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2007-04-26

AIDS Activists Call for Global Boycott of Abbott for Withholding Drug Sales in Thailand

Guests

Jon Ungphakorn, longtime HIV/AIDS activist and former Thai senator. He is the executive secretary of the AIDS Access Foundation and has been at the forefront of the civil society movement in Thailand to increase access to affordable medicines and improve public health.

Dr. Joia Mukherjee, medical director of Partners in Health and assistant professor at Harvard Medical School. She has overseen HIV/AIDS treatment programs in Haiti and in Rwanda.

Anuja Singh, student at Columbia University and member of the Student Global AIDS Campaign.

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AIDS activists from around the globe are converging in Illinois on Friday to protest outside the annual shareholders meeting of the pharmaceutical company Abbott Laboratories. Abbott manufactures several leading AIDS drugs but has been embroiled in controversy over its actions in Thailand, where it moved to withhold medicines from the country over a commercial dispute. [includes rush transcript]

Transcript

This is a rush transcript. Copy may not be in its final form.

JUAN GONZALEZ: AIDS activists from around the United States and the world are converging in Illinois on Friday to protest outside the annual shareholders meeting of the pharmaceutical company Abbott Laboratories.

Abbott manufactures several leading AIDS drugs but has been embroiled in controversy over its actions in Thailand. Earlier this year the Thai government announced that it would break Abbott’s patent on the AIDS drug Kaletra and begin importing or producing cheaper, generic copies of the drug.

Under international trade law, countries can issue what’s known as compulsory licenses to manufacture or import generic drugs. This can be done without the consent of the foreign patent owner if the country deems it necessary to protect the health and welfare of its citizens.

AMY GOODMAN: Abbott responded in a way that shocked many AIDS activists: The company announced it would withhold seven new drugs from sale in Thailand, including a new AIDS drug and treatments for arthritis and high blood pressure. Activists said it was unprecedented for a drug company to withhold medicines from a country over a commercial dispute.

The fight between the Thai government and Abbott has been closely watched by AIDS activists and the international medical community. After coming under intense pressure, Abbott appears to be backing down on some of its original threats, but only if Thailand agrees not to break the drug patents.

A longtime HIV/AIDS activist from Thailand joins us today from Boston. Jon Ungphakorn is a former senator in Thailand and now serves as the executive secretary of the AIDS Access Foundation in Bangkok. He has been at the forefront of the civil society movement in Thailand to increase access to affordable medicines and improve public health. He is planning to attend the Abbott shareholders meeting on Friday in Chicago. We’re also joined by Dr. Joia Mukherjee. She is the medical director of Partners in Health and an assistant professor at Harvard Medical School. She has overseen HIV/AIDS treatment programs in Haiti and Rwanda. Anuja Singh is also with us. She’s here in New York at our firehouse studio, a student activist at Columbia University and a member of the Student Global AIDS Campaign.

Why don’t we begin with Jon Ungphakorn? You are a former senator from Thailand. You have just flown into the United States. Explain why you’re here.

JON UNGPHAKORN: I’m here with the chairman of our national network of people living with HIV/AIDS to campaign first for support for the compulsory license that was carried out by the Thai government. By the way, that’s not called breaking patents. Compulsory licensing is perfectly legal measure according to the World Trade Organization. And the United States and developed countries regularly use compulsory licensing. So there’s a lot of misinformation going out about the compulsory licensing in Thailand.

We are here to campaign for support for the compulsory licensing by Thailand, which gives access to people living with HIV/AIDS in Thailand there — half a million people — to the most important drugs that can save their lives. And we are also here to protest against the action of Abbott of withdrawing important drugs from the market in Thailand.

And what Abbott is doing is, in fact, blackmail. It’s using patients who need important drugs as hostages, and Abbott is trying to make countries of the developing world afraid to use the legal measures that they can use to bring the prices of the drugs that are needed down so that the patients can get the drugs, because Abbott wants to protect its interests and keep the prices of its drugs at a high level, which means that most people in the developing world won’t be able to afford those drugs. So, what Abbott is doing is, in fact, blackmailing the whole developing world, not just Thailand.

