[Ip-health] Holding Big Pharma's feet to the fire

[Ira Glazer]

http://atimes.com/atimes/Southeast_Asia/IE17Ae02.html

By Marwaan Macan-Markar

BANGKOK - For nearly a week, the advertising pages of Thai- and
English-language dailies have been the stage for debates on Thailand's
decision to break patents on anti-AIDS drugs in the interest of public
health.

A lobby championing the cause of the powerful pharmaceutical companies
ran full-page spreads in the morning newspapers with an eye-catching
warning in large, bold text, which said: "The Wrong Prescription for
Thailand".

The charge was supported by allegations that Bangkok's decision was
fraught with errors, such as, "Thailand is refusing American and
European medical technology at the expense of the poor and sick of
Thailand." Another leveled by "USA for Innovation", the organization
leading this pro-pharmaceutical-company drive, declared: "Most of
Thailand's AIDS patients will not have access to the world's best
medicines."


But if those warnings were meant to trouble men like Boripat Dornmon, a
40-year-old who has been living with the human immunodeficiency virus
(HIV) for 11 years, they have made little headway. "I disagree with this
group, USA for Innovation. It shows that the big drug companies do not
care about people like me," he said.

Boripat echoes the views of the group he belongs to, the Thai Network of
People Living With HIV/AIDS, when he says Bangkok was correct in issuing
compulsory licenses to secure cheaper generic drugs. "We need the new,
cheap drugs to live longer."

It was a sentiment conveyed in the full-page advertisements taken out by
a coalition of AIDS activists, humanitarian groups and a university to
hit back at the pro-pharmaceutical lobby's campaign. The generic
anti-retroviral (ARV) drug produced by the state's pharmaceutical body
has "made a phenomenal contribution in reducing the number of deaths
among Thai AIDS patients from an average of 7,282 per year between 2001
[and] 2004 to 3,862 in 2005 and to 1,613 in 2006", states the
advertisement.

And a meeting this week between officials from Abbott Laboratories and
Thai officials from the Food and Drug Administration (FDA) confirmed
that Bangkok has not caved in to pressure from the pharmaceutical lobby
and the US government over a groundbreaking move to secure cheaper drugs.

In fact, a Health Ministry official was quoted in the local media
hinting that Bangkok may not have finished issuing compulsory licenses
for ARVs produced by Abbott, given that a significantly lower-priced
generic version of Aluvia, a second-line anti-AIDS drug, is being
offered by an Indian company.

"If the Public Health Ministry chose to buy drugs at prices higher than
offered by other sources, it must be able to give the public a good
reason to justify its decision," Vichai Chokewiwat, head of the Public
Health Ministry's panel on compulsory licensing, said in Tuesday's
Bangkok Post newspaper.

Thailand's efforts have also received a boost at the ongoing World
Health Assembly in Geneva, where Health Minister Dr Mongkol Na Songkhla
is defending his country's case. "International supporters have entered
the debate, saying that they will support Thailand on the issue in every
way," he told the state-run Thai News Agency (TNA).

"International organizations belonging to the Third World Network, as
well as national groups from Brazil, Germany, India, Malaysia and the
Philippines, had met with him and praised Thailand on the issue," added
TNA.

Mongkol now is reported to be planning to enforce compulsory licensing
for cancer drugs. The pros and cons are being studied of issuing
licenses for a group of cancer drugs that are still under patent in
Thailand.

Thailand's determination to use available provisions in international
trade to break patents emerged late last year, when Bangkok broke the
patent on the ARV Efavirenz, produced by the US pharmaceutical giant
Merck Sharp and Dhome. That was followed by a compulsory license issued
here for Kaletra, another ARV produced by the US pharma multinational
Abbott Laboratories. In January, the patent for Plavix, a blood-thinner
made by Sanofi-Aventis, was broken.

But it was only Abbott that hit back at Thailand's use of the special
provisions under the World Trade Organization (WTO) for developing
countries to break patents on drugs when faced with a public-health
emergency. In March the US multinational refused to register seven new
drugs here, including Aluvia, a drug that can be easily stored in
tropical climates.

Abbott's hopes of steamrolling over Thailand were dealt a blow last week
from a quarter close to home - the foundation of former US president
Bill Clinton. At a ceremony in New York, with the Thai health minister
Mongkol by his side, Clinton endorsed Bangkok's decision to break the
patents on the life-prolonging ARVs.

"No company will live or die because of high-price premiums for AIDS
drugs in middle-income countries, but patients may," Clinton said during
an event that announced the foundation's success at further slashing the
price of second-line drugs, such as Abbott's Kaletra and Aluvia.

While last month Abbott announced that it had reduced the price of
Kaletra in Thailand to US$1,000 for an annual course per patient, from
the $2,200 for the same course it had charged a month before, the
Clinton Foundation announced that it had an even cheaper offer. Matrix
Laboratories, an Indian drug maker, was producing the generic version of
Aluvia for $695 for a one-year course.

Thailand's leadership in securing better care for its HIV and AIDS
patients is in keeping with other pioneering efforts it has embraced to
deal with the killer disease. The Southeast Asian country has more than
600,000 people infected with HIV and has recorded 300,000 deaths due to
AIDS, the disease HIV causes.

"We have to stand up to the pressure from the pharmaceutical companies
and the US," said Jiraporn Limpananont, associate professor in the
pharmaceutical science faculty at Bangkok's Chulalongkorn University.
"If more countries issue compulsory licenses, it will get the point
across that this is the right tool for developing countries."