The convention centre for the International AIDS conference in Toronto, Canada looks like a giant shopping mall. Conveyor belts of people stream from one session to another, with the celebrity names pulling the biggest crowds - the two Bills (Clinton and Gates), Richard Gere – as well as a whole host of UN acronyms and pharmaceutical companies. The general message conveyed by most is that things are going well, we just need more of the same. Activists and health care workers on the ground are more cautious about the claimed successes. The title of the conference ‘Time to Deliver’ appears to be directed at everything and no-one.
Amid the cacophony of press conferences and ever mounting mass of progress reports, statistics, and press clipping comes a report ‘The Economic of Effective AIDS Treatment Evaluating Policy in Thailand’ released by the World Bank today, that sends a very clear wake up call to the Thai government.
The report is the result of a three-year evaluation of the Ministry of Public Health’s efforts to expand access to antiretroviral therapy. It warns that unless urgent action is taken to ensure continued access to newer medicines, the cost of treatment is going to rapidly rise to such an extent that Thailand’s treatment programme, hailed a success worldwide, will begin to unravel.
Currently, over 80,000 people in Thailand are receiving treatment. This achievement was only made possible because of the local production of generic medicines by the Government Pharmaceutical Organisation, which has allowed treatment costs to come down to around 1,200 baht per month. According to the World Bank study the treatment programme is highly cost-effective.
HIV/AIDS is a chronic disease requiring lifelong treatment. This means ensuring access to a range of newer medicines to overcome side-effects that some patients may experience over time and the problem of drug resistance – an inevitability in any HIV/AIDS programme.
The problem is that these newer medicines are patent-protected, and much more expensive than the standard treatment that people start out with. Unless something is done to bring down the price of newer medicines, the cost of the government programme will, according to the World Bank, increase five-fold in the next 15 years.
Take the example of one key antiretroviral medicine Lopinavir/ritonavir. Until recently, the price of Lopinavir/ritonavir, a key medicine used in the developed world for patients who develop resistance to the first line of treatment, was priced at around 125,000 baht per patient per year in Thailand. A group of Thai physicians and academics, together with patient groups and also Médecins Sans Frontières (MSF) (a Nongovernmental Organization, which has been supporting HIV/AIDS programmes in Thailand since 1995) has been pushing the manufacturer, Abbot, to lower the price of this drug since the beginning of the year. In a move motivated more by good PR than concern for public health, the company announced at the Toronto conference that it would lower the price of this drug to 88,000 baht. But this is still far too expensive for Thailand, meaning the drug remains out of reach.
Action can be taken to reduce these costs. The World Bank report points out that by exercising compulsory licensing to reduce the cost of second-line therapy by 90 per cent, the government would reduce its future expenditures by 127 billion baht up over the next 2 years. This is not an unreasonable goal: thanks to generic competition, the cost of first-line treatment has been pushed down from over 400,000 baht per patient per year to around 14,400 baht – a 97% reduction in price.
But doing so will provide strong political resolve, and it is not something the pharmaceutical companies and the US government are keen to see happen. The current US-Thai FTA negotiations threaten to seriously hamper access to affordable generic versions of these drugs. In these negotiations the US is pushing regulations that will limit the ability of the Thai government to override patents – the very mechanism that has allowed Thailand to scale up treatment in the first place.
The World Bank has given Thailand a clear message that compulsory licensing should be considered if long-term care for people with HIV/AIDS can be guaranteed. The recent removal of the WHO representative in Thailand for suggesting that compulsory licensing should be considered an option for securing affordable second-line medicines shows how little progress has been made at the international level to confront these major political barriers. Thailand must show political strength to follow the World Bank recommendations. We cannot afford to do otherwise. |
