The first shipment of 1.2 million generic Clopidogrel tablets from India has arrived in Thailand on 18th June 2008, which has improved the lives of thousands of poor patients who are suffering from chronic cardiovascular diseases (CVD), such as stroke and heart diseases.
The heart-disease and stroke patients, who are entitled to the health benefit packages under the three health insurance systems (the Universal Coverage Scheme, the Social Security Scheme and the Civil Servant Medical Benefit Scheme), are about to receive generic Clopidogrel for free.
The World Health Organization estimates that 80% of all deaths from non-communicable diseases in developing countries today. Cardiovascular diseases (CVD), a serious non-communicable disease, are now one of the leading causes of global morbidity and mortality, with over 16.7 million people dying of CVD in 2002. 80% of deaths from CVD occur in developing countries today.
CVD is now the primary cause of morbidity and mortality in Thailand. The government estimates that approximately 83,000 Thais died of CVD in 2002; by contrast, due to universal treatment with highly potent fixed dose combinations, 21,000 people died of AIDS in 2006.
Previously the Thai government was unable to supply Plavix, the patented brand-name Clopidogrel, to its patients in the state hospitals. This was due to the high price of the medicine. Previously, aspirin was the only medicine available at that time, and a large number of patients had to tolerate unpleasant side-effects or did not respond to the medication. Hence, patients only had the choice to pay out of their own pocket for the pricey live-saving drug by spending their savings or reducing other daily-life expenses of their families. In some cases, they could not afford the medicine at all, and thus had to either skip or take only partial doses of the medicine.
Since November 2006, the Thai Public Health Ministry has issued seven non-commercial government-use (compulsory) licenses for medicines to treat HIV and AIDS, cardiovascular diseases and cancers. Government-use licenses permit governments to override patents to either produce or import affordable, generic versions of medicines that are required to address a country’s public health needs.
The price comparisons below between generic and patented medicines to treat AIDS and cardiovascular diseases demonstrate the effectiveness of compulsory licensing.
Unfortunately, it took more than one year before Thailand successfully imported generic version of Clopidogrel from India. The government issued the compulsory license in January 2007. The patent-owner drug company offered to reduce the price since then. The latest price the firm offered is still far more expensive than the generic version. In the meantime, the company also sent at least two letters to the potential Indian generic-drug manufacturers, warning that it would take legal actions if the Indian firms supplied Clopidogrel to Thailand.
Thailand is one of the first developing countries that has courageously issued compulsory licenses to resolve the lack of affordable antiretroviral medicines. It also took the unprecedented step of using non-commercial government-use licenses to reduce the price of medicines to treat non-communicable diseases, like CVD and cancers, which are now a severe global health threat. Above all, Thailand has used compulsory licensing on non-communicable disease medicines to address a severe public health threat; it has also helped to redress the myth, created by the pharmaceutical industry, that compulsory licensing is merely intended for public-interest infectious illnesses, like AIDS and avian influenza. However, Thailand has tolerated heavy pressures from powerful nations and giant drug companies, which has tried to force the country to give up the legal and rightful measure to protect health and save the lives of its poor people.
Click here for a briefing note on “Legal and Public Health Rationales for the Issuance of a Compulsory Licenses for Plavix (Clopidogrel) in Thailand”: clopidogrel-breifing-note.pdf