Global Trends by Martin Khor

Monday 6 December 2004

Tackling AIDS with cheap generic drugs

On World AIDS Day last week, people around the world, Malaysians included, were given a wake-up call to the need to prevent and treat the fast spreading disease.  A regional workshop in Kuala Lumpur heard how generic drugs in Malaysia are significantly lowering the cost of treatment.

World AIDS Day was marked on 1 December by rallies and pronouncements of government commitments around the world to fight the disease.

Of particular significance was the emergence, slowly but surely, of greater commitment by political leaders in China and India to deal with AIDS more seriously than they have had.

AIDS has been considered by Asians as mainly an African problem, but the centre of the global epidemic is about to shift to this region.  HIV-AIDS has already infected 5 million in India and 10 million Chinese are expected to be affected by 2010.

A frank and straightforward article entitled “AIDS situation worsening” by the Malaysian AIDS Council chairperson, Datuk Paduka Marina Mahathir, was published in her column in The Star last Wednesday.

It should be seen as a wake up call to Malaysian policy makers and the public.  Marina says that more and more people have told her recently that a relative of theirs have died of AIDS.  

Ten years ago, when the numbers were small and manageable, we could have done something to contain the epidemic, like programmes to prevent HIV transmission among drug users, she wrote.

“Instead we didn’t do anything, citing various excuses, and today we have an epidemic that is growing bigger and faster than ever before.  In its wake, it leaves widows, orphans and shattered communities and a society that is no more enlightened about HIV/AIDS than it was before.”

In light of Marina’s reflections, the political leaders should take measures to launch a high-profile campaign to prevent and treat the disease.

The official figure, that 50,000 to 60,000 Malaysians are infected with HIV-AIDS could be reviewed to see if it understates the scale of the problem.   As Marina pointed out, there are one million drug users in the country, according to the National Anti-Drug Agency.  Given the easy transmission through injections among drug users, there may well be many more people infected with HIV-AIDS than the official figure suggests.

While Malaysia may be lagging behind in promoting AIDS awareness, it has taken the lead in one crucial area:  the issuing of a compulsory license (in this case, a government use order) to import generic HIV-AIDS drugs, as the original drugs that are patented in the country are more expensive.  

Malaysia was the first developing country to issue and implement a compulsory license (to offset the monopoly privilege granted for patented products)  following the World Trade Organisation’s declaration that its intellectual property agreement does not and should not prevent countries from taking such a measure to make medicines more affordable.

Last week, the Ministry of Health presented the Malaysian case to an Asian regional seminar on patents and medicines held in Kuala Lumpur.  The 90 participants, many of them officials from Health Ministries and patent offices from 15 Asian countries, were encouraged and even inspired by the concrete example that Malaysia presented.

“If Malaysia can do it, other countries in the region can also do it,” said a senior health official from an Asian country attending the workshop, which was organized by the Third World Network and Health Action International (Asia Pacific) with the cooperation of the UN Development Programme and the World Health Organisation.

At the workshop, a Health Ministry official recounted that in November 2002, the Cabinet approved a Ministry of Health proposal to import generic anti-retroviral drugs from India, using Section 84 of the Patents Act 1983 on the government’s rights to exploit a patent for public non-commercial use.

In November 2003, the Ministry of Health obtained a compulsory license from the Ministry of Domestic Trade to import from an Indian company, Cipla, generic versions of three HIV-AIDS drugs that are patented in Malaysia.

In February 2004, the Health Ministry issued a contract to import the generic drugs, which are now distributed through government hospitals and clinics.

There have been two effects on prices.  Firstly, the prices of the original patented drugs have fallen due to the competition from the generic drugs.  Secondly, the cheaper generic drugs are also available, cutting costs very significantly.   

The Health Ministry data show that the monthly cost of treatment per patient taking three drugs (d4T, ddI and nevirapine) has fallen from USD 261 (MR 1014) in 2001 to USD197 (MR 765) in 2004 for the branded patented products.  Meanwhile, the present cost of treatment using the generic drugs is much lower at USD45 (MR176).

The cost of treatment today based on the generic drugs is only 17.4 per cent the cost in 2001 based on the patented products.  In other words, for the same funds used, six times the number of patients can be treated.

The monthly cost of treatment per patient for taking two other drugs (combivir and efavirenz) has dropped from USD363 (RM1407) in 2001 to USD136 (MR529) in 2004 for the branded patented products.  And meanwhile, the present cost of the generic drugs is USD115 (MR447).

The Health Ministry and the Domestic Trade Ministry are now considering a request from a local producer for a compulsory license to manufacture in Malaysia a three-in-one combination drug for HIV-AIDS patients.  This would be different from the present government-use order which is for importing the drugs from India.

At the workshop, an Indonesian health official also revealed that former President Megawati Soekarnoputri in October 2004 issued a compulsory license in the form of a government-use order for the government to locally produce (or authorize production of) two anti-retroviral drugs (nevarapine and lamivudine) to treat HIV-AIDS.  The two drugs are patented in Indonesia.

Discussions are now going on in other countries, including Thailand, China and India, on whether compulsory licenses should be issued to locally produce generic drugs.

The workshop’s concluding statement urged policy makers to revise their patent laws and to take measures to promote the use and local production of cheap generic drugs that can greatly increase the access of the public to treatment not only for HIV-AIDS but also other diseases including malaria, TB, cholera and leukemia.

Of course, prevention of HIV-AIDs and other ailments is more cost-effective than cure.  But when disease strikes a person, he or she will be desperate to get treatment.

The health authorities then have the task of finding the cheapest way to treat patients with medicines that are safe and effective.