Yesterday Thailand, for the first time, announced it will issue a compulsory licence for use by the government to improve access to a key HIV/AIDS medicine, efavirenz. The international medical humanitarian organisation Médecins Sans Frontières (MSF) welcomes this important move and urges the government to issue such licenses for the production of other essential medicines.
The drug efavirenz, recommended by the WHO for HIV/AIDS treatment, is currently patent protected in Thailand, and the monopolistic situation has affected both supply and affordability in the country. The price the patent holder Merck charges in Thailand (1,500 baht/month - US$41) is double of what Indian generic manufacturers charge for the drug (800 baht/month - US$22). In addition, on several occasions, Merck has been unable to supply the drug in Thailand.
"Merck's supply of efavirenz has not been reliable, and has resulted in treatment interruptions, forcing several hospitals to supply suboptimal dual therapy," said Dr. David Wilson of MSF in Thailand.
The compulsory license will apply both to import and local production of the drug. Thailand is developing its own generic production capacity for efavirenz through the country's public drug manufacturer, the Government Pharmaceutical Organization (GPO). Production in Thailand of efavirenz is expected to begin next year.
In the meantime, the compulsory licence will allow Thailand to import generic efavirenz from India, halving the costs for this drug and expanding procurement options to ensure sustainable drug supply.
It is estimated that at least 12,000 people in Thailand currently need efavirenz, but that due to cost and supply difficulties, the number receiving the drug is significantly lower.
Generic production is the cornerstone of Thailand's universal HIV/AIDS treatment programme. Before generic production, the cost of standard HIV/AIDS treatment in Thailand was over 33,330 baht per patient per month (US $924), and only 3,000 people were getting treatment.
In 2002, Thailand launched a generic version of HIV/AIDS triple therapy, resulting in an 18-fold drop in the cost of treatment. Thanks to this, over 85,000 people with HIV/AIDS are today receiving treatment.
UNAIDS reports that Thailand is the only Southeast Asian country to have over half the number of people on AIDS treatment who need it.
Both the World Health Organization (in August, 2005) and the World Bank (in August, 2006) have predicted dramatically rising drug costs in Thailand due to the fact that patients need to switch to newer and more expensive drugs in cases of resistance and toxicity. Both organisations recommend the use of public health safeguards enshrined in the Doha Declaration on TRIPS
"Thailand is demonstrating that the lives of patients have to come before the patents of drug companies, and this policy needs to be expanded to essential drugs that are expensive and in short supply, such as the AIDS drug lopinavir/ritonavir, which currently costs over 7,000 baht a month (US $194) and is far too expensive for Thailand," said Dr. Wilson.