MSF Press Teleconference: Thailand, Abbott, and the second-line Aids crisis

Operator: Good Day, Ladies and Gentlemen, and welcome to the Médecins Sans Frontières (MSF) "Thailand, Abbott, and the Second-Line Aids Crisis" Conference Call. At this time, all participants are in a listen-only mode. Later, we will conduct a Question and Answer Session; and instructions will be given at that time. If anyone should require assistance during the conference, please press "*" then "0" on your touch-tone telephone. As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Mr. Kevin Phelan. Please begin.

Kevin Phelan: Good Morning Everybody, or Good Afternoon. Welcome to the "Thailand, Abbott, and Second-Line AIDS Crisis" Press Teleconference. Joining us today will be Dr. Tido von Schoen-Angerer, the Executive Director for Médecins Sans Frontières (MSF)'s Campaign for Access to Essential Medicines. Joining us from Bangkok will be Paul Cawthorne, the Head of Mission for MSF programs in Thailand. Also joining us today will be Wirat Purahong, the Chairperson of Thai Network of Positive People (TNP ), Jon Ungphakorn, the Executive Secretary of the AIDS Access Foundation, and Rohit Malpani, the Trade Policy Advisor for Oxfam America.

Before we get to our first speaker, I just want to bring to people's attention that there will be several protests on the 26th and 27th in many cities around the country and also around the world, including in Washington, D.C., Chicago, Austin, Worcester, and Berlin. And, this is an initiative by a coalition of groups, including the Student Global Aids Campaign, Health Gap, and American Medical Students Association.

So, we will go to our first speaker, Dr. Tido von Schoen-Angerer.

Dr. Tido von Schoen-Angerer: Thank you, Kevin. I'd like to start with HIV treatment, because I work with some of the colleagues here on the call in Thailand in '99 and 2000, when we started to put the first patients on treatment. And, we were in a fight about drug prices that at that time were extremely high, above $10,000 per patient per year. And, only after, I think, a lot of fight did the prices eventually come down to $150 per patient per year, which then allowed our organization, but also many others, to really treat people with HIV in the developing world on a much larger scale, and where we, today, have more than 80,000 patients on treatment.

The situation we are facing today is that we increasingly have patients that will need to switch to a second-line, simply because they have been on the older treatment already for quite some time. So, in one of our oldest projects in South Africa, for example, 20 percent of patients had to switch to a second-line regimen after they have been on treatment for five years. Now, these second-line medicines —or in general, all the newer medicines that are coming out for HIV—are still too expensive.

And we are extremely concerned that we're going to see a repeat of the AIDS crisis that we had in the late ‘90s, in terms of the prices. It is very clear that in order to prevent that, and in order to really keep patients on treatment and get them access to newer medicines, it is essential that all measures and flexibilities are used to get the best prices that are possible. And, in the past, it has been very clear that it's the generic competition that has helped to bring prices down.

So, we were very pleased to see that Thailand issued those compulsory licenses to help increase access to AIDS treatment. And, what we see now today, after this has happened, is I think two-fold: One is that one of these compulsory licenses issued in Thailand was for Efavirenz—the drug Efavirenz—and it really worked. Now we're in a situation, or it's clear that Thailand is importing these new medicines—the generic medicine from India and is in a position to put more patients on treatment.

However, the other drug for which a compulsory license was issued—Lopinavir/Ritonavir or Kaletra by Abbott is not in the same situation. We've been very disappointed to see how Abbott has been holding Thai patients really hostage on this issue—how they have stopped the registration of the new heat-stable form of Kaletra in Thailand and how they have not been willing to move. What we see really plain with Abbott in Thailand—and now even after they have been called on by Margaret Chan, the WHO Director General—they have reduced the price, but only conditional on Thailand actually withdrawing the compulsory license.

So, my impression really today is that Abbott is not a company that is serious about the people in developing countries, and Thailand particularly. So, I think the only reason why Abbott is able to play with patients in Thailand is also because the generics are not ready yet; and I think I want to make a very strong call here for the generic companies to speed up as much as possible their process to get ready, to further reduce the prices, and for the World Health Organization to do everything in their power to assess the quality of those products to make them available as soon as possible, because it's clear that we cannot count on Abbott today to ensure access to AIDS medicines in Thailand.