And we are here to protest and to ask for support in our struggle against Abbott and to support compulsory licensing in the developing world, so that the people who need the drugs can live, instead of die. That’s what we’re here for.

JUAN GONZALEZ: Well, could you tell us a little bit about the negotiations that had been going on previously? We understand that for the past four years the Thai government has been trying to get Abbott to reduce prices on some of these drugs, and this latest move of theirs to offer to reduce some prices, but in exchange for recognition or maintaining of its — what it calls its patent rights?

JON UNGPHAKORN: OK. Can I say first that in Thailand we have had a long struggle by the civil society activists and people living with HIV/AIDS. Since 1998, we have struggled for access to care, treatment and essential drugs. We fought for compulsory licensing of ddI in 1999, but were unsuccessful. We then managed to get the Government Pharmaceutical Organization in Thailand to produce the generics at low prices. Then we fought for universal health insurance in Thailand, and that was achieved in the year 2001, meaning that everyone in Thailand can get treatment. But the treatment at first didn’t cover the antiretrovirals.

We then fought for universal access to antiretrovirals, the first-line antiretrovirals, which we achieved in the year 2006. But now we have 120,000 people living with AIDS getting the first-line antiretrovirals, and the death rate has dropped by over 70 percent in Thailand now among people with AIDS. They look forward to a bright future. But now more and more of them will need the second-line antiretrovirals, which are the more expensive patented drugs. And the Thai Health Security Office, which is the office that looks after our universal health program, has been negotiating with drug companies since — for the past four years to get the prices down.

There have been some achievements, only very slight. For example, Merck reduced the price of Efavirenz, which is the first drug that Thailand carried out compulsory licensing for. They reduced the price by 18 percent. But at the same time, the Thai currency rose in value by 13 percent, so in dollar terms it was a very small reduction. After the compulsory licensing was issued, Merck reduced the price another nearly 40 percent, which shows that compulsory licensing is successful in bringing the price down. The same goes —

AMY GOODMAN: We’re going to break for a minute, and then we’re going to come back to this discussion. We’re talking with the former Thai senator, Jon Ungphakorn. He has just come into the United States from Thailand. And then we’ll be joined by the head of Partners for Health and a Columbia University student to talk about why they’re so involved with this issue, as they all deal on this day before the Abbott shareholder meeting. Stay with us.

[break]

AMY GOODMAN: Our guests are Jon Ungphakorn, a longtime HIV/AIDS activist, former senator from Thailand, just into the United States on this eve of the Abbott shareholders meeting. Anuja Singh is with us in New York. She’s a student at Columbia University. And we’re also joined by Dr. Joia Mukherjee, who is medical director for Partners in Health.

Dr. Mukherjee, can you explain compulsory licensing?

DR. JOIA MUKHERJEE: Yes, I can. The concept of compulsory licensing — and I really want to emphasize what Jon said — is, this is not about breaking a patent. It’s very important that the media not keep using this term "breaking the patent." For each country that signs onto the WTO, part of the language is something called TRIPS, the trade-related aspects of intellectual property. Within that language, governments agree to respect a patent with the caveats that in the setting of a national emergency they can either issue a compulsory license, saying they will make the drug themselves — usually this is for a price benefit — or they can do parallel importing, saying bringing in a generic version. The government signs onto the WTO with that protection. So when Thailand issues a compulsory licensing, they are going to make that product, even though there is a patent. That’s not breaking the patent. That’s exercising part of the TRIPS language. So the compulsory language said that Thailand, their government, will — for government use in the public sector — they will be producing that product generically.

