THAI NEWS AIDS 2008

Editorial: The Red Cross and bad blood  - April 04, 2008

Thailand's Red Cross Society should reveal more scientific evidence to support its decision to ban homosexuals from giving blood donations. Thailand's Disease Control Department has found that the greatest risk of contracting HIV/Aids comes from having unprotected sex, regardless of whether someone is homosexual or heterosexual.

Of the nearly 14,000 Thais who acquired HIV last year, 34% were young women and housewives. Gay men comprised the second largest group at 24%, and 84% of those contracted the deadly virus through unprotected sex.

The Red Cross claims it has lots of unused blood donated by men who have sex with men. It should reveal exactly how much blood is contaminated, compared with heterosexuals, and whether anyone has contracted HIV through a blood transfusion in Thailand from a gay man. Moreover, it says that in questionnaires and interviews men will be asked if they are "homosexuals" and women will be asked "if they have had sex with men from countries that have high incidence of Aids cases".

Yet the study cited by the Red Cross to come up with its policy to ban gays - one by J A Musto of the University of New South Wales' National Centre in HIV Epidemiology and Clinical Research - cites Thailand and South Africa as countries with a high incidence of Aids. By this logic, every Thai woman who has sex with a Thai man should be banned from donating blood as well.Of course, that would never happen. But it reveals how decisions must be based on statistics and indisputable evidence rather than broad, sweeping statements that only serve to reinforce cultural stereotypes.

This is not to say that the Thai Red Cross shouldn't do all it can to make sure donated blood is safe. The important question to ask is if homosexuality alone is reason enough to ban donors.

Thailand is not alone in banning gay men from giving blood. The US bans anyone who has ever had sex with a man after 1977, the year HIV supposedly was spawned. That decision was opposed by the American Red Cross, however. The organisation said a lifetime ban for gay men was "no longer medically and scientifically warranted". Even so, the US Food and Drug Administration still bans gay men for life.

England also bans gay men for life, although it imposes only a one-year ban on heterosexuals who have had sex with a partner from a country with a high HIV incidence, mostly in Africa. Thus, it would be nice to know from the Thai Red Cross how much of the rejected blood comes from gay men with risky lifestyles, and how much comes from gays who do wear condoms or are in monogamous relationships. And what is the cost? Is so much blood from gay men being rejected that it outweighs the benefits of having more donors?

Thailand has taken a leading role on many key issues related to access to public health, including policies toward transgender people and the decision last year to issue compulsory licences for Aids drugs.

We hope the Thai Red Cross will come up with a more sophisticated policy that aims to eliminate discrimination in donating blood. Or provide solid, irrefutable evidence that puts the issue to rest.

New steps to fight HIV-drug resistance - 12% of patients need alternative to GPO-VIR  - April 04, 2008

An increase in the number of HIV-positive people with resistance to the first-line drug GPO-VIR has prompted health authorities to step up preventive measures on viral load screening.

The Disease Control Department made a study of HIV-positive people who have taken the medicine for six months, and found 12% had developed resistance to GPO-VIR, up from 10.5% in 2006.

Somchai Pinyapornpanich, Disease Control Department deputy director-general, said drug resistance had increased since the universal healthcare scheme began providing free drugs to HIV-positive patients listed under the programme.

Of the 500,000 people living with HIV/Aids in Thailand, 100,000 were dependent on Aids drugs under the anti-retroviral treatment programme, he said.

HIV-positive people with a CD4 count of less than 200, or a viral load of about 1000-1500, are required to take the medication.

However, the study found that the viral load level in patients' blood did not reduce after taking medication during the study period.

The most likely explanation for drug resistance is that the virus is adapting to stay alive, he said.

Symptoms of drug resistance could also occur in HIV-positive people who did not take the medication as recommended, or those depending on the anti-retroviral treatment programme for over five years, he said.

Dr Somchai said the problem was not caused by the quality of the locally-made Aids drug, GPO-VIR.

It costs the Government Pharmaceutical Organisation 1,200 baht to make a monthly dose of the generic drug for just one patient, which is supposed to be cheap.

Those who develop resistance to GPO-VIR have to take Effavirenz or Lopinavir/Ritonavir as an alternative.

The viral load level of HIV-positive people is checked every six to 12 months after taking the medication.

Dr Somchai said he would talk to people running the medical programme for HIV/Aids patients under the universal healthcare scheme about whether to set aside a fund for viral load checks.

He believed a screening programme could help monitor the effect of Aids drugs.

It could also help curb drug resistance among patients living with HIV/Aids.

Compulsory Licensing: CL vital so long as healthcare lacks funds  - April 02, 2008

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.

Red Cross bans gay donors: New rule rejects blood from homosexual men  - March 31, 2008

The Thai Red Cross Society has resolved to reject blood donations from homosexual men in a move which has met with strong opposition from human rights organisations.

The decision came after a study found that men who had sex with other men were at risk of contracting HIV/Aids and transmitting the blood-borne virus.

The Thai Red Cross said it had large amounts of unused blood that had tested HIV-positive. Most of the infected blood was from men who were having unprotected sex with other men, according to in-depth interviews and preliminary tests, said the director of the National Blood Centre, Soisaang Pikulsod.

For safety reasons, the bank is screening high-risk groups of blood donors through questionnaires. Blood donors are asked if they are homosexuals and female donors will also be asked if they have had sex with men from countries that have high incidence of Aids cases.

"The Thai Red Cross Society has the right to protect patients who are waiting for blood transfusions to save their lives by screening blood from specific donors that have high-risk sexual behaviour," she said. The new rule also followed the World Health Organisation guidelines, she added.

Blood donor questionnaires and declarations can be used to reduce the risk of accepting HIV-infected blood from donors, a study published in Transfusion Medicine said this year, she said.

A study by J A Musto of the University of New South Wales' National Centre in HIV Epidemiology and Clinical Research and his team found that men who have sex with other men and women who have sex with partners from countries with a high HIV prevalence such as South Africa and Thailand were at high risk of HIV transmission.

"It's the responsibility of blood donors to ensure that their blood is of good quality. It will be religiously and morally wrong if you want to only make merit but do not care about your risky behaviour, which could end up putting other people's lives at great risk," she said.

However, the National Human Rights Commission strongly opposes the new rule and plans to call on the Constitution Court to stop the Thai Red Cross from singling out gay men.

What the Thai Red Cross is doing is tantamount to sexual discrimination under the constitution, human rights commissioner Naiyana Supapueng said.

The commission will also try to bring together those affected by the regulation to sit down this week to find a way of stopping it, he added.

"In principle the Thai Red Cross Society should not come up with a total rejection. Taking away people's rights is not the correct thing to do," she added.

But Natee Teerarojjanapongs, leader of the Gay Political Group of Thailand, who previously called on the centre to continue accepting blood donations from homosexuals for human rights reasons, said he now accepted the new rule.

He conceded that homosexuals were at high risk of contracting HIV as a national study showed HIV prevalence among homosexual men, especially in Bangkok, was as high as 28%.

However, he called on relevant agencies to strengthen condom campaigns and monitor public places such as saunas for promiscuous homosexual behaviour. He said the low lighting was intentionally created at these places to encourage homosexuals, especially teenagers, to have sex without protection.

An estimated half a million people are living with HIV/Aids in Thailand. About 14,000 new cases are reported each year.

HIV/Aids cases on rise again  Survey: Unprotected, casual sex to blame  - March 20, 2008

Casual and unprotected sex is being blamed for the high number of new HIV/Aids cases - with at least 40 people a day being infected. The number was released in a survey by the national sub-committee on Aids prevention.

The survey results have prompted health authorities to dust off a campaign to encourage the use of condoms.

Mechai Veravaidya, chairman of the sub-committee on Aids prevention, said new cases were mostly found among teenagers aged between 15 and 19. This group was sexually active and tended not to use condoms while having casual sex with multiple partners.

According to the survey only 13% of students in Mathayom Suksa and university level who had sex used condoms. Moreover, only 9% of office employees used condoms with their partners.

These groups were at high risk of contracting HIV/Aids as they had multiple partners without using protection. A lack of campaigning for condom use had made the HIV/Aids problem become very serious again, Mr Mechai, who was once known as 'Mr Condom' for his relentless condom campaign, said.

Mr Mechai said the country desperately needed to renew the condom campaign in a bid to reduce the number of new infections. Otherwise the disease would affect the national healthcare system.

An estimated 500,000 Thais are living with HIV/Aids. More than 80% of people living with HIV/Aids are in need of antiretroviral drugs.

Meanwhile, the World Health Organisation reported that 700,000 people living with HIV/Aids worldwide had tuberculosis-related problems.

In 2006, around 200,000 HIV-positive people died of TB-associated causes.

At the same time, doctors are studying three professions at risk of TB infection as Thailand ranks 18th out of 22 countries with the highest number of TB cases.

Praparn Youngchaiyud, president of the Thai Chest Association, said a team of researchers was studying TB infections among taxi drivers, food vendors and nurses because their closed working environments could make them more easily susceptible to the disease.

It would take another two years to conclude the study.

However, Dr Praparn believed the TB infection rate among these professions was no higher than others such as labourers.

Paijit Warachit, deputy permanent health secretary, said there were 91,000 new TB cases each year. A high number of TB infections and multiple drug resistance also prompted health authorities to promote screening tests and expand coverage of Directly Observed Treatment, short-course (DOTs), the WHO-recommended strategy for TB control.

The US Trade Representative (USTR) yesterday called for more participation by all parties concerned including drug companies in talks over the issue of compulsory licences for drugs. The call was made in a 30-minute meeting between Barbara Weisel, the assistant USTR for Southeast Asia, and deputy public health permanent secretary Paijit Warachit, who oversees the CL policy.

Dr Paijit quoted Ms Weisel as saying the USTR had called for participation by drug companies, if possible, in any future move to suspend patent protection for expensive medicines.

Ms Weisel did not say anything about downgrading Thailand's trade status to that of "Priority Watch List" for intellectual property violations, he said.

The USTR delegation earlier met Commerce Minister Mingkwan Saengsuwan and Finance Minister Surapong Suebwonglee. However, the two sides did not discuss the controversy over Thailand's CL policy, said Pansak Winyarat, an adviser to the two ministers.