With that, I'll hand over to my colleagues. Thank you.

Kevin Phelan: Thank you very much, Dr. Von Schoen-Angerer. With more on MSF's perspective from Thailand, we are joined now by Paul Cawthorne, the Head of Mission for MSF projects in the country.

Paul Cawthorne: Hi, Everybody. It's 9:00 P.M. here, and the temperature is still around 80_F. During the day, for the last two weeks, it's been over 100_ in the middle of the day. That's one key reason why we, on the field, why patients in countries like Thailand, in countries in Africa, need this new heat-stable formulation of [lopinavir/ritonavir, marketed as] Kaletra.

Kaletra is a key part of the arsenal of drugs for treating people with HIV/AIDS. It's one of the cornerstones—even of the WHO guideline—it's a cornerstone of treatment. Yet, what we are faced with is in developing countries, patients have to use the old formulation, which is a soft-gel capsule, which in temperatures that we are facing at the moment, simply melt unless you've got a refrigerator, which many of our patients don't have.

I feel frustrated, angry at the way Abbott is playing games with patients here in Thailand. The Thai government, over the last two or three years, has made massive strides to offer treatment to as many people as come forward for treatment. So, at the moment, the government is managing to treat something like 100,000 people. They're under huge financial pressure. And, a significant number of the people now need second-line drugs. And, the government cannot afford the prices that are being demanded by companies like Abbott.

Last year, Abbott was offering a price of $2,200 U.S. to patients per year for the full formulation of Kaletra. The Thai government has made a very brave step. And, because of the step that they've made, last week, Abbott, in an attempt to cover its PR disaster, offered $1,000 U.S. to patients per year for both the old and new formulations of Kaletra to over 40 middle income countries, including Thailand. But they say to Thailand: "You can't have this new formulation, unless you back off from implementing this compulsory license." But, the fact that Thailand is brave enough to issue this compulsory license has given 40 other countries the opportunity to get this $1,000 U.S. per patient per year.

So, Thai patients are still being held hostage. Thai patients are still only being offered the old formulation, which is in soft-gel—and melts in the temperatures we're facing at the moment. They really, to me, are playing a terrible game in order to make a point that they feel that Thailand has overstepped the mark. They feel that Thailand is breaking a patent, which it is not. And, they want to teach Thailand a lesson; and they're using patients to do that. And, I find that absolutely appalling.

I also find it quite difficult that the WHO has taken a very soft approach in encouraging Abbott to come out with this $1,000 U.S. per patient per year offer. But I feel that they need to take much stronger steps. They need to lead the way, make up a new debate about how vital drugs like the one that Abbott has gotten a strangle-hold on—how they're priced, so that countries like Thailand, countries like Cambodia, countries in Sub-Saharan Africa, can really try to do what everybody's asking them to do, which is to treat patients and treat as many patients as possible.

If we have to expend the energies that I had to expend and many other people had to expend over the last two months in fighting an individual drug company over an individual drug, we can't do our jobs. Doctors and nurses, and NGOs like MSF, NGOs like Oxfam, cannot do their job, which is saving people's lives, because we have to fight for an individual drug. And, this cannot go on.

We have to—somebody has to find a different way forward. And, it has to be government; it has to be WHO; it has to be UNAIDS; it has to be the World Trade Organization. They have to take this fight forward and to get us the drugs at the price that can be afforded so that we can do our work and give treatment to people who are desperately in need.

So, I would ask Abbott, first of all, to make clear that they are going to register heat-stable Kaletra, begin the registration process in Thailand tomorrow and complete it as quickly as possible, because they drag their feet on registration. We need those drugs now; we need them at a price that is fair. We don't need to have to have a really big fight every time to get drugs. That's all I've got to say.

