Global Trends by Martin Khor

Monday 4 December 2006

A message for all on AIDS Day

World AIDS Day was marked by a rise in the numbers of people infected with HIV.  The good news is that more countries are now facilitating cheaper generic medicines, the latest being Thailand’s issuance of a compulsory license.  The looming threat is that some types of free trade agreements will prevent or hinder the public’s access to medicines to treat not only AIDS but all other diseases.


World Aids Day last Saturday was marked by events globally as politicians, celebrities and activists pledged to do more to fight the deadly disease.

The truth is that the situation has worsened.  There are now 40 million people infected with HIV worldwide, a few millions more than a year ago.  This year 2.9 million will die from AIDS, and 4.3 million people will be newly infected with HIV.

In Asia, 8.6 million are now infected, with almost a million new cases in 2006 and 633,000 deaths.  It is predicted that some years from now there will be more Asian AIDS cases than even Africa.

The situation in that region is catastrophic. About 25 million Africans (6% of all adults) have HIV, with 2.1 million deaths in 2006.  In Swaziland, 36% of adults are infected.

While prevention is still the best strategy to deal with the disease, cure is the only hope for those already infected.  And a combination of two or three medicines a day can combat the virus quite effectively.

The biggest obstacle is still cost.  Although generic drug producers can make available AIDS medicines at US$140 a patient a day, the big drug firms that hold the patents still sell them in most countries at very much higher prices.

To get the cheap generic drugs, a country has to issue a compulsory license to set aside the monopoly of the patented drug. The license, which is allowed by the rules of the World Trade Organisation, allows the government or a private company to import or manufacture the generic medicine.

Malaysia was one of the first countries to issue such a compulsory license in 2004, enabling the import of three cheap generic AIDS medicines from India.  This was followed shortly by Indonesia, which issued an order for local production.

Last week, Thailand marked World Aids Day by announcing that it had also issued a

a compulsory licence to locally produce a much cheaper generic version of efavirenz, which is one of the most effective of the AIDS drugs. 

The Thai Health Minister Dr. Mongkol na Songkhla said only 100,000 of the 500,000 HIV-infected people who need treatment had access to the drugs because of the high prices.

The Thai Network of People Living with HIV/AIDS hailed the Thai government's decision, stating that "This ground breaking decision sets an important precedent for the issuing of compulsory license for other desperately needed but costly medication for other chronic diseases such as kidney disease and cancer".

"Thank you for the courage of the Public Health Ministry. It's remarkably brave," said Nimitr Tienudom, the manager of AIDS ACCESS Foundation.

According to a UNAIDS report, an estimated 8.6 million people were living with HIV in Asia in 2006.  The number of people receiving anti-retroviral treatment has increased to 235,000 by June 2006. But this represents only 16% of those who need treatment.

A new threat on the near horizon comes from the free trade agreements (FTAs) that some Asian countries, including Malaysia, Korea and Thailand, are negotiating with the United States.

The USA is demanding that patent laws be tightened in favour of the big drug firms that would make it difficult or even impossible for generic medicines to be imported or locally produced.

One of the American proposals is that countries adopt “data exclusivity”, which prevents generic medicines from being approved by the drug regulatory authorities on the basis of the safety test data of the original drugs, even if the composition of the generic and original medicines are substantially the same.

If adopted, this proposed FTA provision could well prevent the cheap generic medicines from reaching the public, even if a compulsory license is granted.

The losers will be patients whose access to cheaper medicines, not only for AIDS but for all other diseases too will be blocked.

Peru's Health Ministry has forecast that data exclusivity (included in the country’s FTA with the United States) will more than double its spending on medicine. Colombia predicted its generic medicine industry would lose 71% of its market share.

Many experts, including in the World Health Organisation, and the United Nations Special Rapporteur on the Right to Health have voiced concern on how the patent provisions of FTAs can make medicines unaffordable.

A WHO Commission on public health has recommended that these types of provisions be avoided. Ministers of Health in Latin America and Africa have also urged that FTAs should not be at the expense of patients’ health.

This is a most appropriate message for World AIDS Day.  At stake are the lives and health of AIDS victims and others suffering from other diseases as well.