Former US ambassador to Thailand Ralph Boyce had previously asked the Surayud Chulanont government for similar talks on the CL issue between the government and associations of drug companies.

Compulsory licensing is permitted under World Trade Organisation rules in national emergencies or justified non-commercial cases. The programme allows Thailand to produce or import generic versions of medicines for local use. Patent-holders can receive some royalties but they complain the scheme violates their intellectual property rights.

Mongkol na Songkhla, the public health minister in the Surayud government, had already enforced the compulsory licences for the HIV/Aids drugs Efavirenz and Kaletra, the anti-clotting agent Clopidogrel, and four cancer drugs - Imatinib, Docetaxel, Erlotinib and Letrozole.

The current public health minister, Chaiya Sasomsab, earlier decided to freeze the CL policy on four cancer drugs due to concern that the policy would affect trade relations with superpower nations. But he later gave up the plan and resumed the CL policy, initiated by Dr Mongkol, in the wake of mounting pressure and attempts to oust him from office by a network of medical professionals, patients and NGO activists

Patient forum agrees on need for CL: Cancer and Aids victims get together to voice their views on government policies  - March 16, 2008

A "patient forum" was held for the first time yesterday on access to drug and medical treatment. The forum, chaired by health advocate and former senator Jon Ungpakorn, was attended by about 100 cancer and heart disease patients as well as people living with HIV/Aids who shared their views on problems relating to public access to medicinal drugs.

The commerce and foreign ministers, and representatives from the Social Security Office and National Health Security Office were invited, but only representatives from the SSO and public health minister showed up.

Patient Chariya Chariyanakul said she had lived with breast, bone and lung cancer for several years. But the cost of the medicine needed to treat her did not affect her much, because the healthcare scheme for civil servants covered all expenses.

She said most cancer patients chose not to voice problems regarding the cost of treatment because they believed that cancer required expensive treatment and those who cannot afford to pay had to die.

"Many cancer patients that I know give up on the high cost of treatment and go to temples to take traditional herbal medicine although they know it cannot help them recover," she told the forum.

"It is wrong to think that way because cancer can be cured.

"We can survive cancer if the government is truly interested in developing healthcare services."

She agreed with the state policy on compulsory licensing (CL).

"The CL policy is necessary as long as the government cannot come up with better measures to improve quality of life and healthcare services," she said.

Orawan Owararinm, another cancer patient, said the forum would encourage the public to be more interested in consumer protection.

She also supported the government policy on CL because it would save the national budget and increase access to essential medicines at affordable prices.

Suphan Srithamma, a public health ministry spokesman, said the healthcare budget should be increased so that state hospitals could afford to treat the 48 million people covered by the universal healthcare scheme.

Mr Jon, chairman of the forum, said the forum would help strengthen social mechanisms to monitor the government's work.

Saree Ongsomwang, the manager of the Foundation for Consumers, said about 12,000 people had signed a form calling for Public Health Minister Chaiya Sasomsab to be removed from office. She believed the number of signatures would reach 20,000 by the end of the month.

Under the constitution, people with 20,000 signatures can ask the Senate to remove a cabinet member. The support of three-fifths of the senators is needed to get a minister removed.

Patent-Breaking: GPO plans to make heart, Aids drugs - March 13, 2008

The Government Pharmaceutical Organisation (GPO) plans to manufacture local versions of anti-Aids and heart drugs that are listed under the compulsory licensing scheme. Witit Artavatkun, GPO managing director, yesterday said imports of two antiretroviral medicines, Efavirenz and Lopinavir/Ritonavir, as well as the heart drug Clopidogrel, would no longer be needed after the construction of its new 700-million-baht plant is finished.

This is to save money on drug imports and speed up the distribution of medicine to patients.

The plant is under construction in Nakhon Nayok and is expected to be completed within six months. It may take around 10 months before the plant is ready to produce the first batch of medicines. Its maximum production capacity would be three billion tablets a year, he said.

The agency had already distributed Efavirenz tablets and the second-line Aids drug Lopinavir/Ritonavir, bought from Indian drug makers.

The distribution of Clopidogrel has been delayed however because the India-based manufacturer was uncertain over the Samak Sundaravej government's CL policy. He said the GPO would be able to distribute the imported heart drug within 45 days from the government stating clearly it would continue the previously-announced CL policy.

Dr Witit said the GPO has no plans to produce cancer drugs as they need high-end production technology and also require massive investment.

Meanwhile, the GPO would be distributing the generic lung and cancer drug Docetaxel for patients under the universal healthcare scheme within one and a half months. The Indian generic maker charges 1,245 baht per 80mg of the drug compared to the original version which costs 25,000 baht. The first batch would be enough to treat about 1,000 lung and breast cancer patients.

The GPO was still seeking generic versions of Erlotinib, a lung cancer drug, and Letrozole, a breast cancer drug for local distribution, he said.

Mongkol na Songkhla, public health minister under the coup-maker appointed government, announced the CL policy for the cancer drugs on Jan 4. It was aimed at bypassing the patents on four cancer drugs - Erlotinib, Docetaxel, Imatinib and Letrozole - because the patent holders refused to lower prices after 13 rounds of talks.

Dr Mongkol later cancelled a deal for Imatinib after the patent holder offered the drug free to 900 patients under the universal healthcare scheme.

In a related development, the EU confirmed the legality of Thailand's policy on CL and did not plan to threaten a World Trade Organisation challenge.

"The commission has been in constant contact with the Thai authorities and has stressed that compulsory licensing, while allowed by the WTO rules, should be regarded as a last resort option and that negotiations and collaboration with pharmaceutical companies should be sought. The EU is hoping that this will be the line of the new government," the EU said in a statement.

Deputy Prime Minister and Commerce Minister Mingkwan Sangsuwan said yesterday he fully supported CL for cancer drugs, saying he is ready to explain the policy to foreign countries in the hope of preventing any impact upon trade.

"Personally, I agree with the government's plan to go ahead with CL to ensure access to essential medicines for Thai patients," he said.

All 10 Asean countries have ratified the Convention on the Elimination of all Forms of Discrimination against Women, and have endorsed the Beijing Platform for Action, the Millennium Development Goals (MDGs) and Security Council Resolution 1325 on Women, Peace and Security.

Integrating gender equality and women's empowerment concerns into National Development Plans or formulating Women's Development Plans is a growing feature in East and Southeast Asia. Countries in the region likewise have a plethora of gender equality legislation - overarching gender equality laws, legislation on domestic violence, trafficking, HIV/Aids and land rights, among others.

But there continues to be a yawning gap between policy and practice. Women are disproportionately present at the bottom of the job hierarchy in the poorly protected informal sector - 41% in the Republic of Korea, 65% in Indonesia, 62% in the Philippines - primarily in food processing, petty trading and home working.

In Asia and the Pacific, women work about 12 hours more per week than men, performing both paid and unpaid work. Women are poorly represented at higher levels of formal decision-making, and of 8.3 million people who were HIV-positive in Asia at the end of 2005, 2.4 million were adult women.

An important cause for this is that policy commitments are seldom matched by resources that help the gender equality agenda to make a difference to women's lives.

To call attention to this, the theme for International Women's Day 2008 is "Investing in Women and Girls." Says UN Secretary-General Ban Ki-moon: "Achieving gender equality and empowering women is a goal in itself. It is also a condition for building healthier, better educated, more peaceful and prosperous societies. When women are fully empowered and engaged, all of society benefits. Only in this way can we take on the enormous challenges confronting our world - from conflict resolution and peace building to fighting Aids and reaching all the other Millennium Development Goals."

Reinforcing this is a World Bank estimate that an increase of one percentage point in the share of women with secondary education is associated with a 0.3 percentage point increase in per capita income. Lack of investment in women and girls is therefore an opportunity lost.

According to the Economic and Social Commission for Asia and the Pacific, the Asia-Pacific region loses US$42-$47 billion annually due to women's marginalisation from employment, and another $16-$30 billion per year because of gender gaps in education. The Organisation for Economic Cooperation and Development's Development Assistance Committee estimates that low-income countries would require about $23.8 billion annually to achieve the MDG on promoting gender equality and women's empowerment by 2015. This translates into $7 to $13 per capita per year from 2006 to 2015.

Daunting as this challenge may be, there are achievements to build on - budget allocations that have increased women's employment; microfinance and credit provided for women's businesses; private sector initiatives and innovative resourcing by wo-men's funds and foundations to empower women. Moreover, over 50 countries worldwide are implementing Gender Responsive Results-based Budget initiatives. On the basis of data and inclusive multi-stakeholder consultations, mainstream national and sectoral budgets are analysed to ensure that governments adjust their priorities by reallocating resources, spending and tracking impact of expenditure on gender equality and women's empowerment priorities.

Together with governments, civil society and other UN agencies, the United Nations Development Fund for Women (Unifem) has technically and financially supported over 30 of these initiatives globally. In this region, the Municipality of Hilongos, and Sorsogon City in the Philippines are implementing gender budgeting initiatives in the agricultural and health sector, respectively, with Unifem technical and financial support.

But the way forward requires much more. It demands political will and accountability of all development partners. This includes increasing the share of national budget and overseas development assistance for gender equality and women's empowerment concerns, building national capacity and setting up mechanisms to routinely monitor and report on the impact of national and ODA resource allocation and expenditure on women's lives, promoting women's participation in hitherto male-dominated domains like trade, infrastructure and finance.

Finally, we need a critical mass of capacitated women in positions of economic and financial decision-making in these sectors, to make money really work for women.

** Dr Jean D'Cunha is Regional Programme Director, UNIFEM East and Southeast Asia.

With the whole world watching, the new government must make absolutely clear its stand on the matter of compulsory licensing. The mixed signals being sent out so far have led many to fear this life-saving policy might be scrapped.

