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Thailand and the health-care industry

Christopher Horner's ill-informed references and misleading accusations against Thailand's use of compulsory licensing (CL) on three life-saving drugs require that facts be set straight on this matter ("Thailand stealing out of WTO?" Commentary, May 17).

First, the use of compulsory licensing is permissible under the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPs) Agreement. Thailand, as a founding member of the WTO, has always stood firm on its commitment to WTO rules and obligations. The consistency of Thailand's decision with WTO rules has not been disputed. This was the first time Thailand used such a measure, but we were not the first to do so. In any case, the use of CL is under the purview of each WTO member government's consideration.

Second, the Public Health Ministry's resort to compulsory licensing is for public, non-commercial use only. This means the generic version of the medicines manufactured or imported under compulsory licensing will only be given to patients under the government's healthcare programs, the aim of which is to provide access to essential life-saving medications. However, at least 20 percent of Thais who can afford to pay out of their own pockets and more than two million foreign patients will continue paying market prices for the original patented products. As such, Mr. Horner's allegations regarding the Government Pharmaceutical Office's commercial motives are irrelevant and misguided. The GPO will not be making commercial profits from the government's CL decision.

Third, while continuing vigorously to promote HIV protection, Thailand still has more than 500,000 people living with HIV/AIDS who need or will need treatment to live. Currently, out of over 10,000 patients dependent on second-line treatment like Kaletra, less than 15 percent have access to the drug. The government, therefore, felt compelled by its humanitarian consideration to increase the number of patients with access to the life-saving medicines. The healthcare budget, despite being increased to rank second after the education budget and standing at more than 11 percent of government's overall budget this year, still cannot keep pace with the prices of some life-saving drugs. Many patients remain barely able to afford treatment without government support. Spending on anti-retroviral drugs alone increased to more than $100 million in 2007, from around $17 million in 2004. The costs of drugs like Kaletra, a second-line anti-retroviral drug, which had cost around $2,200 annually per patient before dropping to $1,000 in April, are immense for a country whose average GDP per capita was $3,179 in 2006 and where the poorest 20 percent of the population owns less than 5 percent of national income while the richest 20 percent controls more than 50 percent of the national wealth.

Fourth, of the three compulsory licenses announced, only one has been implemented. In January 2007, an agreement was signed between the Government Pharmaceutical Organization and an Indian drugmaker to import 66,000 bottles of generic Efavirenz. The first batch has already arrived and reduced prices by more than half, allowing an additional 20,000 AIDS patients under the government's health-care programs access to the medicine.

The decision was not made lightly. It had taken the Thai Ministry of Public Health more than two years including several rounds of discussion with pharmaceutical companies before it made its final decision. After the compulsory licenses were announced, the Public Health Ministry still maintains dialogues with all stakeholders to find mutually acceptable solutions. The Thai government has also been engaged in consultations with the U.S. government at many levels.

Finally, the use of compulsory licensing should not be politicized by any linkage with the current political situation in Thailand. Such attempt would not contribute to the ongoing dialogue to find mutually acceptable solutions on the matter relating to patients' lives. The Thai government's decision on compulsory licensing is about saving lives, not making financial gains. It is an exception, not a rule. Preserving and improving human lives and ensuring people have access to essential drugs are causes which we trust are shared not only by governments and NGOs, but also leading pharmaceutical companies as part of their social responsibility.

SONGPHOL SUKCHAN