Developing nations must cooperate to access life-saving drugs

Access to life-saving drugs is among the crucial issues on the agenda at next week's World Trade Organization (WTO) conference in Cancun, Mexico. The Jakarta Post's contributor Debbie A. Lubis talked to Samsuridjal Djauzi on the issue on the sidelines of the recent Yogyakarta Roundtable Meeting, which highlighted the efforts of developing countries to improve access to antiretroviral (ARV) therapy for people living with AIDS (Acquired Immune Deficiency Syndrome). Dr. Samsuridjal is with the Working Group on AIDS at the School of Medicine, University of Indonesia. The following are excerpts of the interview:

Question: What can be expected from next week's WTO ministerial meeting regarding access to generic drugs in developing countries, especially ARV drugs?

Answer: It has been two years since the 2001 WTO Ministerial Conference in Doha, Qatar, recognized the primacy of public health over commercial interests. Patent rights should not be a barrier for providing drugs for diseases that have a tremendous impact on public health, such as tuberculosis (TB), malaria and AIDS. The settlement on the TRIPS (Trade-Related Intellectual Property Rights) should have been implemented one year after that, but it has not been achieved so far.

Sometimes there is exciting news from such negotiations, but there are always deadlocks. People, especially in developing countries, hope that Cancun can overcome protectionist barriers to the exportation of generic drugs, especially life-saving ones.

Indeed, we should appreciate patent rights, which is needed to carry out research on new drugs, but it is impossible to impose the same treatment for all kinds of illnesses or drugs, particularly in regards TB, malaria and AIDS.

But we cannot depend on the result of the meeting, since it is not possible for developing countries, especially Indonesia, to wait for a fair decision established by international regulations. The longer we wait, the more lives will be lost.

The most important thing for Indonesia is the availability and sustainability of ARV drugs that are adequate and affordable. Currently, only 1,000 PLWHA (People Living With HIV/AIDS) have access to imported generic ARV drugs. Although not all of the estimated 120,000 to 130,000 PLWHA need the drugs, there are still many who cannot afford the monthly supply at Rp 650,000 (US$76.47).

Importing drugs does not guarantee their sustainability. India, a producer of generic ARV drugs, does not only receive demands from Indonesia but also from other developing countries. Besides, the drugs sometimes face obstacles in entering the country, while the price is still high.

We need to produce the drugs locally so that thousands of lives can be saved.

What kind of people should comprise the Indonesian delegation to the WTO conference?

Most importantly, our team should consist of people concerned about this issue, because there are still many who perceive that HIV/AIDS therapy is not a priority. The team should also comprise people that can convince others with reasonable arguments.

Our team should also join hands with representatives from other developing countries. They will be heard if they stand together.

But we should also take the initiative ourselves, because we will one day face a dilemma as to whether we should obey international rules or cater to internal demands.

Health professionals will surely prioritize patients' interests above political, economic and other interests.

Actually, TRIPS regulations are not too stiff because there are some safeguards that the country can use. The opportunity to increase our access to life-saving drugs will arise only if our Copyright Law provides the necessary space. Yet this issue does not only involve doctors, but also lawyers and legislators.

What else can be done by developing countries to save lives?

Developing countries that are located close to each other can establish a network and cooperate with each other to increase access to HIV/AIDS therapy. For example, Cambodia with Thailand and Laos, or Indonesia with East Timor and Papua New Guinea.

It would be a pity if Thailand could produce the drugs, but Laos and Cambodia cannot take advantage of them just because of international regulations and rules at the national level. Currently, facilitating and guaranteeing the smooth distribution of generic ARV drugs between countries to keep costs down depends on each government.

For example, PLWHA in Singapore must pay four times more than their counterparts in Malaysia for ARV therapy. This is not fair.

With such cooperation and networking, we could meet the target set by the World Health Organization -- that 600,000 people in the Asia-Pacific region should have access to HIV/AIDS therapy by 2005.

This year alone, Thailand has targeted to provide therapy to 23,000 people, while Indonesia hopes to reach 2,000. We are trying our best to obey international regulations, but if we have to choose between sacrificing our people and international regulations, we don't have any other choice but to stand behind the patient's interest.

What about cooperation and networking in the country itself?

We should overcome the problem of HIV/AIDS therapy together. Cooperation among the government, NGOs, academicians, PLWHA and pharmacies has led to many achievements. We fought for ARV drugs to be inserted in the essential drug list this year, but it was placed on the list last year. We also targeted to have ARV drugs produced locally this year, and state-run pharmaceutical company Kimia Farma is ready to market its ARV products next month.

Still, there are many problems. The price of ARV drugs is still high and the health care services for HIV/AIDS are still limited to 25 or 30 major cities. Even in big cities, not all hospitals or doctors are able to provide the needed service, especially in regards ARV therapy.

Such problems do not arise merely because of the unavailability of drugs, but also because of a lack of capable service providers. ...

Also, we need to lobby the legislature and other related institutions so that the health budget can be increased significantly. Currently, the Ministry of Health receives only 2 percent of the national budget. This makes it hard to sufficiently finance HIV/AIDS treatment and care, because there are still a great many public health problems before our eyes, like dengue fever, access to clean water ... the list goes on.