Immediately after his appointment as the new health minister, Chaiya Sasomsab announced he would review the CL policy initiated by his predecessor. As of now, however, it remains unclear what he is reviewing. At the very least, he should state explicitly the criteria by which the People Power party will judge compulsory licensing. "I've never said I would revoke or retain the recent enforcement of compulsory licensing for cancer drugs," Mr Chaiya declared recently. "I just want to review it so that when someone asks me about this issue I can answer them clearly, particularly at cabinet meetings."

This being one of the most important global issues, and with Thailand having taken a leading role in compulsory licensing, it is a shame the PPP did not have a clear-cut policy from the very first day it took office.

Though the military-installed government of Surayud Chulanont had a reputation for incompetence, the Health Ministry was the exception, with Dr Mongkol Na Songkhla vigorously pursuing a clear CL policy.

The PPP certainly has the right to disagree with that policy but we should at least have a sensible debate. Instead, we've seen wishy-washy statements warning against the damage supposedly being done to trade relations with the United States. It is unlikely the government's use of compulsory licensing will lead to a loss of privileges under the Generalised System of Preferences, no matter what the pharmaceutical lobby says. Even so, this point has been raised by none other than former prime minister Thaksin Shinawatra, who told the Financial Times this week: "For compulsory licensing, we have to be very cautious... We have to be very careful how we move on that."

As premier, Mr Thaksin walked a fine line on the issue of drug access. While compulsory licensing tended to go against the grain of his pro-business policies, he also realised the political implications of bowing to the pharmaceutical industry on this issue. Indeed, the real obstacle to a US-Thai free trade deal in 2005 were the provisions relating to CL, patent lifespan and data exclusivity that went beyond those required in the World Trade Organisation's Trips agreement.

As health minister, Dr Mongkol took the first step in issuing a compulsory licence for two Aids drugs. This move was lauded by NGOs and prompted the drugmaker to cut prices for many middle-income countries, not just Thailand. He then expanded the policy to include drugs for heart disease and cancer, which proved more controversial.

Dr Mongkol's successor has so far essentially claimed ignorance regarding CL policy. But despite his plea for time to understand the issue, Mr Chaiya apparently knew enough to remove CL negotiator Dr Siriwat Tiptaradol as chief of the Food and Drug Administration. (His replacement resigned after five days.)

It is one thing if the health minister removed Dr Siriwat because the two have significant policy differences. But Mr Chaiya hasn't clearly explained what the government's policy is. Any move to scale back CL cannot rest on unsubstantiated threats from US business lobbies. The issue is too important for any sort of hazy politicking.

The government must come up with a clear stand on compulsory licensing that engages all stakeholders. Health Minister Chaiya may eventually still do this, but so far the prognosis is not encouraging.

Secretary-general of the Food and Drug Administration (FDA) Siriwat Tiptaradol has been transferred to an inactive post in a move observers see as linked to the compulsory licensing (CL) policy.

Mr Siriwat is the second senior official to be suddenly moved from his position by the government.

Sunai Manomai-udom was moved from the head of the Department of Special Investigation to a less important position by Justice Minister Sompong Amornwiwat last Friday.

Dr Siriwat's transfer was made by Public Health Minister Chaiya Sasomsab, who oversees the FDA, and was approved by the cabinet with immediate effect. It also involves two other officials.

Dr Siriwat was appointed a ministry inspector and his position at the FDA given to Chatree Banchuen, director-general of the Medical Services Department. Ministry inspector Raywat Visruthvej replaces Dr Chatree at the department.

Dr Siriwat's removal comes as little surprise as he was seen as a close aide to former public health minister Mongkol na Songkhla, who approved compulsory licensing to bypass patents on Aids, heart and cancer drugs.

Dr Siriwat was directly involved in the CL policy as he was appointed by Dr Mongkol to chair a panel working on negotiating drug prices with pharmaceutical companies.

However, Mr Chaiya said the transfer of Dr Siriwat had nothing to do the former government's policy on compulsory licensing.

"The reason for this transfer was only to improve the working of the ministry. I do not personally love or hate anyone in particular," he said.

Mr Chaiya indicated that the change was linked to delayed inquiries handled by the FDA into illegal energy drinks and unhygienic imported pork meat.

The minister said Dr Siriwat's move would not obstruct his planned negotiations on cancer drug prices listed for patent bypassing. He believed Dr Chatree capable of meeting the demands of the FDA's top post.

Dr Chatree was allegedly involved in a 900-million-baht computer scandal at the ministry when Khunying Sudarat Keyuraphan was minister. She is one of the 111 Thai Rak Thai (TRT) party executives subsequently banned from politics for five years.

Dr Chatree, who was then public health inspector, chaired the bidding for the computer procurement contract in 2003. He allegedly revoked the bidding results without sufficient grounds.

He faces no punishment even though the investigation findings by the disciplinary panel reported he was implicated in the case.

Health permanent secretary Prat Boonyawongvirote and Dr Siriwat declined to comment on the transfer, but Dr Chatree said he was surprised by his transfer to the FDA.

A source at the ministry said Mr Chaiya had decided to appoint officials who previously supported the TRT to work closely with him.

While Khunying Sudarat was at the helm of the ministry, Dr Chatree was appointed director-general of medical services and Dr Raywat director-general of health services support.

Kriangsak Vacharanukulkiat, chairman of the Rural Doctors Society, suspected the sudden move of Dr Siriwat to an inactive position was linked to the CL policy.

Dr Kriangsak said the minister had not asked for information from Dr Siriwat when he made his decision to review the licences on four cancer drugs, even though he was heading negotiations with the international drug firms.

"Dr Siriwat's move clearly shows that the health minister doesn't want to continue the CL policy, or stand for the people as he has claimed," he said.

"The public should watch closely if the Public Health Ministry reverses the compulsory licences on cancer drugs," he said.

Saree Ongsomwang, manager of the Foundation for Consumers, urged Dr Siriwat to submit the case to the Administrative Court for what she felt was an unfair transfer and abuse of power.

She said Vichai Chokewiwat, chairman of the Government Pharmaceutical Organisation board chairman and chairman of the compulsory licensing committee from the very beginning might be the next to go.

Nimit Tienudom, chairman of the Aids Access Foundation, said the minister did not make a smart move in transferring the FDA secretary-general outside the usual reshuffle period.

"This unfair transfer of a good civil servant is a ticking time bomb for the health minister himself," he said.

Academic hits at US over CL: Thailand should ask WTO to help, says Aat  - February 23, 2008

Thailand should also petition the World Trade Organisation (WTO) if Washington takes the compulsory licensing dispute to the organisation, says Aat Pisanwanich, an economics lecturer at the Thai Chamber of Commerce University. Like the US, Thailand is also a WTO member country and seeking flexibilities under the Trade-Related Aspects of Intellectual Property Rights (Trips) to bypass patents of Aids, heart and cancer drugs for emergency use was legitimate, the academic told a forum on the CL policy held by the National Economic and Social Advisory Council.

The Commerce Ministry earlier said the US planned to petition the WTO over Thailand's CL stance, saying it was not discussed with the patent holders.

"The lives of Thai people, who still lack rights and opportunities, have to be prioritised over anything else. If the military-appointed government could announce CL to help expand the public's access to medicine, why can't the elected government do the same?" he said.

Mr Aat, also the director of the Centre for International Trade Studies, said it was impossible for Washington to cut all GSP benefits worth about US$3.5 billion each year to Thai exporters. In his opinion, the worst-case scenario would be half of all GSP benefits would be cut totalling about two billion dollars.

There was nothing wrong if the country continued bypassing drug patents by implementing the CL policy, he said, adding Thailand could be an example to other developing countries like Malaysia, Indonesia and African nations.

The Thai healthcare system also depends a great deal on the multinational pharmaceutical industry. In 2007, the volume of medical imports from the US alone was US$143 million.

However, Mr Aat said Thailand should not depend only on Trips flexibilities to increase access to affordable drugs. It was necessary for the government to subsidise more healthcare funding.

That would be a win-win solution for both exporters and the majority of the population, he said.

Public Health Minister Chaiya Sasomsab yesterday said the government would continue to import heart drug Clopidogrel from Indian generic drugmaker Cadila Zydus as he had not revoked the licences on Aids and heart drugs issued by then minister Mongkol Na Songkhla.

Two million tablets of the medicine were expected to arrive for use with patients under the universal healthcare coverage in April, he said.

Nimit Tienudom, chairman of the Aids Access Foundation, said his network would call on Foreign Affairs Minister Noppadon Pattama on Wednesday to learn about his stance on the CL policy.

Compulsory Licensing: Chaiya's plan for CL policyreview hits major hurdle - February 20, 2008

A plan by Public Health Minister Chaiya Sasomsab to review the policy on compulsory licensing (CL) for four cancer drugs has hit a major obstacle after officials from three ministries found that it cannot be revoked.

Mr Chaiya said permanent secretaries of the commerce, foreign affairs and public health ministries had concluded that the ministerial announcements on four cancer drugs made by former public health minister Mongkol na Songkhla were legitimate and could not be lifted.

Although Mr Chaiya could not change the policy, a source said the government might take no further action under CL to bypass the patents of cancer drugs.

The meeting of the three ministries was ordered by Prime Minister Samak Sundaravej last week to decide if it should go ahead with the previous government's scheme to break the cancer drug patents.

Dr Mongkol signed four ministerial announcements on Jan 4 to individually license Letrozole, a breast cancer medicine produced by Novartis, breast and lung cancer drug Docetaxel made by Sanofi Aventis, Roche's Erlotinib, used for treating lung, pancreatic and ovarian cancer, and Imatinib of Novartis used on people with leukaemia.

But he struck a deal with Novartis as the patent holder agreed to supply its medicine free to more than 900 patients under its philanthropic programme.

In a forum about Thai policy on CL yesterday, Foundation for Consumers manager Saree Ongsomwang said health activists and networks of cancer patients and people living with HIV/Aids were monitoring government actions on CL.

"We will definitely not agree with the government if the CL policy for cancer drugs has to be shelved or delayed until the US Trade Representative finishes reviewing the list of countries receiving export benefits from the US Generalised System of Preferences in April," she said.

Pongthep Wongwatcharapaiboon, a rural doctor at Na Noi hospital in Nan province, said the poor would be most affected if the government did not extend access to cancer drugs through CL.