Kevin Phelan: Thank you very much, Paul, for that perspective. Our next speaker will be Wirat Purahong, Chairperson of Thai Network of Positive People. Now, Wirat will be speaking in Thai; and his interpreter will then interpret his comments.

Wirat Porahong: Speaking in Thai.

Interpreter: Hi, my name is Wirat Porahong. I'm the Chairperson of Thai Network of People living with HIV/AIDS of Thailand. Now we have a member organization of around 1,500 groups around Thailand. And, we have 100,000 people in the membership.

Wirat Porahong: Speaking in Thai.

Interpreter: It's a life saving issue. And, we—our goal is not to break the patent. But, we'd like to share the rights of the patent to save a lot of people. And, we stated that it's a legal action.

Wirat Porahong: Speaking in Thai.

Interpreter: Because it's a legitimate action, we found that the second-line treatment is needed for the Thai positive persons, because after they have a drug resistance to our first-line treatment, second-line treatments are needed. And, this is so very needed for poor people in Thailand.
Wirat Porahong: Speaking in Thai.

Interpreter: Clearly, we have about 20,000 positive persons who are in need of the second-line treatment; but those second-line treatments are very expensive drugs and are patented. So, the National Security Fund could not afford to buy those drugs to help us.

Wirat Porahong: Speaking in Thai.

Interpreter: Most of the people of Thailand are under the legislation of the National Security Fund. And, they also—it is the obligation—it's the duty of the government to take care of the life of people. And, if the government—if they get access to second-line treatment, they will have a better life; and they won't be a burden of the society. And also, we are strong enough to take care of our life and our families.

Wirat Porahong: Thank you.

Interpreter: Thank you very much.

Kevin Phelan: Thank you very much Wirat. Now, another community leader perspective from Thailand, we are joined by Jon Ungphakorn, the Executive Secretary of AIDS Access Foundation in Bangkok.

Jon Ungphakorn: Good Morning Everyone. Wirat and I are speaking from Washington, because we have come here to speak to the staff of members of Congress in the U.S. to explain about the Thai compulsory licensing and clear a lot of misunderstandings. The fact is that in Thailand, there has been a long struggle by civil society for access to treatment for people living with HIV/AIDS and then access to antiretrovirals since 1999. This has been a campaign by NGOs and organizations of people living with HIV/AIDS.

We initially campaigned for compulsory licensing of DDI. We campaigned for the Government Pharmaceutical Organization to produce these drugs generically. We then campaigned for universal health insurance in Thailand, which was achieved in the year 2001. But, when universal health insurance was introduced, it did not cover antiretrovirals. We then campaigned for access to first-line antiretrovirals; and gradually, the government increased antiretroviral provision to people living with HIV/AIDS until there was universal access in 2006.

Now, we have—we are also fighting against signing the FTA agreement between Thailand and the U.S. We don't agree to intellectual property rights that go beyond the World Trade Organization fixed agreement

So, this has been a long hard struggle by a civil society. Now we have universal health insurance. It means the Thai government, which is spending around 12 percent of its budget on health, is obliged to provide health—necessary health care to everyone in Thailand. And, HIV/AIDS is treatable since first-line treatment became available. The death rate among people with AIDS has dropped by 70 percent.

People living with HIV/AIDS now have a good future; but their lives depend on access to the second-line treatment. And, that is why Thailand has had to carry out the compulsory licenses, which is perfectly legitimate in accordance with the World Trade Organization and with Thai law. But, there's been retaliation, because from Abbott—from other sources, because developed countries don't like developing countries to use this for life saving purposes while in developed countries, compulsory licensing is regularly used against anti-competitive practices. In Thailand, it's used for life saving practices, which in my view is—life saving purposes, which in my view is more—even more important than anti-competitive.

What Abbott has done in—by withdrawing seven drugs from Thailand—and one of them is to treat—one of them is the heat-stable form of Kaletra, which is needed as second-line. Another is Zemplar, which is used to treat kidney—patients with kidney disease who have complications. This is using drugs as a bargaining chip—access to drugs. And, this is unacceptable; it is a moral outrage that Abbott is doing this. It's playing games, not only with the patients in Thailand; but it's playing games with patients all over the world. Because, Abbott knows that what it's doing is intimidating the whole developing world against using the same measures—legal measures that Thailand has used to get access.

