Marwaan Macan-Markar

BANGKOK, Feb 20 2008 (IPS) – Shortly before he left office in January, Thailand s former public health minister, Mongkol Na Songkhla, offered a gift of hope to the country s poor. But that promise to supply cheaper, generic anti-cancer drugs -now hangs in the balance.
Mongkol s push to secure the generic drugs by issuing compulsory licenses (CLs) is being opposed his successor, Chiya Sasomsab, whose recent announcement to cancel a plan for affordable drugs to treat breast, lung, pancreatic and ovarian cancer has raised howls of protest from public health activists.

Some activists are even weighing the possibility of legal action against the new public health minister if he goes through with his plan. We have already begun discussing with lawyers about taking the minister to court for trying to revoke the decision of the last health minister, Kannikar Kijitwatchakul, a leading activist for the Free Trade Agreement Watch (FTA Watch), told IPS. The new minister is trying to reverse a legitimate decision.

The significance of this odd turn of events has not been lost on other champions of cheaper generic drugs for the economically weak Thais, since Mongkol was a minister appointed in a government that came to power following a military coup, in September 2006. Chiya, by contrast, was named minister by a government popularly elected at the first parliamentary elections after the coup, in late December.

It is ironic that a health minister appointed during a military regime should be better for the country than one appointed by an elected government, Jon Ungpakorn, a former member of Thailand s Senate, said in an IPS interview. Our present health minister has no regard for public health issues. He is behaving like the commerce minister.

Currently, an 80 mg injection for one of the drugs, Docetexel, for patients with lung and breast cancer, costs 25,000 baht (781 US dollars), while the generic equivalent costs 4,000 baht (125 dollars). And the cost of a 2.5 mg tablet of another drug, Letrozole, for breast cancer patients, is 230 baht (7.18 dollars), while the price of a generic version of the same tablet sells for 7 baht (20 US cents).
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According to a health ministry study of the disease burden in the country for 2003, there were 5,215 news cases of breast cancer reported that year, while there were 9,830 new cases of lung cancer reported. Yet the rural and urban poor suffering from such cancers have no access to the brand name drugs available on the market, doctors reveal.

In fact, the stakes here are much higher than the obvious question: Is democracy bad for public health in Thailand? For this South-east Asian nation has emerged as the battleground in a tussle to secure cheap generic drugs for the poor that will have implications across the Global South.

Thailand has won praise from governments, United Nations agencies and activists as a role model for poor and middle-income countries to follow after Mongkol took the lead in late 2006 to issue CLs for two life-prolonging anti-AIDS drugs and a blood-thinner drug for heart patients. His decision to issue CLs for the four anti-cancer drugs was made on Jan. 4, this year.

Under international trade rules, developing countries, when faced with public health emergencies, enjoy the right to break a patent on expensive brand-name drugs produced by pharmaceutical giants and seek alternative and cheaper generic versions. This option is recognised by the World Trade Organisation (WTO) under the flexible provisions of the trade related intellectual property rights (TRIPS).

Yet, though the TRIPS flexibilities was approved at a WTO ministerial meeting in Doha, in 2001, developing countries avoided testing the provision fearing a backlash from the world s powerful economies, such as the United States, which has taken the side of the drug multinationals.

Such concern appeared justified when Washington placed Thailand on a watch list of countries that had, in general, violated intellectual property rights in May 2007. It worried the private sector here, with some fearing that the country s exports, which contribute 60 percent to the gross domestic product, will be hit.

But Thailand has, till the recent flap, refused to cave in, confirming Bangkok s commitment to place the lives of its weak and vulnerable ahead of corporate profits. It has moved from supplying generic drugs for communicable diseases, such as HIV/AIDS, which is a public health emergency here, to non-communicable diseases, such as heart and cancer ailments.

Thailand has led the way for developing countries to use their right, as it is available in world trade rules, Sarah Ireland, director of the East Asia office the global humanitarian agency Oxfam, said at a press conference this week. Thailand has taken a bold step and resisted a lot of pressure from certain companies.

Some local trade organisations are even adding their weight to pressure the health minister to retain the existing provisions. When you talk about medicine, you talk about life and death. This is not the case for normal luxury goods, says Buntoon Wongseelashote, vice-chairman of the Thai Chamber of Commerce. It is like blackmailing: either you pay up or you die.

The country s efforts to care for its people living with HIV and AIDS have been pivotal in shaping such views. Mongkol s decision to issue a CL for one second-line drug for HIV/AIDS has meant that 10,000 Thais who need the cheaper medication have access to it. Currently, an estimated 140,000 Thais receive first-line ant-retroviral (ARV) drugs out of the 600,000 people infected with HIV. Since the pandemic was detected here in the early 1980s, some 300,000 people have died due to AIDS.

In early February, even the World Health Organisation reminded Chiya, the minister, that he is out of step with international trends. Following a visit by a seven-member team, the Geneva-based health body issued a 31-page report about TRIPS flexibilities in Thailand, saying that the WTO rules offer a range of options for developing countries to pursue to improve access to medicines.

The use of compulsory licences and government-use provisions to improve access to medicines is one of several cost-containment mechanisms that may be useful for patented essential medicines not affordable to the people or to public health insurance schemes, it added.