The other, like I said, stipulation is parallel importing. And interestingly, in the United States after the terrible tragedy of 9/11, we said that — in fact, our President Bush said that we would issue — we would parallel import the generic version of Ciprofloxacin for the anthrax epidemic and the anthrax problem that we had, which killed only six people. So governments often exercise these parallel importing and compulsory licensing in the setting of what people consider national emergency. Now, if we considered six cases of anthrax a national emergency, of course a country like Thailand or places that I work, like Haiti and Lisutu, Rwanda, Malawi, would consider the hundreds of thousands of people in desperate need of antiretrovirals a national emergency and certainly a fitting setting to invoke a parallel importing or compulsory licensing. So that is all that Thailand is doing.

Thailand, South Africa, India, Brazil are in unique situations for poor countries with AIDS, because they have a pharmaceutical industry. And so, this is extremely important to the countries where I work, like Haiti and Rwanda and Malawi, which do not have pharmaceutical industries, and so we rely on invoking the TRIPS legislation to do parallel importing of generic products that are made in countries that are able to produce them. So Thailand was issuing a compulsory license, not for export, only for national use, government use, which is fully allowable under the WTO.

JUAN GONZALEZ: Well, Doctor, what about the argument of Abbott and some of the other drug makers that the invoking of that right under the WTO was meant largely for pandemics or immediate emergencies, and not for long-term, even though they are huge medical problems like AIDS?

DR. JOIA MUKHERJEE: Well, I think you would be hard-pressed to find any person that does not consider AIDS a pandemic. I mean, a pandemic is something that affects the entire world and at higher rates than we ever expected, and certainly AIDS is a pandemic. And, you know, for people living with AIDS in any country, whether it’s Thailand, where the percentage is lower than, say, South Africa, it’s still at epidemic proportions. So I think it would be very hard to say that AIDS is not a pandemic.

And, in fact, we were successful — we, the people who care about AIDS, people who are living with AIDS and the activists about AIDS, were successful in Doha, Qatar, in really enforcing this TRIPS language, precisely because the United States had said we have a national emergency here with our few handful of cases of anthrax. So I think every country, as part of our national sovereignty, gets to decide what is an emergency situation and what is a pandemic situation. And so, you know, I think that they are wrong-headed, that this is part of national sovereignty, and countries like Brazil and Thailand that have taken a progressive approach to producing drugs for their people have actually been able to decrease, as Jon said, mortality significantly by producing drugs and using the possibility of a compulsory license as a negotiating strategy.

AMY GOODMAN: We invited Abbott Laboratories to join us on the program; they declined our offer. But the Abbott spokesperson Jennifer Smoter issued the following comment: She said that Abbott’s Liponavir/Ritonavir is priced lower than any generic in the world, including Thailand. She said it’s also the only version that’s proven quality via WHO precertification. There are no generics with this standing. She said the compulsory license action and subsequent statements by the Thai minister of health show they have chosen to provide generics to Thai patients with no intent to purchase the medicine. She says, why does anyone care if Abbott resubmits the application? And she says if the activists’ intent is protecting patients, when today the Thai government can have the lowest price for the highest quality new Liponavir/Ritonavir tablets, why are activists protesting Abbott?

JON UNGPHAKORN: Can I comment on that?

AMY GOODMAN: Yes, go ahead.

JON UNGPHAKORN: That’s completely misleading. Thailand has bought at least 18,000 bottles of Kaletra, which is not the heat-stable — it’s the soft-gel form of Liponavir and Ritonavir — and has spent a lot of money on it. The compulsory license is to allow Thailand now to get it at a much cheaper price. And Abbott was selling it at well over $2,000 U.S. dollars per patient per year, prior to the compulsory license. It’s only after Thailand issued the compulsory license that Abbott has brought down the price to $1,000 for middle-income countries and $500 for low-income countries. The generics now are for — companies are offering it to Thailand for $600 per patient per year. It’s Thailand’s compulsory license that has made Abbott have to bring down their price. Before the compulsory license, Abbott never agreed to bring the price down that far. So what she’s saying is completely misleading.

