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Access For All?
Debate Rages Over Drugs
By Chu Minh Truong
Doanh Nhan

BANGKOK – Six million people living with HIV need treatment now, but only 440,000 have access to drugs that would prolong their lives.

The anti-retroviral drugs can’t cure HIV, but they can slow or stop the virus from reproducing in the body, and enable people to live many more years in relatively good health.

Prices of anti-AIDS drugs have fallen dramatically in recent years, but still are too high for people in developing countries.

Activists argue that it’s business as usual for the profitable western drug makers, and that the poorest and most vulnerable people in the world are being denied treatment. They say the drugs should be donated or that developing countries should be allowed to develop cheap copies or “generic” drugs.

Drug companies counter that the issue is much more complicated. They say they invest hundreds of millions of dollars to develop a new drug, and that the patent on that work must be protected so they can recover their costs 
and have money to develop newer drugs. Moreover, they say, countries lack the trained doctors necessary to prescribe the medicine and the infrastructure to properly deliver and store the medicine.

“Responsible pharmaceutical companies should be able to provide drugs free, but society also has a responsibility,” said Amal Naj, a spokesman for the Pharmaceutical Producers Association and country manager for Pfizer Inc., the world’s largest drug maker. Thailand is an example of a country in the region that has vowed to provide enough anti-AIDS drugs for everyone who needs them. Prime Minister Thaksin Shinawatra made the promise at the recent 15th International AIDS Conference in Bangkok.

The country already had started making inexpensive generic drugs although not quite up to international standards yet.

Itsaraet Gosriwatana, international sales manager of the Government Pharmaceutical Organization (GPO), said the government-owned factory has the capacity to provide drugs for 60,000 people. Experts estimate that up to 100,000 Thais need the drugs now.

Moreover, he said the GPO would increase capacity to 130,000 next year and 300,000 by 2006, with the completion of a second factory. Some of the drugs will be exported. The cost of the drugs is 1,200 baht ($30) a month, or about five to 10 times cheaper than brand-name drugs.

Still, activists said it’s not enough.

“The current prices still are too high for Thai people,” said Jiew Premchaiporn, advocacy team leader for the AIDS Access Foundation, which provides counseling and support for people with HIV and their families.

She also is skeptical, saying many vulnerable groups still aren’t getting treatment, such as drug users and ethnic minorities.

“We have a good policy, but it’s just a policy, not the real actions,” she said. “How to bring the policy into action is still a big question.”

Vietnam, where experts are concerned about an HIV problem fueled by drug users sharing needles, also is struggling with the issue.

Current treatment costs $1,200US a year per person, out of reach of the country’s cash-strapped Health Ministry. The country can afford to treat less than 1,000 people a year if it pays prices charged by foreign drug companies. Vietnam has set a goal of producing cheap generic drugs within three years, but first must settle the issue of patent rights held by foreign companies.
Naj of Pfizer complains the debate “always is focused on the issue of price and patent.

” Pfizer invests $500 million to $800 million for each new drug brought to market, he said. That investment must be recovered, and a profit must be made so drug companies can invest in new drugs. Anti-AIDS drugs today are only good for a few years, he said, and then people build up a resistance and need to change to a different drug combination.

Major drug companies recognize their social responsibility, but society also has a responsibility to put a good system in place, Naj said.

Trained doctors are needed to properly administer the treatment. Stigma needs to be removed so people seek treatment early. Drugs must be delivered and stored properly.

Just bringing down the price isn’t enough, Naj said. “Now all of us have to come together.” But in the meantime, say activists, just a small percentage of the people who need drugs have access to treatment.

“AIDS does not wait for anyone, even one second,” said Paisan Suwannawong, a former drug addict turned activist.

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