Thailand – Patients Before Patents

Thailand’s military-backed Public Health Ministry has moved to assist the more than 500,000 people suffering from AIDS in the Kingdom by issuing its first compulsory license, directed at Efavirenz (brand names Sustiva® and Stocrin®). This decision, announced on Wednesday 27th November, was taken without any consultation with the patentee, Merck & Co. Inc, sparking a protest from the pharmaceutical multinational. Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used for the treatment of human immunodeficiency virus (HIV) type I . Thailand is well known for its efforts to fight HIV/AIDS: its treatment program has received accolades internationally, and is credited with cutting the number of deaths from the virus by about 75 percent last year. In 2002, Thailand produced an affordable triple therapy to combat HIV/AIDS, but the virus is becoming increasingly more resistant to the cocktail, leaving many thousands of Thais without any effective treatment. However, the existing cost of Sustiva in Thailand of 2,500 baht (67 US dollars) a month was proving too expensive for most patients to afford. To date, the generic triple therapy had enabled 84,000 Thais living with HIV/AIDS to receive the treatment.

Thailand’s Ministry has explained that the Government Pharmaceutical Organisation (GPO) will begin manufacturing the drug within six months from the announcement. Also under consideration is the importation of the medicine from India.

Merck has requested that the Thai Government review its decision. Under the arrangement, the compulsory license will last for five years, with Merck & Co paid a royalty of 0.5 percent on sales.

The director-general of the Disease Control Department explained that Thailand is acting within the law and with the benefits of AIDS patients in mind. With the compulsory licensing, the cost for Efavirenz would be reduced to 1,400 baht (38.5 dollars), and further reduced to 800 baht per month, when the GPO’s own supply begins to enter the market.

This policy leaves the door open for the compulsory licensing of other related drugs that are expensive to obtain, and for other countries to follow Thailand’s lead.

Merck & Co. will offer to cut the price of Efavirenz in Thailand in an effort to quash the decision according to a spokesman for the company. Merck explained that other proposals would include a voluntary license to the government, or discounts to its price.

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