Global Trends by Martin Khor

Monday 19 July 2004


Will the aim of “access for all” to life-saving medicines ever be met?  This was the main issue inside and outside the halls of last week’s international conference on AIDS in Bangkok.   Speakers warned that patents and bilateral free trade agreements are undermining the patients’ access to drugs, but also pointed to compulsory licenses as a vital way out of the problem.


Last week’s 15th International AIDS Conference was impressive for the huge number of participants (15,000 in all) and the wide range of topics, from the latest findings on medical treatment to the local initiatives and national policies undertaken.

The theme was “Access For All”, so naturally the political focus was on how to get HIV-AIDs drugs to all those who need them.

We were reminded how daunting the task is by the World Health Organisation’s “three by five” initiative, with the target to provide drugs to 3 million patients by December 2005. 

To date the medicines are reaching only 440,000, yet the ambitious target is for the coverage to jump to 1.6 million by June 2005 and 3 million by December 2005.  

It would be a miracle if this happens.  Even if it does, it would cover only half the demand, for as estimated six million need the antiretroviral (ARV) drugs now, and many more of the 38 million people with HIV-AIDS will need them in future.

The Bangkok conference identified high prices as the main cause for this lack of access, and many participants pointed to the patents on these drugs for preventing competition that would otherwise enable more generic drugs at much lower prices.

Thailand, whose public agency Government Pharmaceutical Organisation (GPO) produces generic drugs, treats 50,000 HIV-Aids victims free and the number will rise to 70,000 next year, according to Thai Health Minister Sudarat Keyuraphan. 

And Thai prime minister Thaksin Shinawatra announced a new policy that Thailand would provide access to drugs for all people with HIV-Aids in Thailand.

The GPO-produced generic drugs are not patented in Thailand, so the government can manufacture and distribute them with no legal problem.  However, the Thai patients need two other ARV drugs which are patented, and Sudarat said the government may have to issue compulsory licenses for making generic copies of these drugs.

Many Aids activists marched into the conference centre carrying mock corpses warpped in black plastic with the slogan, “Killed by Phara Patent Abuse.”   A Thai Aids activist, Nimit Tienudom, said people living with the disease consider access to drugs a basic right and the government should exercise comp[ulsory licensing to produce a drug known as NRTZ which is required by 20 percent of Thai patients who are allergic to the drugs produced by the GPO.

Compulsory licenses can be issued by governments to override patents, and to allow local companies to produce or import generic drugs, and they are seen as vital tools to widen access to medicines.   

At a United Nations Development Programme workshop on “After Cancun: Whose Access Counts?”, in which I spoke, the importance of compulsory licenses was highlighted.

It was pointed out that compulsory licensing is allowed by the rules of the World Trade Organisation, that the developed countries make use of it, and developing countries should now also make full use of it to make cheaper medicines available.

“Unfortunately, only two countries, Malaysia and Mozambique, have mustered the courage to give compulsory licenses to promote access to medicines,” said Mr. D.G. Shah, secretary general of the Indian Pharmaceutical Alliance, which represents Indian drug companies which produce generic medicines.

Shah charged that some developed countries are “working overtime” to try to frustrate efforts by developing countries to implement compulsory license measures that were encouraged by the WTO’s Doha Declaration on patents and public health.

“Why do they want to frustrate the efforts?  Are they not convinced of the need of the poor to have medicines?” he asked. 

The Malaysian compulsory license to a local company to import three ARV generic drugs from an Indian company was also praised by Brazil’s AIDS programme deputy director.  “After hearing of Malaysia issuing a compulsory license, my country is encouraged by this to do the same,” he said.

A hot issue at the Bangkok conference was the negative effect of bilateral trade agreements that a growing number of developing countries have signed or are negotiating with the United States.

D.G. Shah warned that these agreements are creating new barriers to access to medicines, as they forbid the developing countries from policies (which the WTO allows) that promote generic medicines.

There was a diplomatic uproar when the French President Jacques Chirac accused the US of blackmailing developing countries to give up measures to obtain life-saving drugs through these bilateral trade deals. 

In a statement read out at the conference, Chirac said:  “Making certain countries drop thge4se measures in the framework of bilateral trade negotiations would be tantamount to blackmail, since what is the point of starting treatment without any guarantee of having quality and affordable drugs in the long run?”

His charge was refuted by US officials at the conference.

But a Thai academic, Jiraphorn Limpananont of Chulalongkorn University, who has studied the free-trade agreement being negotiated between the US and Thailand, warned that it could lead to the extension of patent periods for drugs produced by US firms, and this would reverse the progress made by Thailand in treating Aids victims. 

Her concerns were echoed by Dr Suwit Wibulpolprasert, senior advisor to the Thai Ministry of Health, who told the UNDP panel that the US-Thai free trade agreement could be a threat to access as it could lead to a five-year extension of patents as well as “data exclusivity”, which the US is requesting.

Data exclusivity is the name of a policy in which a generic producer applying for drug safety registration will not be able to make use of the safety data supplied by a company owning the patent for the same drug, when that company applied for safety registration.

The patent holder has exclusive rights over the data.

Medicins Sans Frontier, a famous medical NGO, also warned in a paper that many countries are trading away their people’s health in free trade agreements with the US.

“These countries are being pushed to accept extremely restrictive intellectual property provisions that could put an end to competition from generic medicine producers and tpo countries’ ability to make use of existing safeguards against patent abuse.”

The conference discussed many other issues, including the problem of resistance by the AIDS virus to several drugs, and the policies adopted by international agencies, national governments and local communities to prevent and treat HIV-AIDS.

Many agencies were appealing for more commitment by political leaders to fight the threat of Aids seriously through a comprehensive plan.  They also asked that more funds be made available.

The goals and targets were ambitious.  But so too are the problems, as the disease which is devastating Africa now spreads its tentacles to other regions, especially Asia.

It remains to be seen if “access for all” turns out to be the Bangkok conference’s successful rallying cry or whether the goals and targets remain elusive.