Cancer drugs were very expensive and available only at private hospitals and large medical schools in urban areas.

The lack of financial support from the National Health Security Office, which runs the universal healthcare scheme, made it impossible for the 626 community hospitals across the country to treat cancer patients in remote areas.

Sarah Ireland, an Oxfam regional director for East Asia, urged the government to continue with CL for cancer drugs and other life-saving medicines so that poor people would have greater access to them. Thailand should be a leader for low and middle-income countries in exercising its flexibility within the Trade-Related Aspects of Intellectual Property Rights (Trips) to widen public access to these medicines, she added.

Minister underattack for plan to reverse CL  - February 19, 2008

Opposition and NLA members oppose idea

Public Health Minister Chaiya Sasomsab's plan to cancel the compulsory licensing (CL) of patented medicines came under attack from the opposition Democrats and the National Legislative Assembly (NLA) on the first day of the government policy debate yesterday.

Democrat leader Abhisit Vejjajiva said Mr Chaiya's swift statement backing the reversal of the CL scheme was inappropriate.

It would weaken the country's negotiating power with giant pharmaceutical manufacturers and trade partners.

The government's policy on compulsory licensing should be based on three principles, he said.

"These are the patients' right of access to medicines; the country's right to apply measures in line with international trade laws and agreements to protect the public's health; and prompt negotiations with trade partners who have trouble with Thailand's bypassing of drug patents," said Mr Abhisit.

NLA member Amphon Jindawattana questioned Mr Chaiya's motivation in halting the policy to override drug patents and urged Prime Minister Samak Sundaravej to clarify the government's stance on the matter.

"Why did the minister come up with such an idea [to end compulsory licensing] despite the fact that it is beneficial to Thai citizens?" he said.

Public Health Ministry spokesman Suphan Srithamma said the health minister's proposal to suspend licensing for life-saving drugs was restricted to four cancer drugs only.

He made the explanation after some health campaigners and patients expressed fears the Samak government would revoke compulsory licences for three Aids and heart drugs - Efavirenz, Kaletra, and Plavix - issued in November 2006 and January 2007.

"The ministry will go ahead with the issuance of CL on the three medicines. Aids and heart disease patients will be able to afford cheap drugs under the scheme," he said.

Dr Suphan said the revision of the previous government's bypassing of drug patents was aimed at making the scheme more transparent and the patients' benefits would be the centre of concerns.

The permanent secretaries for the Foreign, Commerce and Public Health ministries met last week to discuss whether the CL scheme should be continued after Mr Chaiya voiced his opposition to the decision to override the patents of four cancer drugs by former minister Mongkol na Songkhla on Jan 4.

The four drugs are the breast cancer drug letrozole produced by Novartis; leukaemia drug Imatinib also of Novartis; breast and lung cancer drug docetaxel of Sanofi-Aventis, and lung cancer drug erlotinib of Roche.

The officials are expected to come up with policy recommendations and submit them to the ministers next week, he said.

Kiatphong Noichaiboon, a director of the Federation of Thai Industries, urged the government to continue with the compulsory licensing of pharmaceuticals.

He said the CL issue was unrelated to international trade or favourable tariffs received by Thai exporters from foreign countries.

"CL is the right measure and there is no need to reverse what has been implemented," said Mr Kiatphong.

The network of nongovernmental organisations working on HIV/Aids said the committee and consumer groups would file administrative charges against the Public Health Ministry for dereliction of duty if the ministry refuses to proceed with the compulsory licensing scheme.

Rayong - Industry from now on will also be required to submit health impact assessment (HIA) study reports for approval before going ahead with their investment projects, in a bid to protect surrounding communities from life-threatening industrial pollution.

Drafted by experts from the Public Health and the Natural Resources and Environment ministries, the new regulation is expected to be enforced by the Office of Natural Resources and Environmental Policy and Planning (Onep) within this year.

Kamjad Ramakul, director of the Public Health Ministry's occupational and environmental diseases bureau, said the draft regulation covers 22 industries with the potential to harm human health.

"We are about to finish drawing up a regulation for the mining industry, which will be the first of the 22 industries required to conduct HIA studies," he said.

The list includes power plants, transport projects, hotels and other heavy industries.

The regulation would assure people living near industrial sites that their health would be well protected, Mr Kamjad told a two-day seminar on industry and health impact held in Rayong province.

Under the new rule, investors are required to come up with health protection measures, such as medical check-ups before and after industrial projects become operational.

Project developers must also run long-term monitoring schemes to detect potential health risks from industrial activity.

The current law on environmental impact assessment (EIA) requires project developers to look into the possible health impact from their projects, but it does not cover all industry-generated diseases.

Mr Kamjad, however, said the new regulation may not bring about a dramatic improvement in public health protection as hoped for.

It is the country's first regulation of this kind and therefore is unlikely to be as effective as those implemented in the United States or Europe, he added.

"We still have to find the balance between health protection and economic growth," he said.

The issue of industrial estates' adverse impact on human health came to light in recent years when people living near the Map Ta Phut industrial estate in Rayong province complained about severe health problems which they believed were caused by industrial pollution.

According to the Disease Control Department's survey released in August last year, around 42% of residents of tambon Map Kha who underwent health checks were found to have high levels of benzene in their body systems.

Dangerously high levels of other toxic substances, including toluene and styrene, also were detected in urine samples from some of the residents.

The study was conducted on 2,177 people from 25 communities around the Map Ta Phut industrial estate.

Mr Kamjad said people exposed to toxic substances could develop serious health problems such as respiratory diseases, brain damage and leukaemia.

Health statistics also showed that residents of Rayong, which is home to hundreds of factories, faced a high cancer risk.

Dechrat Sookkamnerd, manager of the Healthy Public Policy Foundation, said although industrial development had brought financial prosperity to Rayong, it also gave rise to a host of social and health problems.

His study showed that the suicide rate among young people in Rayong was as high as 299.61 per 100,000, compared to only 34.31 in Nakhon Pathom province, which is the country's major agricultural hub.

Rayong's HIV infection rate was also higher at 21.46 per 100,000 people, compared to 8.87 per 100,000 in Nakhon Pathom.

The possible downgrading of the country by the US Trade Representative to make Thailand fall into the Priority Foreign Country list - so that Thailand could face US trade sanctions - has nothing to do with the state's compulsory licensing policy on drugs. Importing the cheaper generic versions of some expensive patented US Aids, cancer and heart drugs is a different matter altogether, says a senior member of the Thai Chamber of Commerce.

Buntoon Wongseelashote, vice-chairman of the Thai Chamber of Commerce's committee specialising in international trade rules, said the possible loss of trade privileges under the Generalised System of Preferences (GSP) programme actually stems from the state's failure to suppress intellectual property rights (IPR) violations, involving pirated CDs and DVDs as well as other brand-name products.

The continuing high levels of IPR infringements have caused some $400 million in damages to the US business sector each year, he said.

Mr Buntoon asked the Intellectual Property Department to seriously enforce the existing Patent Act by taking tough action against the importers of pirated CDs and DVDs.

"The government is fixing trade problems at the wrong place by falsely blaming the CL policy and not tackling goods piracy. The chief of the Intellectual Property Department is aware that this is a fact," he said in a telephone interview.

Puangrat Asavapisit, chief of the Intellectual Property Department, late last month said she was informed that the Pharmaceutical Research and Manufacturers of America had threatened to press Washington to take tougher action against Thailand if the government refused to abandon its compulsory licensing policy.

As soon as Public Health Minister Chaiya Sasomsab assumed office, he made clear his intention to review the policy for four lung and breast cancer medicines previously announced by his predecessor Mongkol Na Songkhla.

Dr Mongkol on Jan 4 approved compulsory licences on four medications - Letrozole, a breast cancer medicine produced by Swiss-based Novartis, the breast and lung cancer drug Docetaxel made by France-based Sanofi Aventis, and Swiss-based Roche's Erlotinib, used for treating lung, pancreatic and ovarian cancers. However, he reached a deal with Novartis over its leukaemia drug Imatinib as the patent holder agreed to supply it free to more than 900 patients under its philanthropic programme.

Mr Chaiya's move has upset the public sector as the National Health Security Office does not have a big enough budget to afford the costly cancer treatment drugs for 48 of the 64 million people listed under its universal healthcare coverage.

The Thai export sector is worried that if the government refuses to do away with the CL policy, more than 2,000 Thai products which are exported would lose the privileges they now enjoy under the low-tariff Generalised System of Preferences if and when the country is put on the Priority Foreign Country list.

They have urged the government to come up with measures to protect Thai businesses from US retaliation since 20% of Thai exports which go to the US, worth about US$4 billion, are exported under the GSP programme. They have also asked the government to subsidise drug purchases for the poor, instead of enforcing compulsory licensing.

After the country was placed on the Priority Watch List by the US Trade Representative under Section 301, hundreds of Thai products including jewellery, rubber, artificial flowers, television sets and shrimp exports faced the threat of losing the GSP benefits.

The GSP was designed to promote economic growth in the developing world, and provides preferential duty-free entry for more than 4,650 products from 143 countries and territories.

In related development, Public Health Ministry spokesman Suphan Srithamma said the ministry's representatives yesterday met health activists and the Network of HIV/Aids patients for talks and came to a resolution that Thailand's move to implement the CL policy was legitimate.

He said the ministry had negotiated with pharmaceutical firms 12 times over the issue, countering a claim by the industry that CL was prepared without its knowledge. He said the resolution would be forwarded to Prat Boonyawongwirote, permanent secretary for health and Mr Chaiya.

The ministers of commerce, foreign affairs and health are to meet next week to make a decision on the compulsory licensing (CL) of some drugs.

Tharit Charungvat, the Foreign Affairs Ministry spokesman, told the media the permanent secretaries of the three ministries widely discussed the advantages and disadvantages of drug patents during a two-hour meeting at the Foreign Affairs Ministry yesterday.

He refused to reveal the details of the meeting, saying the options and prospective consequences that were narrowed down during the meeting will be sent to the concerned ministers, Mingkwan Saengsuwan, Noppadon Pattama and Chaiya Sasomsab, for consideration next week. He did not say when the meeting will take place.