And, I would like to end by saying what Thailand has done does not really affect the market price of the market share of branded products, because in Thailand, the compulsory license is only for government non-commercial use, which means it goes to those patients who make use of the universal health insurance program government services. And, these are mainly poor to low and middle-income people who can't afford these drugs anyway. The better-off people in Thailand generally go to private hospitals where they have to pay for the branded product.

And, I must say that compulsory licenses in Thailand have worked. They've worked, because the drug companies concerned have immediately lowered the prices of these drugs. But, prior to the compulsory licenses, these drug companies refused to carry out any real meaningful reduction in the prices. They only did it after the compulsory licenses and for the whole of the world, which means the whole world is benefiting from what Thailand has done. But, we would like to see—we would like to express our outrage at what Abbott has done in holding the whole world hostage—patients all over the world hostage for its own commercial purposes.

Abbott has a very bad track record regarding social justice, access to drugs in developing countries. Earlier, Abbott for example, increased its price of Ritonavir by 400 percent to prevent competitors from using their drugs with Abbott's. These are very bad practices by Abbott and should be condemned. So, that's what I'd like to say for the moment.

Kevin Phelan: Thank you very much Mr. Ungpa-korn. Now our final speaker, before the Q & A session will be Rohit Malpani, Trade Policy Advisor for Oxfam America.

Rohit Malpani: Thank you very much. Oxfam believes it is the duty of governments, including developing country governments, to ensure that people have access to health care and to provide medicines. We believe developing countries must have the right tools to do this job. And, this includes the uses of safeguards and flexibilities in the TRIPs agreement to preserve generic competition, which many studies have shown is the only proven method to reduce medicine prices in a sustainable manner.

Now, reducing the prices of medicines is critical for treatment of HIV and AIDS, as all of the other speakers have eloquently stated. But, the duty extends far beyond this disease; and Oxfam notes the toll that other infectious diseases and non-communicable diseases have upon developing countries today. According to the World Health Organization, over 80 percent of all deaths from non-communicable diseases now occur in the developing world.

In Thailand, diseases such as cardiovascular disease, cancer, and diabetes are major causes of morbidity and mortality. And, new patented medicines that could improve and save the lives of many people are priced out of reach for use in the public health care system and, therefore, are affordable only to a tiny elite.

And so, to give some background, Thailand issued two compulsory licenses, as everyone has mentioned for Efavirenz and for Lopinavir and Ritonavir, and also issued a third compulsory license for Plivex, which is an important medicine to treat cardiovascular disease. And, Oxfam believes that this was a very important step towards expanding the use of safeguards for all medicines.

Now, the pressure exerted by Abbott Pharmaceuticals, and by some parts of the U.S. government, upon Thailand must be understood in the context of a wider effort, by both the pharmaceutical industry and the U.S. government, to deny the right of developing countries to use safeguards legally and responsively to reduce the cost of medicines.

For the U.S. government, this includes the use of many trade-related measures, such as free trade agreements, threats of sanctions, or withdrawal of trade preferences, promote a narrow agenda driven by the pharmaceutical industry, such as Abbott. And the pharmaceutical industry, as evidenced by Abbott's actions in Thailand, has also employed direct pressure upon developing countries, including the use of litigation, intimidation, and heavy lobbying of developing country government officials.

And, for us, this is just not a legal dispute or a case of government action. This affects real people, and in particular poor people. High medicine prices create a financial burden upon poor people who pay out-of-pocket for these medicines in developing countries.

Today, medicine prices account for 40 percent to 80 percent of out-of-pocket health care costs, for many people in developing countries. And, the cost of medicine often drives many individuals into poverty.

