[Ip-health] Bangkok Post: CL vital so long as healthcare lacks fund

[Sarah Rimmington]

http://www.bangkokpost.com/020408_News/02Apr2008_news20.php

COMPULSORY LICENSING
CL vital so long as healthcare lacks funds
April 2, 2008

APIRADEE TREERUTKUARKUL

Public Health Minister Chaiya Sasomsab has finally decided to push
forward the policy on compulsory licensing, spearheaded by his
predecessor Dr Mongkol Na Songkhla, to extend access to four generic
versions of cancer drugs. Mr Chaiya's about-turn is seen as an attempt
to tone down mounting pressure on himself _ evident in the ongoing
effort to oust him from his post by a network of patients, doctors and
non-governmental organisations strongly in support of compulsory
licensing for expensive, life-saving drugs.

On the other hand, the CL issue is being bullied by the export industry
and pharmaceutical companies, which want the government to consider the
issue carefully, as they claim the policy could adversely affect trade
and exports if the United States and the European Union use the matter
as a pretext for trade retaliation against Thailand.

Whether or not compulsory licensing can really extend public access to
medicine (as claimed by supporters), or end up hurting the country's
trade and eventually its economy (as claimed by opponents), the CL
squabble is essentially the tip of the iceberg. It reflects the impact
populist policies are having on the state's healthcare system and how
the previous Thaksin government and now the People Power party-led
coalition both failed to live up to their promise.

The universal healthcare programme launched by the deposed Thaksin
government under the trademark ''30-baht health scheme'' has undeniably
been one of the most successful populist polices of the dissolved Thai
Rak Thai party.

Truth be told, however, the policy was not really the party's
brainchild. The idea had, in fact, been pioneered a year earlier by a
network of medical professionals, health advocates and non-governmental
organisations on consumer rights protection.

To his credit, the then TRT leader Thaksin Shinawatra took up the idea
and turned it into his party's campaign agenda _ bringing it enormous
political gains, as the party won by a landslide in the election of 2001.

Unfortunately once in government, the TRT leaders failed to allocate
sufficient funds to the universal healthcare scheme for its efficient
operation. Seven years after its inception, the scheme is still
teetering on the verge of crisis, in which the public demand for medical
services continues to rise and overwhelm medical personnel at state
hospitals throughout the country.

''The PPP government has been in office for over a month but it is clear
that it doesn't understand the necessity of CL policy in running the
universal healthcare scheme, which has been plagued by financial
problems and a brain drain of medical professionals,'' said Pongthep
Wongwachirapaibul, secretary-general of the Rural Doctors Society.

Former public health minister Mongkol Na Songkhla himself said he would
not have opted for the CL policy had the TRT-led government allocated
enough money to support the healthcare scheme. It received about 96.6
billion baht funding last year.

Dr Pongthep, also director of the Nanoi Hospital in a remote area of the
northern province of Nan, said that while the universal health care
concept was noble in principle, it was put to work in the wrong
direction from the start. The scheme was aimed at providing medical
services for the young, the elderly and the unemployed. With only a
limited budget of about 2,300 baht per head per patient, up from an
earlier 2,100 baht, it was impossible for the state to provide medical
treatment for chronic and costly illnesses such as cancer, heart disease
and kidney dialysis, especially for poor villagers in remote areas.

The 30-baht programme appears even shabbier when compared to the
country's other two healthcare schemes. The Social Security Office's
scheme, which requires both employers and employees of private companies
to contribute part of their income to support it, now has about 400
billion baht in reserve. The Comptroller General's Department also has
an open-ended budget for civil servants and their family members to
access free medical services without any limitations, ostensibly in
compensation for the relatively low salaries they are accorded.

The imbalance in both the funding and access to healthcare treatment is
unfair for the majority low and middle income population listed under
the universal healthcare scheme, which is on the verge of bankruptcy due
to financial shortages. This is why compulsory licensing comes in handy
for developing countries like Thailand, with an annual US$3,000 GDP per
capita, to effectively run universal healthcare programmes by producing
or importing generic versions of a patented drug for emergency use. It
is the only way for the majority of 48 million Thais under the
healthcare scheme to gain access to life-saving medicine. Even though
the breach of patent rights is permitted by the World Trade
Organisation, most developing countries do not dare exercise the right
to compulsory licensing because of trade pressure from superpower
nations. This is a tragedy. Former US president Bill Clinton, speaking
in support of Thailand and Brazil in issuing compulsory licenses, noted:
''No company will live or die because of high price premiums for Aids
drugs in middle-income countries, but patients may.''

Jon Ungpakorn, former Bangkok senator and health care activist, said the
PPP-led government should not be intimidated by trade-related pressure
to provide essential medicines for the majority of the population.

Take the anti-Aids drug Efavirenz for example. According to a study by
the National Health Security Office which runs the universal healthcare
scheme, an additional 20,000 people living with HIV/Aids are expected to
receive the medication after the government bypassed the drug patent in
November 2006.

Undoubtedly, the issue of access to universal healthcare treatment will
be a challenge for any government coming into office from now on. For
all that, the CL policy will continue to serve as an effective tool to
test the political will to stand up for the public's right to access
life-saving medicines _ at least until the government manages to solve
the financial problems which threaten to compromise the state's
universal healthcare system, Mr Jon said.


--
Sarah Rimmington
Attorney
Essential Action, Access to Medicines Project
Washington, DC
Tel: (202) 387-8030
Cell: (202) 422-2687
www.essentialaction.org/access/