The ministers' decision will be forwarded to the cabinet for approval, he said.

The meeting venue, originally set for the Commerce Ministry, was changed three times before they decided to meet at the Foreign Affairs Ministry because of a protest by health activists, who have called for the government to keep CL on four cancer drugs.

About 300 health activists and a network of Aids and cancer patients gathered at the Public Health Ministry - the meeting's original venue.

Before attending the meeting, Public Health permanent secretary Prat Boonyawongwirote refused to confirm if former health minister Mongkol na Songkhla approved CL implementation before he left office.

Saree Ongsomwang, the manager of Foundation for Consumers, said she was extremely disappointed with Dr Prat's statement.

"How can a high-ranking official like a permanent secretary say he did not have any information regarding compulsory licensing?" she said. "How can he protect the benefits of patients if he did not have any information at hand to discuss with executive of the commerce and foreign ministries?"

On Jan 4, Dr Mongkol signed four ministerial announcements to license Letrozole, a breast cancer medicine produced by Novartis, the breast and lung cancer drug Docetaxel by Sanofi-Aventis and Roche's Erlotinib, which is used for treating lung, pancreatic and ovarian cancer.

The commerce, public health, and foreign affairs ministries will meet today to make a joint decision on whether compulsory licensing (CL) on three cancer drugs should be discontinued. The urgent meeting follows the cabinet's decision on Tuesday to delay reviewing CL, a highly sensitive and controversial issue.

The Commerce Ministry has raised concerns over trade ramifications with the United States.

"It's too soon to tell now whether Thailand will maintain CL. We have to evaluate carefully any potential damage from the policy," Commerce Minister Mingkwan Saengsuwan said after meeting with HIV/Aids and heart disease patients who turned up to support CL.

The outcome of today's meeting, attended by senior officials of the three ministries, will be proposed to the ministers to make a conclusion and forwarded to the cabinet for a final decision.

Mr Mingkwan said the government should give an answer right after its policy announcement on Feb 18-19.

"It would be wrong if the government put trade over people's lives," warned Saree Aongsomwang, executive secretary for the Foundation for Consumers.

Buranat Samuttarak, the shadow deputy health minister appointed by the Democrat party, yesterday warned the government not to fall into a US trap of commercial interests by discontinuing CL which could help the majority of the Thai population access affordable life-saving medicines.

He said the US Trade Representative and the Ministry of Commerce could not invoke the Special 301 measure to downgrade Thailand from the Priority Watch List to the Priority Foreign Country list, which is the last and most severe US copyright protection category, making the country subject to trade sanctions.

Under World Trade Organisation rules, it is legitimate for member countries, including Thailand, to use the Trade-Related Aspects of Intellectual Property Rights (Trips) to issue compulsory licences to make or buy generic versions of patented drugs deemed critical to public health as long as the medicines are meant for domestic and emergency use.

Mr Buranat, who works on the Democrats' health and welfare policies, said the opposition party would closely monitor the government's attempt to further free trade talks with Washington.

The trade pact has drawn the most concern because it includes the issue of "data exclusivity" that guarantees extra market protection for drug patent holders by preventing authorities from accepting applications for approval of generic medicines during the period of exclusivity, usually six to 10 years. Thailand would inevitably have to shoulder high medical treatment cost, he said.

Former health minister Mongkol na Songkhla said he did not have any hidden agenda or conflict of interest when approving the four ministerial announcement on cancer drugs on Jan 4.

Hard landing after 'goodwill' feast: Chaiya makes it clear he puts trade benefits above compulsory drug licensing  - February 14, 2008

Former PM Thaksin may return to Thailand as early as this month / Several Democrat MPs weren't sure the party should have proposed Abhisit as alternative PM

Public Health Minister Chaiya Sasomsab made headlines recently on his first day in office when he threw a Chinese banquet for 400 ministry officials on Chinese New Year.

He also pledged his first-month's salary to helping doctors being sued for malpractice.

Yet despite all the "goodwill", the first-time minister has experienced a bumpy landing.

Last Friday, Mr Chaiya returned from his first cabinet meeting only to be met by a boisterous protest against his plan to review his predecessor's compulsory licensing (CL) policy.

Former health minister Mongkol Na Songkhla approved patent busting for four key cancer drugs just before he left office.

Mr Chaiya said on taking office he thought the compulsory licences "might have been a politically correct decision, but [were] legally incorrect".

"Compulsory licensing is politically and legally correct," the noisy protesters informed the freshman minister.

The 50 or so health activists included people from a network of cancer and lung patients as well as people living with HIV/Aids. They eventually discussed the pros and cons of CL with the new minister, trying to convince him to leave the policy in place.

They are worried that any change would block access to life-saving medicines, especially for the poor who depend on universal healthcare coverage.

The state policy on CL, which allows Thailand to make or buy cheap copycat versions of patented Aids, heart and cancer drugs, is considered to be Dr Mongkol's masterpiece from his 16 months in office under the Surayud administration.

The policy won massive praise and support from health activists, but was denounced by pharma giants, which accused Thailand of stealing intellectual property.

But despite the support from health workers and activists, Mr Chaiya insists the compulsory licences approved for the four cancer drugs are not legitimate and that demonstrators should be aware of and abide by international trade law.

He said there were only 15,000 cancer fatalities in Thailand each year. Providing them with the patented drugs cost only about 500 million baht a year. This was a small cost compared with the potential losses in exports worth billions of baht that could be affected by the CL policy if trade sanctions were imposed.

The discussion between Mr Chaiya and the activists became quite heated during their 30-minute meeting.

One of the HIV/Aids sufferers said he might have to take weed killer instead of proper medication if the licences for the generic drugs were withdrawn.

Out of nowhere, Mr Chaiya retorted with appalling bad taste that he would rather take chan flowers - paper flowers traditionally used at a cremation - if he were HIV-positive.

When asked if he had been lobbied by pharmaceutical companies, he replied: "Drug companies aren't as rich as I am. Come and have a look at my house and you'll see."

The new health minister has so far been unable to win approval from the cabinet for a reversal of the policy. Prime Minister Samak Sundaravej on Tuesday instructed agencies to meet and discuss the issue.

You can bet your bottom dollar that this will be a long battle between the new minister and health activists, since Mr Chaiya has made it clear he puts trade benefits over public health.

Wanted - a safety guarantee

Former prime minister Thaksin Shinawatra will return to Thailand sooner than expected if his safety is guaranteed.

A source said Mr Thaksin wants to return this month, not in March, April or May as earlier reported. Yet he is uncertain about his own safety even though those loyal to him won the election and became the government.

An army source said Mr Thaksin phoned his pre-cadet classmate, army chief Anupong Paojinda, who was a key member of the coup, and asked his old friend to ensure his safety.

"Seeking cooperation from Gen Anupong is a way but it cannot completely guarantee safety for Mr Thaksin because Gen Anupong cannot control all military forces," said the source.

Mr Thaksin fears that some people who want him dead are in uniform and the group he is concerned most about is soldiers who are ready to serve their boss even without being ordered. This is why his recent phone conversation with coup leader Sonthi Boonyaratkalin may not guarantee his safety, the source said.

"There was an attempt to assassinate Mr Thaksin before the coup," said a source close to him.

As the coup proved a failure and Mr Thaksin cannot be blocked from returning to power, the issue of the former premier's safety has been revived.

The source said Mr Thaksin's followers are approaching special warfare units to revive old connections with unit heads to secure Mr Thaksin's return. These approaches are being conducted by his team of bodyguards led by close aide Pol Lt-Gen Athakrit Thareerat.

The main targets are the special warfare units formerly under the direct command of Gen Sonthi.

This is why there are rumours that Mr Thaksin asked Gen Anupong to transfer to other positions those special warfare commanders whom the army chief cannot control.

The source close to Mr Thaksin said the former prime minster would return soon.

"It will be a dignified return at Suvarnabhumi airport. The time and date are withheld for safety's sake but everything is being prepared."

A real test of 'togetherness'

The Democrat party has not led or been in a government for a long time but the country's oldest political party continues to hold together.

It has revealed that the secret to keeping united is the party's ability to reconcile the different opinions of its members.

As a political institution, the Democrats say they know very well not to cook up a recipe for disintegration by letting one person or family rule the party.

Core members contribute financially to the coffers and the leader supervises the overall running of the party. The party insists, despite arguments from a number of quarters, that all members enjoy equal opportunities to be assigned important posts in the legislative and executive branches.

Observers said that since the time Chuan Leekpai became party leader, the Democrats began to embrace unprecedented unity as its members had faith and confidence in Mr Chuan's corruption-free, untainted public image.

Critics of the party have also noted that the power structure in the party appears to be organised in a such a way that it may not be conducive for young political talent to make their presence felt among the decision makers.

But the party has also had its share of internal divisions and the latest test of "togetherness" came a few weeks ago when the party nominated its leader Abhisit Vejjajiva as candidate for prime minister competing with People Power party boss Samak Sundaravej. The contest was seen as only a formality for Mr Samak as the deal for him to become prime minister was sealed given the parliamentary majority support pledged to him by coalition parties.

The Democrat members had been split over whether the party should allow Mr Abhisit to wage what they knew from the outset to be a losing battle.

After sounding out views, Democrat secretary-general Suthep Thaugsuban recommended the party put forward its prime minister's nomination in keeping with the spirit of democracy. He said the party had an obligation to offer a suitable choice for prime minister.

One day before the House session was held to vote on the new prime minister, the Democrats met to discuss the nomination issue with deputy party leader and Democrat MP for Phetchaburi Alongkorn Ponlabutr.

Several party MPs were opposed to the nomination. Among them were Songkhla MP Sirichok Sopha and Songkhla MP Thavorn Saenniem.

Mr Sirichok argued that the Democrats had earlier announced they would not form a government to compete with the PPP. If the party nominated a candidate for prime minister, the issue might be politicised by the media.

He reportedly felt there was not much sense in Mr Abhisit suffering an unnecessary defeat in parliament.