Not only that, but Abbott has actually withdrawn the registration of Aluvia, the heat-stable form, which is needed in countries with hot climates, like Thailand. So Abbott has brought down the price, but they are not allowing Thailand to get the best form of the drug, Kaletra. So what she is stating is completely misleading.

DR. JOIA MUKHERJEE: And can I add that it’s cynical in its wording?

AMY GOODMAN: Dr. Mukherjee, yes.

DR. JOIA MUKHERJEE: Yes. It’s cynical in its wording. I mean, what she’s saying is, today they could get the best price today and that no generic is prequalified. Well, this is precisely because of the barriers that these companies are putting up to people using compulsory licensing. So, I mean, what we have to look at with the AIDS pandemic is the long term, as Juan mentioned. This is not a disease that we only think about today. We think about five years and 10 years. And when generics came into the market for antiretrovirals, for first-line antiretrovirals, the price dropped 100-fold. I mean, this kind of price drop in just five years has allowed us in Haiti, for example, to scale up from 75 patients to 5,000 over the two projects, Partners in Health and GHESKIO. So, you know, without the generic competition, without generics coming onto the market, today is not meaningful to us. Five years, 10 years, 20 years, that’s how long we expect people to live with HIV and live well.

JUAN GONZALEZ: And, Dr. Mukherjee, how important is this particular battle now with Abbott and Thailand? Our understanding is, for instance, other nations — the Philippines, Indonesia — are also considering, watching this particular battle in deciding their policies, in terms of some of these generic drugs. Could you put this battle in the context worldwide?

DR. JOIA MUKHERJEE: It’s extremely important. It’s extremely important, and I thank so much Jon and the other Thai network of solidarity. It’s extremely important for countries that have the possibility of manufacturing these drugs, like Brazil, like South Africa and some of the countries you mentioned, the Philippines and Indonesia, and it’s also extremely important for those of us who are struggling in countries that will never be able to make these drugs, but will rely on generic formulations.

So, you know, we have to say that companies that produce drugs, there is part of their work that is service. And if you’re making widgets, perhaps you don’t have to bring your price down on widgets for compassionate use. But on the other hand, you know, these companies are making enormous profits, and, you know, as long as rich people have these diseases, the profits will exist for these companies, and we have to really think about poor people who are really suffering and will die without access to these drugs.

AMY GOODMAN: I want to bring into the conversation Anuja Singh. This weekend, I was in Chicago, and I met with a number of medical students in Chicago from many of the different medical schools there. It was this group that brought my attention to this struggle, and they’re very active on this issue. Anuja Singh is a student at Columbia University and a member of the Student Global AIDS Campaign. Why is this an issue that medical students, that — well, you’re not a medical student, you’re a university student, Columbia undergrad — why is this an issue that you have taken on?

ANUJA SINGH: I think this issue is one that appeals to students all across the United States that, to a large degree, aren’t directly affected by the disease and, because the disease so largely affects people in the Global South, may not even know that many people who are directly affected by the disease, but the issues of a common humanity, of solidarity with people around the world, are so strong that it really does compel people to act.

Abbott is a company that has been making, in the last few years, over 50 percent profit. It is not a company that cannot go on without, you know, having people in Thailand, in Guatemala, in these middle-income countries, have access to these medications. As Dr. Mukherjee said, this is an issue of essential medications. When medications are available for pennies and we do not value lives over those pennies, that is an issue for huge action, and I think students have really mobilized around this. I think also the idea that AIDS affects people who are the most disempowered — it affects people who are in the Global South, who are politically disempowered, economically disempowered, socially disempowered, and affects women so much more than men — all of these come together in AIDS and really works on the vulnerabilities that people feel. And that really has compelled me and, I think, a lot of people to take action on this issue.

JUAN GONZALEZ: And on campus, what specifically have you been involved in or doing, and what will you be doing over the next few weeks, in terms of this campaign?

