Monday, January 12, 2009

Thailand's battle to provide for HIV patients

Sometimes good things happen under military appointed regimes. Take the case of Dr. Mongkol Na Songkhla (a minor royal here in Thailand). After the 2006 coup that took out the elected government of Thaksin Shinawatra, the Thai coup leaders installed a civilian government. No one really expected Dr. Mongkol to make many waves. He was, after all about as "establishment" as they come. He was a retired civil servant, a royal and was appointed as Minister of Health in a regime full of old time royalists and bureaucrats dubbed by the Thai media as the "Old Ginger" cabinet for it's "seasoned, staunchly conservative members, many of them unschooled in modern politics" (Simon Montlake: Thailand's IP Gamble).

A seat-warmer Dr. Mongkol would soon prove to not be. Not only did he preserve Thaksin's 30 baht (about a dollar) healthcare system for the poor, but he actually made it entirely free. Not ony did he do that, but he also fought for more funding for the program (though some of it was later removed). And, not only did he do those things but he also did something far more controversial.

Dr. Mongkol in November of 2006 ( I think) sent a letter to the Thai branch of Merck & Co. to tell them that their HIV drug, Efavirenz is "highly effective" but costs too much for Thailand to afford, so Thailand would break the patent and begin buying generic varieties produced in India. With this one letter, Dr. Mongkol began "war over the use of compulsory licenses" (Montlake).

According to the WTO, only 28% of the world's 7.1 million (as of 2006) HIV infected people in low and middle income countries are able to get the antiretroviral drugs that they so desperately need. Thailand is unusual in that everyone who needs them, gets them...for free. The number of Thais on antiretroviral medication was at 100,000 in 2006 (sorry that I don't have any more recent numbers...I'll look around in the next few days to see if I can find some figures for last year) and the number is expected to increase as more people become ill from HIV.

The problem that Dr. Mongkol took on was that the bill for these drugs was so high that at some point it might have become impossible to provide all of the medication required by the infected. first-line antiretrovirals such as Efavirenz are expensive but as time passes HIV infected patients may require second-line (and highly expensive) medications such as Kaletra. The latter, sold by Abbott's negotiated a deal to provide a year's worth of medication for Thai patients at the discounted price of $1,000 per year.

According to Simon Montlakes article, The World Bank has already concluded that Thailand's provision of antiretrovirals has had a positive economic impact as breadwinners are able to keep providing for their families for much, much longer while doing so more productively.
Importance of treatment

Without treatment, 9 out of 10 infected people survive for 10-15 years. With optimal treatment, that number balloons to 32 years. So, yes HIV research has had amazing results and it is realistic to expect a cure. It is also clearly important, economically speaking, to provide these antiretrovirals.

Going beyond what is simply economic, we should also think about the human side of this. The suffering that HIV infected people endure is high. They are often socially isolated, depressed and too sick to look after their families. The progression to full blown AIDS can sometimes happen very quickly (without proper treatment) and, well you only have to do a quick web search to see how these people live.

Those with HIV here in Thailand should be thankful that Dr. Mongkol Na Songkta didn't think of himself as just an interim Minister, but instead took action that will help ensure that everyone who needs these pills is able to get them.

For me, this is personal. I have a number of friends who are HIV positive and at least they know that they can get the medication that they need. For just a moment, try to imagine going for a test and finding out you are HIV positive. Just picture yourself suddenly finding that out. Think of your families, think of your friends, think of the people you've had sex with. Now imagine finding this out and also knowing that you have absolutely no financial means and that you have a family that will starve if you can't go out and earn money. Imagine that you have no means to buy these pills that will keep your family from starving and that you might only have a few years before you can no longer work. What do you do? Where do you go? Who do you turn to? In many countries, you have no one to turn to. You have no help. So, for countries that do provide this help, they are indeed doing something really admirable.

Sometimes good things do happen from military appointed regimes.

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