However, Chamni Sakdiset and many other Democrats said Mr Abhisit should go through with it because the party was answerable to the people who counted on it to fight even though it would lose. If the party had sat on its hands, it would have been tantamount to betraying the voters, he said.

Democrat MP for Bangkok Korn Chatikavanij, a close friend of Mr Abhisit, who backed the nomination, said 12 million people voted for Mr Abhisit in the Dec 23 election.

If the situation arose where Mr Samak, who is fighting legal charges, was removed as prime minister, then the public would ask the Democrats why they had not nominated Mr Abhisit.

Prime Minister Samak Sundaravej has instructed the Public Health Ministry to hold talks with the Foreign and Commerce ministries to decide if it should go ahead with the coup-appointed government's scheme to bypass heart and cancer drug patents.

The decision was seen by health advocates and consumer groups as a tactic to buy time which could worsen the situation for tens of thousands of patients who have to spend hundreds of thousands of baht or more every year on patented drugs.

Mr Samak said Public Health Minister Chaiya Sasomsab had told him about the problem he came across regarding the previous government's decision to issue compulsory licencing (CL) schemes for cancer and heart disease drugs.

Speaking after yesterday's cabinet meeting when the CL issue was tabled for discussion, the prime minister alleged that former Public Health Minister Mongkol na Songkhla's imposition of CL went against a cabinet resolution which required that the move had to be agreed upon by three ministers.

Dr Mongkol reportedly went on an overseas trip and failed to attend the tripartite meeting, Mr Samak said.

The former public health minister, however, has denied the allegation, saying he had already assigned senior officials in charge of CL issuance and drug price negotiations with drug manufacturer to attend the tripartite meeting.

Dr Mongkol said the meeting was surprisingly postponed by then deputy prime minister Kosit Panpiemras, who chaired the joint-panel.

Mr Chaiya said Deputy Prime Minister and Commerce Minister Mingkwan Saengsuwan would meet officials from the Foreign and Public Health ministries to discuss the CL policy some time after the government announced its policy to parliament on Feb 18.

The minister said it was not necessary to ask for additional input regarding drug patent overriding from Dr Mongkol, non-governmental organisations, or health officials because he already had enough information.

Mr Chaiya promised the government would come up with a win-win solution to protect both trade and patient benefits and vowed to work with experts and officials working on the CL-related committees set up by Dr Mongkol.

Meanwhile, health advocates and fair-trade campaigners threatened to hold a mass demonstration at the Public Health Ministry if it decides to revoke the CL scheme.

Around 100 activists rallied in front of Government House yesterday to pressure the cabinet not to comply with Mr Chaiya's proposal to revise the drug patent bypassing scheme.

The demonstrators, from the Aids Access Foundation, the network of people living with HIV/Aids, and the Foundation for Consumers, said it was clear that the CL scheme was legal and was in line with international trade agreements, so there was no reason for this government to revise it.

"Without the bypassing of drug patents for government use, some 73,000 cancer patients would have to die because they cannot afford the costly drugs which can save their lives," said Virat Purahong, chairman of the the network of people living with HIV/Aids.

He said each cancer patient had to pay at at least 1.3 million baht a year for cancer treatment drugs.

Kannikar Kijtiwatchakul, of FTAWatch, blasted the Samak administration for resorting to tactic of buying time on such a "life and death" matter.

"There is no need for further discussion [between the three ministries]. It is clear that the Thai government's CL scheme is in accordance with the World Trade Organisation and trade agreements," she said.

Ms Kannikar cited a remark from an expert on international law who joined the WTO/WHO delegation to meet those parties concerned about the CL issue in Thailand earlier this month, and who confirmed that the scheme was legitimate and that no country had lodged a complaint against Thailand so far.

As expected, the new government is apparently taking a pro-business view on the issue of compulsory licensing

Despite the uproar, the new Public Health Minister Chaiya Sasomsab's vow on his first day in the office to review the ministerial announcement of compulsory licensing schemes for four cancer medicines, did not come as a complete surprise.

It had been expected for some time that Thailand's new cabinet - allegedly packed with puppets of ousted premier Thaksin Shinawatra - would take a pro-business view on the patent issue.

Mr Chaiya's remarks, when facing protesters last week, that saving only 500-million-baht budget for treating 15,000 cancer patients each year could not compare to the effect on the country's trade and exports worth billions of baht, was evidence enough of the reversed trend.

Former health minister, Mongkol Na Songkhla, signed ministerial announcements on Jan 4 to individually license Letrozole, a breast cancer medicine produced by Novartis, the breast and lung cancer drug Docetaxel made by Sanofi Aventis and Roche's Erlotinib, used for treating lung, pancreatic and ovarian cancer. However, Dr Mongkol struck a deal with Novartis over the leukaemia drug, Glivec, as the patent holder agreed to supply it free to over 900 patients under its philanthropic programme.

The former minister is aware of the controversy and the possibility that all his work may be upended. He emphasised during his final days in office that if the elected policy-makers reversed the policy, aimed at making drugs more affordable for the majority of people, the poor would lose out.

Undoubtedly, drug firms have tried to win back their business profits by petitioning the commerce minister and pressuring the new government.

Puangrat Assawapisit, director-general of the Intellectual Property Department, late last month said she was informed that the Pharmaceutical Research and Manufacturers of America (PhRMA) had threatened to press Washington to take tougher action against Thailand by putting the country on the Priority Foreign Country (PFC) list, which is the most severe US copyright protection category and subject to trade sanctions.

Critics may argue that the previous government's aggressive move to issue licences for several drugs without sufficiently warning each patent holder, unnecessarily led to retaliation by drug firms. However, the former minister had his reasons. The "White Paper," soon to be available on the ministry website, seeks to explain the other side of the controversy.

According to the White Paper, cancer is the main cause of death among the Thai population. An estimated 30,000 fatalities and thousands of new cases are reported each year. The number is higher for lung and breast cancer.

Although the so-called drugs for targeted cell therapy which could cure or prolong the lives of cancer patients are available, they are very expensive - the low and middle-income population usually cannot afford the treatment.

Details in the Paper also show that a patented lung and breast cancer regimen, Docetaxel, costs 25,000 baht per shot, compared to 4,000 baht for the generic version, which is six times cheaper.

Patients suffering from breast cancer who depend on Letrozole have to pay 230 baht per tablet, totalling 6,900 baht each month for the patented version. However the generic version costs only 6-7 baht per tablet or about 30 times cheaper.

For Erlotinib, lung cancer patients have to pay 82,500 baht every month whereas the generic version costs 735 baht. Finally, patients suffering from leukaemia and gastro-intestinal stromal tumour (GIST) have to pay at least 1.3 million baht each year for the treatment, which costs 917 per 100mg. They would pay only 50 to 70 baht per milligramme if they could use the generic version.

The Paper argues that with a gross national income per capita of US$3,000 a year, or roughly one-sixteenth that of the United States, not only the cancer patients and their families but also the Thai health system was under threat of going bankrupt if the government did not try to do anything about the patented drugs prices.

The National Health Security Office (NHSO) running the universal healthcare scheme for 48 out of 64 million Thais, could not afford these drugs and asked the Public Health Ministry to solve the sky-high cost of healthcare via compulsory licensing.

Vichai Chokewiwat, chairman of the Public Health Ministry's panel on compulsory licensing, explained in the online Paper that negotiations were held 12 times with the patent-holding companies on the possibility of lowering drug prices - all of them fruitless. Some pharmaceutical companies did not even join the meetings.

The Paper states that worldwide experience has shown that the issuing of a compulsory licence is often the only negotiating tool drug companies seem to take seriously.

And so it was, that it became the last resort for the interim government to extend access to life-saving drugs to the low- and middle-income population and solve the overwhelming healthcare cost borne by the NHSO.

In addition to the ministry's White Paper, a report by the international trade and health experts which aims to help Thailand extend public access to costly life-saving drugs by seeking flexibility in global trade rules, is expected to reach the newly-appointed government by mid-February.

Seven delegates from the World Health Organisation, World Trade Organisation and United Nations Development Programme made a three-day visit to Thailand earlier this month, to listen to relevant sectors about the Thai policy on CL and lessons learned after putting it into practice.

The new health minister should examine the White Paper and the experts' report before formally reviewing the country's stance on compulsory licensing.

Mr Nimit Tienudom, director of Aids Access Foundation, argued that the new minister's suggestion that poor patients ask for financial assistance from the Ministry of Finance, would pose an impossible task.

"Listening to what the new health minister said makes me feel sad and tired. It seems that we will have to fight for affordable access to drugs for a long time to come, because this problem won't be solved by having a wealthy man who doesn't really understand the health system, working as public health minister.

"The loss of human life cannot be compared to that of business opportunities," Mr Nimit commented.

Another round of discussions between Commerce Ministry officials and pharmaceutical representatives over the review of CL issue has been scheduled for today.

Patients and universal healthcare supporters might have won the first round, but the battle over respecting drug patents versus expanding access to medicine to the poorer segments of population, is going to be a long and arduous one for both the public and the policy-makers.

Health activists, cancer and Aids patients yesterday urged Public Health Minister Chaiya Sasomsab to stick with the compulsory licences on cancer and Aids drugs announced by the previous government.

About 50 protesters from a network of people living with HIV/Aids and cancer patients gathered at the Public Health Ministry to hand a protest letter to Mr Chaiya who is under public criticism after announcing that he plans to immediately review the CL policy on patented lung and breast cancer drugs Docetaxel, Erlotinib and Letrozole.

The minister was of the view that the CL policy was politically correct but "legally incorrect." The activists expresssed concern over Mr Chaiya's position, arguing that there was no better choice to extend public access to cheap life-saving medicines at this time.

They also asked him to listen to public views, not just the pharmaceutical industry and the Commerce Ministry, before revoking the licences.

"He doesn't know in what difficultly poor cancer patients and their families are. Most of them die because they can't afford the costly patented drugs," said Saichon sae Lim, a patient who has been suffering from ovarian cancer for five years.

"If the new minister really wants to help the poor at the grassroot level who elected him, he will not terminate the licences of cancer medicines," she said.

Mrs Saichon said many cancer patients were dying simply because they found the life-saving drugs unaffordable.