ANUJA SINGH: Over the last year or so, as the Abbott campaign has developed with SGAC, it’s been part of a larger treatment access campaign. Abbott has been one of our key targets because of its policies, which have been historic. It’s been with Kaletra and also in the past. And we started off in the very beginning with faxes, with emails, with online petitions, with really those grassroots mobilizing tools that have been very successful in getting the attention of Abbott and showing them that there is a constituency, internationally and in the United States, that does care about their policies and is willing to act.

And today, as well as in — with the shareholders meeting tomorrow, there’s going to be actions on campuses throughout the country, based on the idea of the crime scene, with the idea that Abbott’s actions are actually criminal against the people of Thailand, and they need to be stopped. There’s going to be calls made to people that are leaders in Abbott, encouraging them to consider the actions that they’re taking and to improve their policies so that they don’t put pennies over the lives of the people.

In addition to the actions that are going on on campuses, there’s going to be actions taking place at Abbott facilities. For example, in Worcester, Massachusetts, there’s going to be a coalition of the American Medical Students Association, the Student Global AIDS Campaign, people living with AIDS, and the Thai activists are going to be joining them, in going to the Abbott facilities there and presenting them with a prescription for Kaletra in Thailand. Since they’re not getting it in Thailand, the idea is, maybe if they give this prescription to the people in Abbott, where they’re actually manufacturing it, they’ll maybe have some sympathy and provide these medications.

AMY GOODMAN: Yesterday, this report from Associated Press: Brazil said that it is going to strip — let’s see — Brazil says it’s going to strip the patent on an anti-AIDS drug produced by Merck Corporation. Do you think these kind of actions are leading to effects beyond Abbott?

ANUJA SINGH: I think that when —

AMY GOODMAN: If the company, I should say, doesn’t offer Latin America’s largest country a deeper discount.

ANUJA SINGH: Yeah, I think these — as was mentioned previously, the role of compulsory licenses is crucial here, and if they don’t offer the lower prices, that’s going to affect hundreds of thousands of people. But, as was mentioned previously, the compulsory license, in itself, is a really important right that countries have and has the power, in itself, to bring down the prices far beyond what the companies are often willing to do. There’s a marginal cost of production that’s so much lower than what the companies are willing often to offer. And because the markets are so largely in Europe and the United States and some other highly developed countries, this often does not make sense, so the ability to do a compulsory license and really bring down the price significantly is very important.

AMY GOODMAN: When did you start your activism, Anuja?

ANUJA SINGH: I started a little bit before my freshman year in college.

AMY GOODMAN: Why on this issue?

ANUJA SINGH: This issue really appeals to me, because I really think that it acts on a nexus of vulnerabilities and really acts on those who are most disempowered in a way that is just appalling. And it also appeals to me because I really think we do have the tools to address it and — because of things like profits with corporations and not having the proper prevention techniques, we’re simply not doing it — because the tools are so available and the injustices are so stark. I think that’s what brought me into this.

JUAN GONZALEZ: Have you approached yet the whole issue of the —- Columbia University obviously has a huge investment portfolio -—

ANUJA SINGH: Yes.

JUAN GONZALEZ: I’m sure they have quite a bit of Abbott investment, as well. Have you approached the issue of the university’s investment policies?

ANUJA SINGH: Definitely. Definitely, actually. The university has a meeting every year on socially responsible investing, and the Columbia chapter of the Student Global AIDS Campaign has regularly attended that and made a statement on the university’s investment policies, specifically regarding its pharmaceutical investments.

AMY GOODMAN: Well, we’re going to leave it there. I want to thank you very much, Anuja Singh, for being with us, as well as our guests in Boston, Jon Ungphakorn, as well as Dr. Joia Mukherjee of Partners in Health. We’ll continue to follow this issue and see what happens at the shareholders meeting, the Abbott shareholders meeting tomorrow in Chicago.

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