Aids was widely discredited, yet the
queues went right around the block.

The people waiting patiently in the Bangkok heat came from all walks of life.

There were street vendors, civil-servants and respectable-looking
middle-class women - evidence of the extraordinary reach of the HIV/Aids
epidemic in Thailand.

Few were under any illusions that V1 Immunitor would help them, but then
what did they have to lose?

None could afford the anti-retroviral drugs (ARVs) available in Europe and
the US.

To them, the HIV virus was a virtual death sentence.

Generic copies

Fast-forward six years, and nobody talks about V1 Immunitor any more.

Affordable ARVs are now available to tens of thousands of Thais - in fact
many do not pay anything at all for them, as they are provided by the
government's universal healthcare scheme or by HIV/Aids organisations.

This is possible because of Thailand's decision to make cheap, generic
copies of ARVs at a fraction of the cost of the branded drugs.

It is something the big pharmaceutical companies resisted at first, but
then went along with.

But they are strongly resisting Thailand's latest move. Last November the
new country's health minister, Dr Mongkol na Songkhla, announced he would
issue what is known as a compulsory licence to manufacture low-cost
versions of the HIV drug Efavirenz.

Efavirenz - which is made by the German pharmaceutical giant Merck MSD,
and protected by a patent in Thailand - is an alternative treatment for
patients who do not respond well to the locally made ARVs.

Three months later, Dr Mongkol announced that two more drugs would be
targeted with compulsory licences - the second-line ARV Kaletra, which is
manufactured by the US company Abbott and is important for HIV/Aids
patients showing signs of resistance to first-line ARVs - and most
controversially the heart-drug Plavix, manufactured by the French company
Novartis.

Suddenly Thailand, long seen as a loyal trading partner of the US, has
seen its image transformed into that of a violator of intellectual
property rights.

Its decision has been condemned by the pharmaceutical industry, but
applauded by non-governmental organisations campaigning for wider access
to affordable medicines.

Actually what Thailand has done is completely legal under international
trade regulations.

The landmark 1995 World Trade Organisation agreement on intellectual
property, Trips, gives governments a large amount of freedom to bypass
patents on drugs if they face any kind of health crisis.

The language of the agreement is vague. It recommends that governments
consult the drug companies first, and requires them to pay a small
royalty. But crucially, the government itself can decide what constitutes
a health crisis.

The drug companies have always assumed that the Trips exception would only
be used for a dire emergency, like HIV/Aids or avian flu.

Issuing a compulsory licence for a heart drug, they say, breaks the spirit
of the agreement.

Abbott has now withdrawn all its future products from the Thai market -
including a new heat-resistant form of Kaletra which is desperately needed
by HIV patients.

Healthcare for all

Dr Mongkol is quite open about his motives for challenging the patents on
these three drugs.

"Our health system is in danger of going bankrupt," he said, "and one of
the biggest expenses we face is the cost of drugs."

A developing country now approaching middle-income status, Thailand has
very high levels of heart disease.

At Bangkok's main chest hospital, doctors say they spend almost 20% of
their entire budget on Plavix, which is why it was one of the drugs
targeted.

But should a developing country be allowed to fund its public health
service by breaking the patents of drugs developed by multi-national
pharmaceutical companies?

Thailand is one of the first countries at its income level to introduce
such a service.

Richer countries like Britain have difficulty funding their health
systems; Thailand, with a much lower government budget, inevitably finds
it harder still.

The nationwide health scheme was first introduced in 2001 by then-Prime
Minister Thaksin Shinawatra, who had a gift for coming up with populist
policies that would keep getting him elected.

When he was over-thrown by a military coup last September, the new
government, needing to shore up its own legitimacy, went even further and
eliminated the nominal charge for treatment.

It was encouraged in this by Dr Mongkol, who suddenly found himself
promoted to becoming a minister after 40 years fighting for better health
care as a career civil servant in the Ministry of Health.

Supporters of the compulsory licences, like Paul Cawthorne from Medicins
Sans Frontiers, believe Thailand's bold step is the right one.

He argues that the big pharmaceutical companies make plenty of money from
less essential drugs, like Viagra, and that they spend a lot more on
advertising their products than they do on research and development.

Much of the research in the US is, in any case, done by government-funded
universities, he says.

He is calling for a radical shake-up in the pricing of a whole range of
essential drugs, to make them affordable in every country - and he
believes Thailand has set an example other governments should follow.

Opponents argue that governments cannot feel free to break the patents on
any drugs they choose, just to fund cheap healthcare for their citizens.

That, they say, destroys the incentive to develop new drugs.

Backing down?

But the situation varies enormously from country to country.

Until recently India, for example, did not recognise the patents of
multinational drug companies, and has built up a huge industry making
cheap generic drugs without incurring the wrath of the industry.

Because Thailand went along with patent protection many years ago, it is
being criticised for following India's example.

Indeed, some of the cheap drugs Thailand now wants to give its patients
are actually imported from India.

Tellingly the US, normally a vocal defender of intellectual property
rights, has not criticised Thailand's decision, nor has the World Health
Organization.

The drug companies are also showing signs of flexibility, offering
significant price cuts to Thailand.

Even Abbott, which has taken the most hardline stand, is under great
pressure to reverse its decision to pull future products from the Thai
market.

Whatever the rights and wrongs of Thailand's drugs pricing policy, it
looks as though Dr Mongkol is starting to win his battle for affordable
healthcare.