In Thailand, despite strong government commitments to improve public health care, including significant increases in public health care spending in the last year, many new medicines are still unaffordable for government purchase and use. What Thailand has done is perfectly legal. If Thailand is unable to use compulsory licensing to reduce the cost of medicines, then the TRIPs agreement and the Delhi Declaration, which reaffirms the right to use public health safeguards over the provision of intellectual property [ph] protection, can only be viewed as documents including empty promises for developing countries.

Oxfam expects that developing countries who increasingly need to use these safeguards to ensure affordable health care for the wide range of diseases currently afflicting developing countries. Abbott's actions in Thailand not only jeopardize access to medicines in Thailand, but across the entire developing world, by sending a powerful deterrent message to other developing countries contemplating the use of public health safeguards.

Rather than fighting with Thailand, Oxfam believes Abbott should be supporting and working with the Ministry of Public Health to ensure that Thai people have affordable access to medicines. Oxfam calls upon Abbott to immediately re-register its medicines in Thailand and to reaffirm the right of developing countries to use all safeguards to provide medicines at affordable prices. Thanks.

Kevin Phelan: Thank you very much Rohit. Now, we will open the conference to questions and answers.

Operator: Ladies and Gentlemen, if you have a question at this time, please press the "1" key on your touch-tone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the "##" key.

And, our first question.

Q1: Hello. Thank you for taking my call. Can you hear me?

Multiple Speakers: Yes.

Q1: Okay. I'm wondering about quite a few things. First of all, the $1,000 price that has been offered—I'm wondering if you consider that a reasonable and acceptable price, and if so, would that be grounds for some negotiation and discussion on the compulsory licensing issue?

Kevin Phelan: Tido? Do you think you can field that question?

Tido von Schoen-Angerer: Yes, I mean, it's a reducing the price—it's a good step in the right direction. I think it's quite unfortunate to only see this happening once the compulsory license has been issued and not before. It's clear, at the same time, it's still double as high as the prices that are offered for the least developed countries; and it's certainly higher than the production cost of these medicines. So, it's a step in the right direction; but I don't think it's low enough. And, I think, all the flexibilities need to be used to get the cheapest possible price; and I'm sure if—with the generic competition, these prices can get even lower.

Jon Ungphakorn: Can I answer that also please?

Kevin Phelan: Of course, Jon.

Jon Ungphakorn: I'm not speaking for the Thai government, but as a member of Thai civil society. We already know that the Indian generic companies are preparing to produce their heat-stable form of Kaletra and probably we hear that they can offer a price around $600 to $700 U.S. per year, which is already substantially below what Abbott is offering. But, what Abbott is offering is, at the same time, while they are holding Thailand to ransom, because they have withdrawn registration of seven important drugs, including this heat-stable form.

I don't think the Thai government should negotiate at all with Abbott, unless all the drugs that have been withdrawn are first reinstated. I don't think that negotiations while patients are held to hostage is the right way to go about it.

Q1: If I could just follow up with one question—Tido, you mentioned the manufacturing cost. I saw a press report that Thailand is going to require all drug companies to provide them with information on the real manufacturing costs of drugs. And, I'm wondering if you have any information on that policy.

Tido von Schoen-Angerer: I don't have further information on that policy. Maybe, Jon has.

Jon Ungphakorn: Yes, I know that that is true. And, I think it is fair. I think there should be much more transparency regarding the prices of drugs and what they cost to produce and maybe, also, what they cost—what the actual—who actually did the research—very often, it's not the drug companies that did the initial research—and how much the research actually cost and how much was put into advertising.

I think that drug companies generally—the brand names are very reluctant to release such information, because they make such huge profits at the expense of depriving many people in the world from their essential life-saving drugs. So, what I think the Thai government is doing in asking for information or requiring information be given regarding the manufacturing costs and other costs is perfectly legitimate.

Operator: And our next question.

Q2: Hi there. A couple of things—can you talk about the extent of the protests that you have planned and where you think the biggest ones might be? And, to the gentleman who is meeting with people in Washington, who are you meeting with? And, well, I'll just keep it at that for now.

Kevin Phelan: Okay, for the first question, I think maybe if Matt Kavanaugh is there?

Matt Kavanaugh: I am.

Kevin Phelan: So, Matt, I think it would be best for you to answer this question.

Matt Kavanaugh: Sure. This is Matt Kavanaugh. I'm with an organization called the Student Global AIDS Campaign. And, we are working with a handful of activists around the country to put on demonstrations.

There will be a big demonstration in Chicago. There will be people going at—in the morning will be over near the shareholders' meeting; and we'll be talking with shareholders. And then, the biggest will be in downtown Chicago at 11:00 A.M. where people will be gathering near the Tribune building where Miles White, CEO of Abbott is on the Board of Directors. The other protests will happen in the United States in Massachusetts tomorrow—in western Massachusetts. There will be a demonstration in D.C. downtown on Friday. There will also be smaller demonstrations in North Carolina, Austin, Texas, and in Oregon. That's the Student Global AIDS Campaign in partnership with the American Medical Association in groups like AMSA. There'll also be actions all over the world. And, maybe, Jon can speak to some of them.

Jon Ungphakorn: Okay. I can add that in Thailand itself, civil society organizations will be putting in a complaint against the Anti-competition Commission in Thailand against Abbott before we join registration of the drugs, which we believe contravenes Thai laws against monopolies. There will also be demonstrations all over the world in many countries.

But, I would like to point out, in particular, that Mr. Wirat Purahong—the chairman of the Network of Thai People with HIV/AIDS and myself will both be going into the Abbott shareholders' meeting. We have proxies, and we will very much like to speak—try to speak out on this issue directly to Abbott—to the Abbott Board.

Q2: And, the person mentioned a couple of Indian companies are working on generic Kaletra—do you know which companies are doing that? Have they talked publicly about that?

Jon Ungphakorn: We know Cipla is one company that is developing the Kaletra.

Q2: Okay.

Jon Ungphakorn: Hetero also apparently.

Operator: Ladies and Gentlemen, please press the "1" key if you have a question. I'm showing a question.

Q3: Yes. Thanks for holding this call. I was just wondering—I forget who mentioned this earlier, but somebody said that WHO has taken a rather soft approach in terms of dealing with the lack of drugs for developing countries. And, in fact, a couple of weeks ago, they issued a press release commending Abbott for their decision to reduce the price of these second-line drugs. I wanted to ask what your relationship is with the WHO and what you would like to see them do to take a stronger role in advocacy for AIDS patients in developing countries. Thanks.

Paul Cawthorne: Okay, shall I take this one?

Kevin Phelan: Okay, Paul, yes, and then Tido.

Paul Cawthorne: Yes. I think it was me that made that comment. It's really active frustration with the fact that since this huge furor has occurred in the last couple of months, there's been very, very little said by WHO. And, yes, Margaret Chan's patting herself on the back if you like, because she's had discussions with Abbott that have led to the situation we're in today.

The situation we're in today—it means nothing. It means nothing, because Abbott, before it said that they will offer $1,000 per patient per year if Thailand backs off from the CL. It means even less if we look at what happened last year with the $500 price for low-income countries, because you—in fact, that price means nothing if the drugs aren't available in the country. And that's dependent on Abbott registering their drugs. And, they dragged their feet on registration. We know that, because we saw what happened with Abbott's registration of the new heat-stable formulation in Thailand before they pulled the plug. And, they were really very, very slow. They were not sending in documentation. The Food and Drug Administration were asking them for documentation, and they weren't sending it.

So for me, as a person on the field who daily, my staff and myself, see patients in need of these treatments—we won't believe what Abbott is saying. We won't believe anything until we see these drugs going inside patients' mouths. Now WHO, for example, keep saying, "Oh, Kaletra is the backbone of second-line. All countries should have Kaletra available." Yet, they don't go the next step. It's easy for people to say, "Okay, you know, we think that these drugs should be available. We can write the guideline of WHO and then walk away from the problem." The problem is that these guidelines are unaffordable. So, WHO has to take a much more central role in ensuring that these drugs are available in the countries where they're needed without countries having to have these endless battles with drug companies.

