Marwaan Macan-Markar
BANGKOK, Jul 17 2006 (IPS) – For Thais living with HIV, the country s heat and humidity have been one more enemy because the life-extending drugs they need are temperature sensitive and need to be stored in refrigerators.
So news of an anti-AIDS drug that retains potency when kept under the normal tropical climatic conditions of around 30 degrees Celsius was a welcome development for those who are on second-line medication.
Yet, till now, Thais who desperately need this medicine have little access to it. The reason, says the global humanitarian agency Medecins Sans Frontieres (MSF or Doctors Without Borders), is because of a hurdle placed by the sole manufacturer of Iopinavir/ ritonavir, the United States-based pharmaceutical giant Abbott Laboratories.
Abbott has refused to provide the medicine to Thailand, because they say Thailand still has the older version. But that is a double standard, because the stocks of the old drug have been replaced by the new drug in the U.S. and in Europe, Nathan Ford, coordinator of MSF s Access to Medicine initiative, told IPS. This is another test of whether pharmaceutical companies are seriously engaging with the global HIV/AIDS problem.
MSF s decision to turn the heat on Abbott could make Thailand the venue of a confrontation in the way South Africa was some years ago when humanitarian groups and public health activist clashed with pharmaceutical giants to make first-line anti-AIDS drugs easily and cheaply available.
This is a classic example of the problems faced when you are held to ransom by one drug company and where there are no generic drugs for it, adds Ford. We have no choice but to pressure Abbott, because drug companies are not automatically benevolent.
Thai HIV/AIDS groups are just as concerned. There are people here who find the first-line of drugs not effective anymore and their only hope is to start a course in the second-line of medicines, Nimit Tienudom, director of AIDS Access Foundation, a Bangkok-based non-governmental group that champions public health issues, said in an interview. The drug must be made available here or Abbott must let the GPO (Government Pharmaceutical Organisation) produce it locally.
Thailand is seen internationally as one of the world s success stories in containing the spread of HIV and caring for those infected by the pandemic. Currently, over 80,000 people living with HIV/AIDS have access to a cheap, generic anti-AIDS drugs produced by the GPO, the state s pharmaceutical agency. The monthly cost of treatment per patient is 1,200 baht (30 US dollars).
At the same time, according to available estimates, between 5,000 to 8,000 people have developed resistance to the first-line of drugs and need the new, second-line drugs. The asking price is nearly 3,000 dollars per year, a figure few Thais can afford and a course of treatment that is not covered by the government s affordable universal health care programme, unlike the first-line of medication.
Thailand has over 600,000 people with HIV, out of a population of 64 million. Over 300,000 people have died from AIDS-related diseases since the pandemic hit this South-east Asian country in the early 1980s.
But Thailand s success at reducing the spread of the killer virus will not translate to a reduction in the country s public health budget to treat its citizens who need both the first and second-line of anti-AIDS drugs. In February, William Aldis, who was the head of the World Health Organisation (WHO) office in Bangkok, revealed just why in a newspaper article.
The cost of the government s HIV treatment program may rise from 38 million dollars to 500 million dollars a year within 10 years, as the virus resistance to present drugs means they have to be replaced by more expensive new drugs, wrote Aldis.
According to officials at the Joint United Nations Programme on HIV/AIDS (UNAIDS), the emerging debate in Thailand over second-line drugs was inevitable in the same way it emerged in countries grappling with AIDS, such as Brazil. Second-line medicines should be discussed and placed on the table, Patrick Brenny, UNAIDS country coordinator for Thailand, told IPS. You can t assume that all you will need are first-line drugs. The second-line drugs are expensive and policies must be made about dealing with it.
MSF is hoping that Abbott would change its tone and not only make Iopinavir/ritonavir available here but also sell it at the reduced price the company is offering the medicine to many MSF projects in Africa. Under this arrangement, the medicine costs 500 dollars per year for each patient.
This drug, which has been approved by the WHO, also has other features that makes it more advantages over its older version, adds MSF. One takes lesser amount of pills for every dosage and there are no dietary restrictions.
It is a pill that is easier to prescribe and has fewer storage problems, says Brenny. Were they to make it available in Thailand, it will be extremely useful.
