Bangkok Post - January 9, 2006
William L. Aldis**

Thai and US trade officials are now meeting in Chiang Mai for yet another round of negotiations in an effort to move closer to a bilateral free trade agreement (FTA) between the two countries. On the agenda this time is the complex and controversial issue of trade-related intellectual property rights (Trips) and implications for access to affordable life-saving medicines. Trying to understand the intricacies of these trade negotiations is enough to put most people to sleep. But appearances can deceive. Behind the technical jargon and closed-door negotiations is an eye-opening reality: at stake are the lives of hundreds of thousands of Thai citizens and the future of Thailand's much praised "30 baht" universal health-care scheme.

If the outcomes of other US bilateral trade negotiations are anything to go by, Thailand may well be in for a rough ride. Similar agreements have been signed with Australia, Chile, Morocco, Singapore, Bahrain and Central American countries, and all contain provisions that oblige these countries to tighten their intellectual property rights legislation well beyond internationally agreed standards. To the surprise of many observers, these countries have bargained away reasonable flexibilities and safeguards in the implementation of intellectual property rights provided by the World Trade Organisation. These safeguards ensure access to life-saving medicines at an affordable cost by permitting countries to produce or import less expensive versions of essential drugs.

Last month, a group of world-renowned experts from Argentina, India, France, Malaysia, Philippines, Switzerland, Thailand, the US and Venezuela assembled in Bangkok for a two-day consultation about these complex issues with Thai government officials, trade negotiators, academics and activists. The meeting was organised by the Thai Food and Drug Administration, the Department of Disease Control of the Ministry of Public Health, Chulalongkorn University, UNAids, UNDP and World Health Organisation.

These experts urged the Thai government not to give up its sovereign right to use, to the fullest extent, all available flexibilities contained in the Trips Agreement of the World Trade Organisation and reaffirmed by the Doha Declaration.

They declared that Thailand should not be obliged to accept any so-called "Trips-plus" provisions that have been inserted into other bilateral free trade agreements.

They suggested that Thailand should consider following the example of Malaysia and issue "compulsory licences" (permission to produce drugs locally) for second-generation HIV drugs, as allowed by the World Trade Organisation. This will ensure an affordable supply of HIV treatment for those patients that are inevitably developing resistance to the first generation treatment.

They also recommended that Thailand ensure transparency of the FTA negotiating process. Negotiating texts should be given to all relevant government agencies, civil society, private sector firms, consumers and other stakeholders, and all these groups should be consulted before any final agreements are concluded.

The stakes are indeed high, especially for the 600,000 Thais living with HIV/Aids and whose survival will depend on the availability of affordable anti-retroviral drugs.

As of today, more than 80,000 people have access to these life-prolonging treatments, thanks to the supply of cheap locally produced generic drugs, and the target is 150,000 by 2008. As a result, Aids deaths in Thailand have fallen by an extraordinary 79%.

The recent decision of the Thai government to include HIV treatment in the 30 baht health-care scheme is being praised the world over. It is also a tribute to Thailand's firm commitment to the human right to health care as enshrined in the Thai Constitution.

But this also means there is no turning back. As HIV-positive people inevitably develop resistance to first-generation drugs, the public health services will be morally and legally obliged to find ways to ensure access to second- and third-generation treatments to keep these people alive and healthy, whatever the cost.

This is why so many experts and activists are worried about the US-Thai FTA. Restrictive intellectual property rights will prevent Thailand from using locally produced affordable generic drugs and the price of second- and third-generation HIV drugs will remain exorbitantly expensive.

Depending on the rate at which patients become resistant to first generation HIV treatment and the rate of expansion of the programme, the cost of the government's HIV treatment programme may increase from a current US million (1.5 billion baht) to as much as 0 million (20 billion baht) a year within 10 years.

Add to this other diseases requiring long-term treatment and the accumulated financial strain on the national health budget would be untenable.

Giving up internationally agreed flexibilities in the implementation of intellectual property rights would put at risk the survival of hundreds of thousands of Thai citizens, and would likely bankrupt the 30 baht scheme in the process.

**William L. Aldis, a medical doctor, is with the World Health Organisation.

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