Inter Press Service - October 18, 2002
Satya Sivaraman

Thailand's state-run Government Pharmaceutical Organisation (GPO) will go ahead with the production of didanosine (ddI), an AIDS drug patented by the U.S.-based drug company Bristol-Myers Squibb (BMS), at half the price charged by the multinational, according to GPO director Dr Thongchai Thawichachart.

The GPO's move was made possible by a landmark judgement on Oct. 1 by a Bangkok court which struck down the U.S. company's exclusive right to produce ddI.

"This is the first court victory for HIV/AIDS patients and we expect this ruling to set a precedent for other AIDS advocacy groups and patients to follow," says Nimit Tienudom, executive director of AIDS Access Foundation.

The foundation, along with two AIDS activists, launched legal action against Bristol-Myers Squibb over its illegal patent amendment on May 9, 2001.

In 1992, Bristol-Myers Squibb patented ddI at dosages of five to 100 milligrammes. But while renewing its patent in 1997, the company expanded its claim to dosages beyond this range.

The court ruled that this expansion was unlawful and ordered the company to amend its patent and stick to producing the drug at dosages specified by its original patent.

The decision means that other manufacturers -- like the GPO -- can now produce the drug in pill form at dosages different from that produced by BMS.

Currently, in order not to violate patent rights, the GPO produces ddI only in powdered form, but this has more side effects. Patients complain that it is difficult to take.

The company has 30 days after the court ruling to appeal the decision, however company representatives in Thailand were quoted by the local media as saying that the decision to appeal rests with BMS' American headquarters, which is yet to respond.

According to Thongchai, until an appeal is lodged, the GPO will produce pills of four milligrammes and 125 milligrammes, and the price for the highest dose will not be more than 20 baht (46 U.S. cents) a pill.

The price of ddI, as sold by BMS, costs 11, 22 and 44 baht (25 cents, 50 cents and one U.S. dollar) for 25mg, 50mg and 100mg tablets respectively.

BMS's easier-to-take ddI capsules cost even more at 123 baht (2.81 dollars) per 250mg tablet and 194 baht (4.44 dollars) per 400mg tablet.

Currently, less than 5 percent of Thailand's 1 million people with HIV/AIDS have access to anti-retroviral drugs, considered the best treatment for the health condition.

But these life-saving medicines often cannot be accessed in developing countries because they are extremely expensive -- a triple combination therapy costs 10,000 dollars per year.

The high price is linked with the monopoly on many of these drugs held by global pharmaceutical companies using stringent patent protection laws.

The efforts to reduce prices of medicine used by HIV-affected people in Thailand started in late 1999, with a protest outside the Thai Public Health Ministry by non-government organisations like the AIDS Access Foundation and the Network of People Living with HIV.

They have also been helped by a global campaign against big drug multinationals trying to charge high prices for the life-saving medicine that most people with HIV cannot afford.

Under pressure from the U.S. government and drug multinationals, Thailand has not invoked the compulsory-licensing clause provided in the World Trade Organisation agreements to produce life-saving HIV drugs.

But where possible, the Ministry of Public Health has been attempting to provide high-quality anti-retroviral drugs at reasonable cost. Generic versions of anti-retroviral like zidovudine (AZT), not patent protected under Thai law are already being manufactured by GPO.

Thanks to these initiatives and to the increasing pressure on drug multinationals to reduce prices, the cost of HIV treatment has been declining.

There are eight sets of medicines, which are recommended by the doctor depending on the patient's condition, activists say.

"The cost of this medicine until some years ago was 26,000 baht (595 dollars) per month. But now it has come down to around 1,200 baht (27 dollars) per month," says Samran Thakan, founder of the New Life Friends Association, a self-help group of HIV-affected people in the north of Thailand.

But for many of Thailand's HIV-affected people the drugs are still unaffordable because apart from their health problems they also face unemployment and poverty.

This affects their ability to look after themselves properly and to keep their morale high -- both of which are necessary for their long-term physical survival.

"My organisation welcomes the government distributing cheaper drugs but their responsibility does not end with this," says Bunnium Wongchaikham of the Northern Network of People Living with HIV here.

"They should think about how to take care of the overall health of the patient. The patient should get regular advice and should have access to doctors to give them continuous care," Bunnium points out.

With these concerns in mind, activist groups have been demanding that their treatment be included in a low-cost health insurance scheme introduced by the Thai government last year.

HIV-related drugs and treatment are not included in this scheme, which allows Thai citizens medical care at just 30 baht (69 cents) per hospital visit.

But after lobbying by HIV activist groups, the Ministry of Public Health promised to include AIDS drugs if the monthly cost of production drops below 2,500 baht (57 dollars) per regimen.

With the October court decision leading to lower drug prices, the inclusion of HIV drugs in the low-cost health insurance scheme is now financially feasible for the government.

According to HIV activist groups, Friday's landmark production will coincide with the public health ministry's first steps to distribute anti-retroviral drugs on an experimental basis as part of the government's public health insurance scheme.

As this takes hold, the benefits of the Thai court judgement earlier this month will have made its way down to the grassroots to start saving the lives of the country's poorest and most desperate people. (END/IPS/AP/HE/HD/SS/JS/AAG/02)

021018
IP021014

Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .