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Published on February 15, 2008

Senior officials of the three ministries concerned - Public Health, Foreign Affairs and Commerce - failed to reach a decision yesterday on whether to enforce compulsory licensing of three drugs to treat breast and lung cancer.

Compulsory licensing of these drugs - Docetaxel, produced by Sanofi-Aventis, Roche's Erlotinib and Novartis's Letrozole - was approved by the health minister in the previous government.

The ministers sought to distance themselves from the controversy by meeting briefly to discuss the issue at the Foreign Ministry in the morning, and then assigning permanent secretaries and other officials to meet on their behalf in the afternoon.

The Thai Chamber of Commerce yesterday suggested two options to the government.

First, if it wants to impose compulsory licensing, the government must have measures in place to protect Thai businesses from US retaliation since 20 per cent of Thai exports to the US, worth about US$4 billion (Bt131.5 billion), are under its low-tariff Generalised System of Preferences programme.

Second, the government could subsidise drug purchases for the poor instead of enforcing compulsory licensing.

"The Thai private sector favours the second method as we are afraid of losing tariff privileges if the US decides to impose trade retaliation," said chamber of commerce chairman Pramon Sutivong.

Pramon said the government should set aside part of its budget for populist policies to give the poor access to low-cost drugs. The plan would cost only Bt2 billion-3 billion, compared with losing 20 per cent of exports to the US.

Teera Chakajnarodom, general manager of the Pharmaceutical Research and Manufacturers' Association of Thailand (PREMA), said the association was willing to provide more drug access for low-income earners if the government decided not to use compulsory licensing.

"Compulsory licensing should be the last resort for the government. There are many measures to help increase drug access which should not create any trade problems for the Kingdom," he said.

Teera suggested the government increase its health-insurance budget for special drugs. He said governments so far have allotted too much budget for general drugs that most people are able to afford.

Teera said the previous government had been able to save only Bt15 million from imposing compulsory licensing on HIV/Aids drugs last year.

The Thailand head of Medecins Sans Frontieres (Doctors Without Borders) called for broader consultation with those affected.

"If [the government's] going to go for a review it needs everybody sitting down and discussing this together," Paul Cawthorne said yesterday as officials held their meeting.

"At the moment, [the Ministry of Health] has only met with representatives of pharmaceutical companies in Thailand.

"To be fair and get a complete picture, we're asking that the Ministry of Health, the Ministry of Commerce, talk to all interested parties," he said.

After taking office last week, Public Health Minister Chaiya Sasomsab announced that he planned to review the compulsory licensing of the three cancer drugs because the proper procedure may not have been followed. The Cabinet postponed a decision on the issue at its meeting on Tuesday.

According to Cawthorne, Thai cancer patients must be consulted about the proposed review, particularly the large number of women with breast and cervical cancers.

"[These women] need access to life-saving medicines that are cheaply available without bankrupting themselves and their families in the process," he said.

"They're the ones who will be hit hardest if the decision goes ahead not to look for cheaper alternatives."

He also said that if the compulsory licensing was revoked, the National Health Security Office, as the agency responsible for treating people with cancer, would need more funding to "cover the cost of treating people and of reducing the cost of drugs".

Manufacturers of the three cancer drugs were unavailable for comment yesterday.

Last year, the military-installed previous government issued compulsory licences to override patents for the popular heart drug Plavix and HIV/Aids medicines Kaletra and Efavirenz. Generic versions of these drugs are now being imported from India, at a fraction of their original prices.

While permitted under World Trade Organisation rules, compulsory licensing has been rejected by international pharmaceutical giants and the US and Europe, because they say it impedes trade.

Jon Ungpakorn, a health activist and former senator, said the plan to revise the recent compulsory licensing for cancer drugs would affect the country's strategy to impose compulsory licensing for HIV/Aids drugs. He said there were other HIV/Aids drugs needed to treat patients after they received efavirenz and alluvia.

He said the prices of other HIV/Aids drug were still expensive and most patients could not access them. That was why these compulsory licensing had to be imposed to help patients access the live-saving drugs.

"Compulsory licensing is the best tool to help patients access life-saving drugs. If the government revises or cancels the recent enforcement of compulsory licensing for cancer drugs, how can we negotiate with pharmaceutical companies for price reductions in future?" he said. "There are more than 500,000 people living with HIV who hope to live longer."

He said cancellation of compulsory licensing for the cancer drugs would affect the national health system, which cause the government to collapse if it did not have enough money to purchase expensive drugs.

"The cancellation of enforcement of compulsory licensing would prevent patients having the opportunity to get access to life-saving drugs which are expensive," he said.

Petchanet Pratruangkrai,

Danielle Kirk,

Pongphon Sarnsamak

The Nation