So, for me, what Thailand has done is great. Like Jon said, you know, what Thailand has done has opened up the availability of these drugs to many, many other countries around the world. But, we cannot have a position where a government and a ministry of health, as in Thailand, under the kinds of pressure they're put under for doing something that is totally legal.

And so, it needs a whole new debate on how essential medicines—life-saving medicines—are made available in countries where they're needed without the country having to bankrupt themselves or the patients having to bankrupt themselves. It can't always be the NGOs and the civil society. It has to be the whole new debate of TRIPs flexibilities. All countries that signed up for WTO agreements, agreed to have these flexibilities. As soon as a country like Thailand tries to use them, an atom bomb drops on their head. It is not a way forward; this is not a sensible mechanism.

So, we have to have somebody to start opening up this debate and look at new ways of ensuring the TRIPs flexibilities work, because if Thailand backs down now, this means that TRIPs flexibilities are dead in the water. And what—let's forget about them, because no other country will ever dare use them. So, this is why, for me, this is a key issue.

If Thailand backs down, forget about TRIPs and forget about developing countries being able to save patients' lives, because they will not dare do it. And, that's why I think WHO, UNA, WTO—they need to look again; and they need to be far more center stage.

Kevin Phelan: Okay. Is there anything you would like to add to that Dr. Von Schoen-Angerer?

Tido von Schoen-Angerer: Just briefly, I think it's clear that what WHO—Margaret Chan—has done so far, in terms of talking behind the scenes with the companies is not enough, because even though they've been called on by Margaret Chan, Abbott has still not committed to continue the registration of the medicine; and they made the price decreases conditional.

So, we really need WHO to make a firm public support and, also, give technical support to the countries to make use of all the flexibilities they have to— like compulsory licenses—to get the cheapest drugs and for WHO, also, in-house, to really prioritize, to validate the generics that are—as soon as they come out so they can be used in the country. So, just talking to the originator companies behind the scene is clearly not enough. Thanks.

Operator: Our next question.

Q4: Hi, thanks. I was just wondering, there was a lot of talk, I guess, earlier this year or the end of last year about the U.S. government putting pressure on Thailand. That doesn't seem to be big focus of your talk today. Has USTR been weighing in on this? Is there any evidence that the U.S. has been putting a lot of pressure on the Thai government?

Jon Ungphakorn: Initially, I understand the USTR sort of implied that Thailand should negotiate first, which I think was a misunderstanding of the Thailand situation, because in Thailand, we have held negotiations with drug companies for years. But, after that, the USTR did acknowledge that what Thailand had done was completely legal. But, I think we are still—we still think that we have the threat of—the Free Trade Agreement is the main threat that we are afraid of from the U.S. government now.

Luckily, at the moment, the talks are on hold, because we are not yet—we don't yet have a democratic government. And, I think there will be more time to campaign in Thailand also, because to be honest, if Thailand signed the same kind of free trade agreement with the U.S. that other countries have signed, that's the death sentence for many thousands of people living with HIV/AIDS in Thailand, because that would allow data exclusivity, which will prevent generic companies from being able to produce vital drugs at least for five years.

It would not allow pre-patent—it would not allow challenging patents before they were granted. It would extend patent terms and many other measures that would make it much more difficult for people in Thailand to get the medicines they need.

So, the main—in our talks with staff of Congress people, we are also raising the FTA issue. And, we hope that the Democrat majority in the House will—in Congress will change—help to change U.S. policy regarding Thai intellectual property rights beyond TRIPs with the Free Trade Agreement. If they still continue to do so, we will fight very hard so that Thailand never signs such an agreement with the U.S.

Operator: I'm showing no further questions.

Kevin Phelan: Okay. I want to thank everyone again for joining us today for "Thailand, Abbott, and the Second-Line AIDS Crisis. The audio of this teleconference will be available in a few hours, and the transcript we hope to have prepared by Thursday or Friday.

Operator: And, Ladies and Gentlemen, this does conclude today's conference. Thank you for your participation, and have a wonderful day. You may all disconnect.