MORE COMPULSORY LICENSES LIKELY FOR THAILAND

UNCLAS SECTION 01 OF 03 BANGKOK 000527 SIPDIS SENSITIVE SIPDIS STATE PASS USTR FOR B. WEISEL, C. WILSON STATE PASS USPTO HHS/OHGA FOR AMAR BHAT, ERIKA ELVANDER USDOC FOR JKELLY E.O. 12958:N/A TAGS: ECON ETRD KIPR TH SUBJECT: MORE COMPULSORY LICENSES LIKELY FOR THAILAND REF: SECSTATE 9256 ¶1. (SBU) Summary: The Minister of Public Health announced his intention to issue further compulsory licenses next week for HIV/AIDS medicines and heart medicine. Similar to its earlier compulsory license on another HIV drug last November, the Ministry did not discuss or negotiate with patent holders before making the announcement. Local industry is disturbed that the Ministry is considering licensing not only AIDS drugs but is moving toward breaking patents on other, more profitable therapeutic medicines and is considering changes in their investments in Thailand. End Summary. ¶2. (SBU) On January 24, Minister of Public Health Mongkol na Songkhla announced to the press his Ministry's intention to issue compulsory licenses on three patented drugs, two for HIV treatment and another for heart disease. The Minister withheld further details until an official announcement could be made on Monday, January 29. The Minister's statement follows on the compulsory license announced last November for efavirenz, an HIV medicine patented by U.S.-based pharmaceutical company Merck & Co. Although Mongkol did not identify the drugs to be licensed in this round, we understand they will be Kaletra, an antiretroviral produced by U.S.-based Abbott Labs, and one of its component drugs, probably ritonavir; and Plavix, a heart medicine produced jointly by French firm Sanofi-Aventis and U.S.-based Bristol Myers Squibb (but distributed by Sanofi Aventis in Thailand). The RTG was also reportedly considering Pfizer's anti-cholesterol statin Lipitor, but is now looking into similar drugs that are already off patent as an alternative to breaking patents. ¶3. (SBU) The RTG intention to compulsory license Kaletra was unsurprising, health activists in and out of the government have long expressed a desire to find a cheaper version of this expensive second-line antiretroviral. The RTG has committed to expand treatment to more HIV/AIDS patients and as a percentage of those patients inevitably develop resistance to first-line generic regimens, there will be both an increasing number and proportion of patients who require second-line drugs such as Kaletra. Health officials have long expressed their fears that the commitment to 
treatment will stretch health budgets and possibly place at risk the financial situation of the entire universal health coverage system. ¶4. (SBU) Entry into other therapeutic medicines such as the heart medicine Plavix opens a new front. Reportedly, an interagency committee on compulsory licenses met January 8 and developed a target list of drugs in four disease categories for potential future compulsory licenses. In addition to cardiovascular drugs Lipitor and Plavix and the HIV drug Kaletra, the committee listed four cancer drugs and two antibiotics. The committee recommended Kaletra and Plavix be next in line to be licensed, but it is unclear what timeline the others may follow. ¶5. (SBU) According to one member of the compulsory license committee, the Ministry of Public Health (MoPH) will follow a similar procedure to that done with efavirenz. The Department of Disease Control will issue the license for Kaletra, while the Department of Medical Services will handle the process for Plavix. Both agencies have been instructed to send official letters of notification to the Department of Intellectual Property and to the patent holder once the compulsory license has been officially announced. The committee does not believe cabinet approval is necessary for this round of compulsory licenses and it does not appear to have been discussed at that level. ACTIVIST OFFICIALS DRIVING MORE CL'S -------------- ¶6. (SBU) The step to issue compulsory licenses is increasingly seen as a populist move by the military-installed government. In a new government that is still feeling its way on how to govern, Mongkol is an activist Minister who has seen an opportunity to make a bold step forward in improving access to medicine with little opposition from other parts of the government. A relatively small group of people is driving the compulsory licenses. Dr. Sanguan Nitayaramphong, Secretary General of the National Health Security Office which manages the universal health care program and chairman of the interagency committee on compulsory licenses, apparently began the process of identifying which drugs to consider for compulsory licenses. However, the main actor behind the process is considered to be Dr. Suwit Wibulpolprasert, Special Advisor