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Held to ransom

March 26, 2007 By Apoorva Mandavilli This article courtesy of Nature News.

A pharma giant's decision to withhold new drugs from Thailand will only hurt patients, says Apoorva Mandavilli.

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Is there ever a good enough reason to deny life-saving medicines to an entire country's citizens?

I say no. But it seems pharmaceutical giant Abbott begs to differ.

The Chicago-based company decided on 14 March not to introduce in Thailand any of its seven new drugs — including an antibiotic, an important AIDS drug called Kaletra and medicines to treat blood clots, kidney disease and high blood pressure. Without this crucial registration, the drugs cannot be imported to or sold in that country.

It seems to me that Abbott is, in effect, holding millions of Thais' lives hostage to force their government to respect its patents. This is good business?

What's shocking to me is that the company is making no bones about the fact that its decision is retaliation against Thailand's decision in January to issue 'compulsary licenses' allowing some locals to import or make cheap copies of Abbott's new version of Kaletra. "This matter is about intellectual property and the integrity of the patent system," Abbott spokeswoman Melissa Brotz said in a statement.

Lofty words, but I'm reminded more of a schoolyard fight.

It's true that Thailand has been flirting with this particular disaster since last year, when it stunned drug makers by issuing a similar verdict for Merck's AIDS drug efavirenz and the heart disease medicine Plavix, made by Bristol-Myers Squibb and Sanofi-Aventis.

And it's not that I don't understand or respect these companies' right to protect their intellectual property. Patents do encourage innovation and companies deserve a return on their massive investments into developing drugs.

But surely this is not — cannot be — the only way to resolve this standoff?

Unfriendly haggling

The thing that kicked off this argument was, of course, money. According to Abbott's tiered price access, a year's supply of Kaletra costs $500 per patient per year in Africa and more than $4,000 in Thailand. Abbott offered to lower that figure to the bargain price of about $2,000, but the Thai government said that was still too high. A generic copy of the drug would cost less than half of that.

The lower price would have been effective only for Thailand's well-respected AIDS drug programme, which doles out medicines to more than 82,000 people who cannot afford them. Those who can afford the higher price would still have paid it.

The Thai government and Abbott had reportedly been trying for weeks to negotiate a lower price before Abbott made its decision. The government is apparently still willing to talk with the company to resolve the matter; negotiations may continue.

Abbott's decision won't affect drugs that are already being sold in Thailand, including an older version of Kaletra that is already available there. But the new version is heat-stable, something that is desperately needed in the country, where refrigeration is a rare luxury. Kaletra is an important drug for people who have already become resistant to first-line drugs, so this is no academic argument.

Exception to the rule

Technically, the step Thailand took in January is not a violation of World Trade Organization rules, which allow countries to make or buy cheap versions of expensive drugs when there is a 'public health emergency'. I should think AIDS qualifies, although Abbott is contesting this conclusion. The head of the World Health Organisation agrees that Thailand was well within its rights.

Three years ago, Malaysia and Indonesia also took advantage of that clause to issue licences for AIDS drugs. But by threatening to go after drugs for heart disease, cancer and other serious illnesses, it looks like Thailand has made pharma companies angry. The result is a very bitter fight.

On one side are activists and the humanitarian organization Médecins Sans Frontières (Doctors without Borders) who are condemning Abbott's move as "appalling" and "a betrayal to patients". On the other side, of course, are pharmaceutical companies. German company Bayer has already come out in support of Abbott.

After Abbott made its announcement, an editorial in the Wall Street Journal, known for its business-friendly stances, said that "In the long run, Abbott's withdrawal may have a salutary impact if it demonstrates to Thai officials and other governments that they will pay a price for stealing intellectual property".

But let's face it, the real price here will be paid not by the officials or the government but by the Thai citizens who badly need these drugs. And I still say there's no reason good enough to make them pay it.

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