She has decided to put her survival hopes on a strict and healthy diet and exercise, instead of modern medication, because she too can't afford the cancer medicines. Her condition is now too serious and considered incurable by any of the available drugs.

Nimit Thien U-dom, the director of Aids Access Foundation, said the network of people living with HIV/Aids and consumer groups were closely monitoring the new minister's performance, particularly on the licences policy, as any CL termination would seriously hurt the poor. "It will be a shame if he does, as the country would lose so much and the poor would be deprived of life-saving drugs. They will die a premature death," he said.

Mr Chaiya has, however, made it clear he would stand firmly by his decision to review the compulsory licences imposed against four cancer-fighting drugs even though he insists there was no plan to revoke the policy for the time being.

"Saving 500 million baht through the CL policy would mean nothing compared to the damages we could suffer if billions of baht worth of our exports are boycotted," he told the health activists.

He said it was all so clear that the CL policy was the reason why the US Trade Representative had penalised Thailand by putting it on the Special 301 Priority Watch List (PWL). Being put on the PWL has led to the elimination of the duty-free access Thailand enjoyed under the Generalised System of Preferences (GSP) for gold jewellery and other exports to the US since July 1, 2007.

Mr Chaiya said he received a confidential letter signed by former commerce minister Krirk-krai Jirapaet asking the new government to review the policy on compulsory licensing. The letter was sent through permanent secretary for health Prat Boonyawongwirote on Feb 4, the day Mongkol na Songkhla ended his term as health minister.

According to the letter, commerce officials are worried about the policy's impact on the country's relations with its key trading partners, the European Union and the United States, home to several pharmaceutical giants.

The concern is now greater about the possibility Thailand would be downgraded further and put on the Priority Foreign Country (PFC) list, which is the last and most severe US copyright protection category and subject to trade sanctions. The Pharmaceutical Research and Manufacturers of America (PReMA) has threatened to press Washington for tougher action against Thailand.

Drug firms and have continuously accused Thailand of stealing their intellectual property.

But under World Trade Organisation rules, it is legitimate for member countries, including Thailand, to use the Trade-Related Aspects of Intellectual Property Rights (Trips) to issue compulsory licences to make or buy generic versions of patented drugs deemed critical to public health as long as the medicines are meant for domestic and emergency use. Cancer is a leading cause of death among the Thai population. Around 15,000 Thais die each year due to lung and liver cancer alone.

Dr Mongkol on Jan 4 signed four ministerial announcements to license Letrozole, a breast cancer medicine being produced by Novartis, the breast and lung cancer drug Docetaxel by Sanofi-Aventis and Roche's Erlotinib, used for treating lung, pancreatic and ovarian cancer. However a licence issued on a leukaemia drug, Glivec, was eventually cancelled after its maker, Novartis, agreed to supply it free to hundreds of Thai patients under its philanthropic programme.

Dr Mongkol earlier overrode Merck's Aids drug Efavirenz in Nov 2006 and later Abbott Laboratory's Kaletra and Sanofi Aventis' heart drug Plavix in Jan 2007, saying the country could not afford patented drugs to cover 48 million of the 63 million Thais under the universal healthcare scheme.

Mr Prat said he and the minister would discuss and review the CL policy with commerce officials on Feb12.

Newly-appointed Public Health Minister Chaiya Sasomsab has started to diagnose his ministry's ills and has already put the thorny issue of compulsory licensing on his agenda, along with the latest regional outbreak of bird flu. Surprisingly, he says he will also give his attention to fighting the menace of dengue fever, a disease all too often overlooked by ministers.

So he might find a recent warning by the Food and Drug Administration (FDA) to be of interest - not for what was said, but more for what was left unsaid. The FDA used a public forum to wag its finger at anyone thinking of buying drugs from internet-based pharmacies and warned that such medicines would, in all likelihood, be fake.

The agency added that prospective purchasers also ran the risk of being defrauded by identity-stealing cyber-criminals and cited the complaints it had received from Thais who had been cheated. There were a great many of them.

This was a predictable but sensible warning. Although most of the disreputable online pharmacies located here or in South America or India have been closed or brought under control, there are still plenty of pitfalls for the unwary. Anyone shopping online for illegal narcotic or controlled hypnotic drugs will not find brand names or generics available. They will merely find fakes and be given the opportunity to spend thousands of baht on what probably will turn out to be powdered glucose. Unregulated dietary and other nutritional supplements are, however, available and can usually be trusted if ordered from a reputable supplier.

In its warning, the FDA singled out such prime targets of pill pirates as erectile dysfunction drugs, which it said were most likely to contain fake ingredients, no ingredients at all or just a tiny amount of the active substance. In making this claim, the drug control agency was absolutely correct.

But it overlooked one very important home-grown aspect of all this. It neglected to mention that potential customers do not need to shop overseas on the internet to find fake drugs. They are already being peddled through a few dishonest pharmacies and clinics right here in this country. In fact, the World Health Organisation believes the problem is such a big one that at least 25% of prescription medicines sold in the developing world are fake.

And, as for the FDA warning about anti-impotence drugs, a prominent local urologist tells of what happened when Pfizer, the manufacturer, purchased samples of Viagra from a range of pharmacies in Bangkok and the provinces and then examined the test products they had bought for the survey - the packaging on nearly all of them was perfect, right down to the hologram, but of 217 purchases of the little blue pill, only 15 were the original product. The copies each contained anywhere from 17% to 48% of the required necessary ingredients. An independent survey done by Swedish medical researchers came up with much the same result.

But such drugs, unless taken by certain heart patients, are normally not life-threatening. Other drugs being counterfeited by unscrupulous criminal gangs are. And these pose the biggest danger. The most commonly counterfeited of these are treatments for conditions such as HIV/Aids, tuberculosis and, especially, drug-resistant malaria.

The malaria problem, endemic in border areas, is worsened by a growing trade in fakes, including the relatively new and effective Artemisinin-based Combination Therapy (ACT) drugs.

Our present drug law is more than 40 years old and too outdated to deal with e-commerce and counterfeit pharmaceuticals being shepherded across borders.

Taxes and tariffs on legitimate imported drugs are high. Fakes are tax-free. The current fine of 5,000 baht is laughable compared to the lucrative profits available. While counterfeits with a face value of 84 million baht were seized last year, we have to do better, and that will require action at Mr Chaiya's level. It deserves a place on his priority list.

Chaiya warned against ending drug licensing  - February 8, 2008

Mongkol: People will know who benefits

New Public Health Minister Chaiya Sasomsab came under fire yesterday from his predecessor, medical experts and health activists for his plan to review the compulsory licensing (CL) of cancer medications. Former public health minister Mongkol na Songkhla said Mr Chaiya had the right to review the schemes, but if compulsory licensing was dropped, the public would know who was benefiting from the decision.

It would be a shame if the programme was terminated because poor people would not get access to costly life-saving drugs and would die with no dignity.

Dr Mongkol, who approved CL schemes to override the patents of four cancer drugs on Jan 4, said that although only about 15,000 people with lung or liver cancer needed the drugs, ending compulsory licensing would have a severe impact on the patients' families and relatives. Many would be forced into bankruptcy if they had to help pay for the costly patented drugs.

It would be wrong if the number of cancer patients was the only factor considered by the new minister.

Mr Chaiya earlier said he wanted to review the correctness of the decision to issue compulsory licences for the breast cancer drug letrozole produced by Novartis, the leukaemia drug Imatinib, also from Novartis, breast and lung cancer drug docetaxel from Sanofi-Aventis and lung cancer drug erlotinib by Roche.

He also wanted to see if the number of cancer patients in need of those four drugs was high enough to justify CL schemes, and whether those patients had any difficulty accessing the drugs.

Nimit Thien-udom, the director of Aids Access Foundation, said networks of Aids, kidney and cancer patients, consumer protection advocates and academics had requested meetings with Mr Chaiya to discuss the matter.

The minister's aides had yet to set any dates for the meetings.

"We want to know his stance on the issue. We are hopeful that his review will provide good results and benefit the public, and patients in particular," Mr Nimit said.

"If he ends the compulsory licensing schemes without good reason, society will question his suitability to be public health minister."

Paul Cawthorne, the head of mission of Medicin Sans Frontieres (MSF), said it was too soon for the minister to comment on the CL issue as he had only just taken up the job. He should listen to other views first.

Mr Chaiya might be under pressure from economic ministries, he said. The minister should care more about the health of the public than about pressure from the Commerce and Finance ministries.

Government Pharmaceutical Organisation chairman Vichai Chokewiwat said the ministry had the authority to review compulsory licensing.

If the minister felt there were other, better ways, he could reverse the announcement, said Dr Vichai.

However, the minister should carefully weigh the advantages and disadvantages before making such a decision.

Rosana Tositrakul, chair of the alliance of 30 NGOs against corruption, questioned Mr Chaiya's move to review the schemes.

His action would spark public speculation about conflicts of interest with international pharmaceutical manufacturers, she said.

Mr Chaiya said he would welcome a meeting with representatives of pharmaceutical firms to discuss the CL issue.

The ministry's announcement of compulsory licensing for the four drugs may please the public, but it was not right.

A report by international trade and health experts which aims to help Thailand extend public access to costly life-saving drugs by seeking flexibility in global trade rules will reach the new government by next week.

Paul Cawthorne, the head of mission for Medicin Sans Frontieres (MSF), said it was "very good news" after being informed by officials from the World Health Organisation (WHO), the World Trade Organisation (WTO), the United Nations Development Programme and international law experts that the report would be ready within 10 days.

"A report will be important for the new government and the new public health minister to come up with a clear and right policy on public access to the medicines," he said.

The delegation started a three-day visit yesterday after a request by outgoing Public Health Minister Mongkol na Songkhla when he was under political pressure in November 2006.

The pressure came after he announced a policy of compulsory licensing (CL) to bypass patents on Aids drugs Efavirenz and Kaletra and the heart drug Plavix.

Due to pressure from the pharmaceutical industry, he downplayed his recent decision to override patents on three drugs for treating breast and lung cancer before completing his term.

The mission is aimed at learning about the Thai policy on CL and lessons learned after putting the policy into practice.