on Health Economics at the MoPH. Suwit had been an opponent of BANGKOK 00000527 002 OF 003 pharmaceutical provisions in the proposed US-Thai FTA. Dr. Suwit also this week spoke before a WHO Executive Board meeting in Geneva railing against pharmaceutical firms that use virus samples from Thailand to produce vaccines, but sell it back at unfair prices, saying "when the pandemic occurs, they survive and we die". HHS is reportedly drafting a strong response. ¶7. (SBU) The expected spiraling financial outlays for HIV treatment and other medical care is an obvious motive for proceeding ahead with compulsory licenses, but less clear is why the MoPH has declined to negotiate or seriously discuss with pharmaceutical firms before issuing the licenses. Dr. Sanguan and Dr. Suwit have each said privately and publicly that they had undertaken negotiations with the pharmaceutical firms and had made little progress, thus necessitating moving forward with the licenses. The pharmaceutical firms, on the other hand, insist they never entered into any formal negotiations or discussions, though they have not publicly challenged the RTG on this point. An executive VP of Sanofi-Aventis reportedly met with Minister Mongkol yesterday and offered to discuss prices on their antiplatelet agent Plavix, but asked that a CL not be issued as it would compromise their ability to negotiate later. The Minister responded positively, but nevertheless notified the press only hours later that the license would go ahead (the Minister reportedly told Sanofi today he had not made the statement and that there had been a leak, but somehow most Bangkok papers sourced the information directly to him). The local office of Abbott Labs has requested a meeting with the Minister as well, but the request was pushed down to the Department of Disease Control whom they will meet on Friday. ¶8. (SBU) The local industry pharmaceutical association, Prema, is reacting strongly to the move to issue licenses for not just HIV/AIDS drugs but other therapeutic medicines. Prema issued a strongly worded press release today that expressed their alarm and suggested that a number of major firms will be reexamining their investment strategies in Thailand. The statement aims to raise concerns over the already battered investment climate in Thailand. ¶9. (SBU) Ambassador Boyce lunched with PM Surayut on Wednesday and brought up the compulsory license issue, noting that consultation with affected firms was important for transparency. Surayut appeared to be familiar with the issue and while not offering comment on it said he would bring it up with the Minister of Public Health. The Ambassador also brought up the issue in his meeting today with Foreign Minister Nitya (reported septel). Update on individual CLs -------------- ¶10. (SBU) Merck has heard that MoPH has ordered 66,000 bottles of a generic version of their drug efavirenz from Indian generic Ranbaxy, and that the first shipment should be arriving the second week of February. The Government Pharmaceutical Organization (GPO) apparently was able to procure the generic for 700 baht per bottle (a one-month supply),approximately 180 baht less than Merck had been able to offer. Thai FDA has approved the 200 mg version of generic efavirenz and will soon approve the more common 600 mg version. Merck believes they are still in discussions with the RTG and may be able to present further price reductions. ¶11. (SBU) Abbott Labs has heard that the RTG is considering importing generic versions of its antiretroviral Kaletra from either Indian generic Cipla or Hetero. Abbott does not believe that the WHO has qualified the generic from either company. Abbott also expects to complete the registration process in March for a new heat-stable version of the drug which does not require refrigeration. The new version has a reduced pill count (4 instead of 6 per day) and no dietary restrictions. Abbott is uncertain whether a CL on Kaletra would cover its new version as well, but noted that no generic companies have yet to produce the new version. ¶12. (SBU) Comment: Although we have been critical of the process the RTG has followed on issuing compulsory licenses, providing cheap antiretrovirals to poor AIDS patients is certainly a worthy goal. However, we and industry are concerned that a new front has opened and Thailand now seems to be moving to break patents on drugs simply because they are highly priced, and not necessarily for diseases that afflict the poor. Embassy would appreciate any guidance on whether compulsory licenses on drugs not intended to treat pandemic diseases are treated differently under WTO TRIPS regulations. We would also appreciate any guidance on whether points provided in BANGKOK 00000527 003 OF 003 reftel have changed given today's new information. BOYCE