Affordable Aids drugs in Thailand: The fight for ddI

Over the last year, MSF has been part of an unfolding story in Thailand which pitted MSF, local NGOs and activists against the Thai government and an international pharmaceutical giant. At stake were cheaper drugs and more widespread treatment for some of Thailand's one million people who suffer from HIV/AIDS. Antiretroviral therapy (or combination therapy, use of a combination of drugs to attack the HIV virus directly) has reduced illness and death and improved the quality of life for people living with HIV/AIDS in developed countries. However, for those of the world's 34 million HIV-infected people who live in developing countries, these drugs might as well not exist. Their high cost puts them beyond the reach of the vast majority of people in poor countries. In Thailand, fewer than 5% of HIV/AIDS patients currently have access to antiretroviral therapy. For most Thais living with the disease, ddI, an important AIDS drug used in standard combination therapy, was just too expensive. The price of the brand-name drug, at US$136 per month, is higher than the typical monthly wage of a Thai office worker, which is only US$120 per month. A generic version of the drug (interchangeable with the brand-name product but manufactured without a license from the company that developed the drug after the expiration of the patent) would be much more affordable. DdI was developed by a US government research institute, the National Institutes of Health (NIH). The NIH then licensed it to the pharmaceutical company Bristol-Myers Squibb, with the condition that it would be fairly priced. However, despite repeated requests by MSF, the NIH has been unwilling to enforce the fair pricing clause of the license agreement. In Thailand, other AIDS drugs were already being produced at reasonable prices: Generic AZT is sold at 1/5 the price of the brand-name drug, and generic fluconazole, used for treating the common opportunistic infection cryptococcal meningitis, is sold at 1/14 the price of the brand-name drug. The Thai government's Generic Pharmaceutical Organization (GPO), which produces a number of high-quality generic drugs, was on the point of producing ddI when Bristol-Myers Squibb secured a patent in Thailand, blocking the GPO. Attempts to get the Thai government to use a compulsory license - a provision of the Trade Related Aspects of Intellectual Property Rights (TRIPS) part of the WTO which permits generic production of a patented drug if a government considers it to be in the health interest of the country - failed, initially because of worries about US trade reprisals. The US subsequently backed down after demonstrations at the WTO meeting in Seattle and in Bangkok. But the Thai government itself then became reluctant, fearing the alienation of foreign investors. Finally, after receiving indications from the US saying that it would not object to generic production of the drug, Thailand agreed to go ahead and produce ddI. But it avoided issuing a compulsory license, something sought by MSF and other organizations because it could have set an important precedent for other governments struggling to make affordable drugs available for their people. Instead, generic ddI is now produced by the GPO in powder form. This form is not patented (the original patent was for tablets), but was not previously produced because of pressure from Bristol-Myers Squibb and government inaction. MSF has been treating patients with powdered ddI since April. The struggle to get cheap ddI produced in Thailand has resulted in fruitful cooperation between academic lawyers and pharmacists, certain courageous government officials, generic producers (the GPO) and US-based activists (including Consumer Project on Technology and Act Up). It has led to a strengthened local network and a sense of empowerment among NGOs and people living with HIV/AIDS in the country. On a more negative side, MSF has experienced the alienation of the Thai government, especially the Ministry of Public Health, which disapproves of interference by civil society in their dealings with drug companies. The Thai campaign has also roused the strong interest of the local and international press in the need for affordable HIV medicine. The extensive media attention has contributed to growing international pressure on drug companies and the US government. In collaboration with many more organizations around the globe, over the last year MSF has succeeded in raising the profile of the issue of access to essential medicines at the United Nations and European Commission. The campaign has also helped push the subject onto the agenda of major international forums, including the World Trade Organization meeting in Seattle, the World Health Assembly in Geneva, the International AIDS conference in Durban, South Africa, and the G-8 meeting of key industrial nations in Japan.