It claims the only way to reconcile the need for expensive drugs with universal healthcare is by breaching patents and manufacturing the drugs oneself. But behind the rhetoric, the military government and MSF show an inexplicable disregard for patients.

Thailand has previously experimented with producing its own Aids copy-drugs and the results are already clear. Rewind to 2002, when the Global Fund for HIV/Aids awarded Thailand US$133 million (Bt4.7 million) to test and manufacture its locally-made triple-dose combination-anti-retroviral (ARV) called GPO-Vir. The grant carried two conditions: Thailand had in the interim to purchase the drugs from companies approved ("pre-qualified") by the World Health Organisation, and the Government Pharmaceutical Organisation facilities had to meet international standards in two years' time.

Last August, the Global Fund finally withdrew funding for GPO-Vir because the GPO still had not brought its facilities up to standard, nor had the WHO "pre-qualified" the drug. But it was too little too late: Thai scientists had announced back in July 2005 that the poor-quality GPO-Vir was causing a rise in patients' drug resistance.

The effect of using substandard drugs was to force patients onto "second-line" therapies - increasing the drug price from $24 per person per month to $239, according to MSF's own figures.

Although the WHO considered GPO-Vir inadequate for sale outside Thailand, this drug continues to be used on Thai patients. MSF proudly says: "Thanks to this, over 85,000 people with HIV/Aids are today receiving treatment" in Thailand - and MSF distributes GPO-Vir in Burma too.

Faced with this self-inflicted rise in treatment costs, the Thai military government repeated the policy. In November of last year, it announced a "compulsory licence" to break the patent on Efavirenz, another first-line HIV/Aids therapy, in order to cut its drugs bill. MSF then encouraged Thailand "to issue such licences for the production of other essential medicines".

The Thai military government followed that advice by issuing additional compulsory licences this January, for a second-line ARV called Kaletra and for a heart disease drug called Plavix. According to MSF, these drugs are "essential medicines", so their patents should also be expropriated.

But an MSF statement of November 30 of last year noted that rising ARV resistance will create a need for more of the expensive second-line drugs, causing "dramatically rising drug costs" and therefore justifying more compulsory licences. ARV resistance develops even under the best medical care but substandard drugs accelerate resistance as well as mutations of the HIV/Aids virus. The risk is that more compulsory licences could accelerate this resistance.

Behind the activists' talk of prices and access to medicines, their avowed aim is to remove patent protection wherever they can and to put research and production under governments' control - a technique that proved its worth in the former Soviet Union - all in the name of "equitable access". So the State-owned, corrupt and inefficient GPO is to manufacture the compulsory-licensed Efavirenz, after a few months of buying copies from India. This makes little sense because the Global Fund would subsidise now the purchase of Efavirenz copies from India that are "pre-qualified" by the WHO. If they are manufactured in Thailand, the Global Fund will not fund anything connected with the GPO, so the Thai taxpayer will get the bill and, judging by past performance, Thai patients will continue to suffer the consequences of substandard GPO drugs.

But Thailand actively discourages using these cheap Indian drugs by imposing tariffs and taxes on them. The WHO has found that these levies on drugs in poor countries "frequently contribute more to the final price than the actual manufacturers' price" but MSF has yet to criticise this tax on suffering.

So with cheap and subsidised drugs available in India, why bother manufacturing in Thailand at all? Why does the government exclude other private Thai manufacturers from procurement contracts, if the need is so pressing as to require a compulsory licence? GPO has made a good profit from its government contracts for many years and the national Auditor-General said in 2002 that it had pilfered more than Bt1.9 billion over the previous four years. Producing more drugs could create many such opportunities.

If the Thai military government and MSF continue the promotion of Aids treatment with drugs that haven't been "pre-qualified" by WHO, then the drug resistance identified by Thai scientists could become worse. The current prices faced by Thailand on first-line Aids drugs are nothing compared to the medical costs and hospital bills they will face when more patients move onto complicated and expensive second-line treatments. According to MSF, the drug costs for 59 patients on second-line therapies is equivalent to 555 on first-line therapies, not counting the increased clinical costs, often requiring hospitalisation.

The world's new drugs come from private companies investing billions of dollars in research but breaking patents scares investment away. So when resistance inevitably sets in to the latest round of GPO drugs, there may not be any new products to expropriate.

The victims who will suffer most from this populism will be poor Aids patients around the world.

Philip Stevens

Special to The Nation

London

Philip Stevens is director of the health programme at the International Policy Network, a London-based development think tank.