The fact-finding team yesterday visited the Department of Intellectual Property, the National Health Security Office (NHSO) running the universal healthcare scheme, the Food and Drug Administration (FDA) and the Disease Control Department.

They also met with representatives of consumer groups and non-governmental organisations including MSF, Oxfam and the Network of People Living with HIV/Aids.

Siriwat Tiptaradol, the FDA secretary-general chairing the price-negotiation panel, said the international team asked the panel about the process of putting the compulsory licensing policy into effect.

However, Wirat Poorahong, leader of the Thai Network of People Living with HIV/Aids, said he was not certain about getting any help from the delegates after talking to them.

But, he believed the report would help the new public health minister follow a similar policy in a bid to increase public access to life-saving drugs.

The seven-member delegation will today meet officials from the Foreign Ministry, the Government Pharmaceutical Organisation and the pharmaceutical industry including representatives from Abbott, Sanofi-Aventis and Merck. They own patents for drugs on the list which are subject to compulsory licensing.

For millions of the world's poorest people, ill-health and disease too often go hand in hand with grinding poverty and blunted national aspirations. In looking for solutions to this troubling state of global health, we can learn a great deal from Thailand. Given that most of the world's development thinking cascades from wealthy OECD countries in the North to countries in the South we need to hear more from Thailand and other countries like Cambodia, Ethiopia, Rwanda, and Vietnam, which have achieved breakthroughs in primary healthcare, to export their development experience in a South-South dialogue to show their neighbours in South Asia, Africa and other regions what works, what doesn't, and why. This experience should not stay confined to national borders.

At the Prince Mahidol Awards Conference in Bangkok this week, we have heard yet again that weak health systems are a significant roadblock to improving the health of people in developing countries. Thailand, by contrast, has focused on strengthening its health system and this has allowed the nation to cope with and contain other epidemics of global significance such as avian influenza and Sars.

This a clear case of how a stronger national healthcare system can not only protect the people of Thailand, but the greater worldwide community as well.

Thailand has also shown the world that HIV/Aids could be confronted with well-financed prevention, care and treatment programmes. These programmes, initiated in the 1990s, may have prevented as many as 7 million new cases of HIV infection by 2006.

Thailand is in select company here. Only a handful of other countries have been able to reverse an HIV epidemic in this way.

Sadly, for millions of other people in South Asia and Africa, this level of healthcare is a distant mirage. Despite some notable examples of success, we continue to see unacceptable levels of sickness and death that abandon people to poverty and desperation.

Almost 11 million children die every year, mainly from preventable causes like pneumonia, diarrhoea and malaria. More than 500,000 women die during pregnancy and childbirth every year. In 2006, almost 3 million people died from HIV/Aids. Tuberculosis is curable, yet 1.7 million people die from it every year.

Nearly one-third of children under five in the developing world remain underweight or stunted, leading to irreversible brain and physical damage. Prevention is therefore a long-term investment which greatly benefits both present and successive generations.

A country's sustained economic growth rate is significantly influenced by the health of its people. It is little wonder, therefore, that illness is a cause of poverty as families tap into savings or sell what they own to cover the costs of medical care. If we are serious about fighting poverty, improving the perilous health of millions of the world's poorest people must be a top priority of the global development community.

What can we do? We need to strengthen health systems across the board; we need to focus on verifiable results; and we all need to work together better. Stronger, integrated health systems are an essential platform for effective universal prevention, treatment, care and mitigation of diseases.

In practical terms, strengthening health systems means putting together the right chain of events that, for example, gets life-saving drugs and health workers to mothers and their newborns where they are needed most. It means making sure that poor people get the good quality health services they need. Many existing aid programmes for health stall or actively fail because there is no functioning health system with the capacity to deliver services and drugs to the people who need them. Focus on results - without results, health system strengthening has no meaning. Without health system strengthening, there will be no results.

One promising approach to strengthening health systems is "results-based financing." In fact, using this approach, the World Bank is working with Mozambique, Rwanda and other African countries to help them lower their numbers of child deaths and improve their maternal health. This innovative approach links aid directly to verifiable results.

Health systems, however, don't function in isolation; they need to show their worth and their value to people at the household level, at the local community and national levels. It is important to have systems that not only show results but respond to demand.

We need to work together better. With the health and development arena increasingly crowded by bilateral and multilateral partners, as well as new foundations and charities, it is clear that donors, too, have a bargain to keep. In fact, there is widespread recognition that the Millennium Development Goals of maternal and child survival will not be achieved without significantly improved performance and coordination by all stakeholders within countries and internationally.

And we all have to learn from each other's successes and failures. This is key to moving forward faster.

With this task in mind, it is fitting indeed to invoke the memory and achievements of Prince Mahidol, the Father of Modern Medicine in Thailand, and a man who saw many years ago that a well-functioning public healthcare system was a cornerstone of a vibrant, modern society.

Let us use the Prince's health summit in Thailand this week to step up our efforts to help middle-income and developing countries to strengthen their health systems to achieve long-term, sustained good health, stronger growth, and more promising national prospects in the global economy.

** Joy Phumaphi is vice-president of the World Bank's Human Development Network; a former WHO assistant director-general for family and community health; and a former minister of health in Botswana.

After-Effect Of Compulsory Licensing: Activists want panel's decision on Aluvia drug reviewed

 - January 18, 2008
 

Health and consumer activists will ask the Administrative Court to look into the Internal Trade Department's decision not to take legal action against the US pharmaceutical giant Abbott Laboratories for alleged violations of trade laws.

Abbott cancelled the registration of the heat-stable version of an anti-retroviral drug with the trade name Aluvia with the Food and Drug Administration for use in Thailand after the government announced a policy to override patents of three Aids and heart drugs last January.

Activists say the move violated sections 25 and 28 of the Trade Competition Act.

Section 25 stipulates restrictions against market dominance and section 28, controls on parent companies' influence on decision making by their subsidiaries.

They petitioned the Commerce Ministry's panel on trade competition to look into the matter.

The panel ruled on Dec 27 that Abbott's decision to withdraw the registration of Aluvia was legitimate.

About 50 people living with HIV/Aids and consumer protection activists rallied at the Commerce Ministry yesterday urging the Internal Trade Department director-general and the panel's secretary Yanyong Phuangrach to review the decision.

"I was surprised by the panel's decision. They should have prioritised health problems caused by HIV/Aids and consider essential life-saving drugs as a special case rather than protecting the benefits of big pharmaceutical business," said Saree Ongsomwang, manager of the Foundation for Consumers.

She said the network of patients, health activists, and consumer groups would ask the Administrative Court to look into the panel's ruling in favour of big pharma if the department refuses to revise its ruling.

Ms Saree said during an hour-meeting with Mr Yanyong that Abbott's removal of Aluvia registration for distribution in Thailand could violate provisions of the constitution regarding fair trade competition and consumer rights protection.

Aids Access Foundation chairman Nimit Tienudom petitioned the panel to reveal details of its decision concerning Abbott's removal of Aluvia registration.

He also proposed the appointment of neutral academics to sit on the trade competition panel since most panel members are from corporates and that any decision could be biased.

Mr Yanyong said that the panel's ruling was based on the Trade Competition Act and that it was fair and final. Those who disagreed with the panel decision could take the case to the Administrative Court.

He said the market value of local pharmaceutical products was about 74 billion baht whereas Aids drugs and second-line anti-retroviral treatment were worth only 2.7 billion and 1.3 billion baht respectively.

The market value of Aluvia alone was considered too small to cost market dominance as claimed by the consumer rights group, he said.

Most of the 12,000 HIV-positive people who have developed resistance to first-line anti-retroviral treatment need second-line Aids drugs, namely Kaletra and its heat-stable form Aluvia, both produced by Abbott.

The firm offered to cut the price of Kaletra to $1,000 (32,500 baht) per patient per year on condition that the ministry. revoke its compulsory licensing policy.

The ministry rejected the offer and went ahead with bypassing the drug patent.

It has imported the first lot of Aluvia from India's generic drug maker Matrix Laboratories, enough for 8,000 HIV-positive patients for six months.

In a move to increase public access to affordable cancer drugs, the Food and Drug Administration (FDA) has registered one of three generic versions of a cancer drug that is likely to be listed for a compulsory license.

Public Health Minister Mongkol Na Songkhla yesterday said Indian-made cancer drug docetaxel had passed the registration process with the FDA. He did not disclose the generic maker, but said the process would help fast-track the import of the drug for use if the policy to bypass the patent of the drug is needed for the original version.

Sanofi-Aventis owns the patent of this medicine commonly used to treat breast cancer.

Speaking after visiting cancer drug manufacturers in India, Dr Mongkol said the ministry would import the cancer drug and use it for treating patients under the universal healthcare scheme only.

He conceded that it may be impossible to derive the knowledge of how to make the cancer drug for use in the country because the research and development needed was too complicated for local industry.

The National Health Security Office, which oversees the universal healthcare scheme for 48 million people, last September asked the Public Health Ministry to consider overriding the patents of four cancer drugs - imatinib, letrozole, docetaxel, and erlotinibas - because they are too expensive for local people.

However, the government revoked a decision to bypass the patent on imatinib after both the state and patent owner Novartis agreed to provide free medication for 900 patients under the universal healthcare scheme.

FDA secretary-general Siriwat Tiptaradol said he would have to negotiate the price of the cancer medicine with the Indian drug maker before importing the drug for local use.

The cost of the generic version of docetaxel is 4,000 baht per 80mg dose.

The retail price of erlotinibas is 2,800-3,000 baht per tablet compared with the generic version, which costs between 275-735 per tablet.

Letrozole, meanwhile, costs about 230 baht per tablet, but its generic version is priced at only 7-10 baht.

The Thai government angered some of the world's biggest pharmaceutical firms by announcing compulsory licensing for the Aids drugs Efavirenz and Kaletra along with the heart drug Plavix last year.

Compulsory licensing is allowed by the World Trade Organisation in the case of a national emergency. This lets the government bypass drug patents and import or produce generic versions of patented drugs for non-commercial purposes.

GPO-VIR

photos shock Jack Picone