Back in the 1990s Thailand was desperately trying to deal with the problem of several hundred thousand people living with HIV, the Human Immunodeficiency Virus that causes AIDS. The estimates then ranged from 500,000 to as many as a million—no one will really ever know because many people may have been infected and died without ever knowing they had HIV.

Projections about Thailand’s future were all doom and gloom. Unkind moralists said that Thailand deserved the epidemic, what with its sex industry. Local conservatives chimed in, saying that it was condom use that caused Thailand’s epidemic.

But Thailand pushed on with its educational prevention programs that included condom use. In red-light districts they even had a “100% condom use” program, where sex workers could turn away customers who refused to use the life-saving devices.

Infection rates have dropped since then and at an ongoing regional AIDS conference in Indonesia, public health authorities are warning about other countries that are facing serious HIV/AIDS problems. Papua New Guinea is one of the potential trouble spots. The Philippines, always proud to be one of the countries with a “low and slow epidemic,” is now described as having a “growing” epidemic.

Back in Thailand, even as prevention efforts continue, there is growing focus on helping those already infected to gain access to antiretroviral medicines. These medicines do not completely eradicate HIV infection but can slow down the virus and limit its destruction of the body’s immune system and the development of AIDS.

The problem is that these medicines, largely produced by multinational companies, are very expensive. Locally, this can run to several thousands of pesos each month and the costs have to be subsidized with government money as well as funds from international donors.

Until recently, a few multinational companies could dictate the prices of the medicines because they had no competitors but slowly, through the years, their hold on the market has slowly been challenged. One Indian company, Cipla, is now a major producer of antiretrovirals and was able to reduce the cost of antiretroviral treatment from about $12,000 a year to $300.

Ever enterprising, Cipla is producing many other vital drugs like antibiotics and cardiovascular medicines. They are also producing a cheap version of oseltamivir, better known by its brand name Tamiflu when produced by Roche. On the lighter side, Cipla has its own cheaper version of tadalafil, better known as Cialis, for erectile dysfunction.

From Thailand to the world

But let’s get back to antiretrovirals. Thailand is fortunate to have “one tough lady,” in the words of a Thai friend of mine, who could challenge the multinational drug companies.

Krisana Kraisintu is a pharmaceutical chemist who has worked with Thailand’s Government Pharmaceutical Organization (GPO) since 1983. When HIV/AIDS erupted in Thailand Krisana Kraisintu set out to develop antiretrovirals, and in the words of the Ramon Magsaysay Foundation, this was done despite “the lack of government support, skepticism of many colleagues, and lawsuits from drug companies.” In 1995, Krisana was able to formulate a generic version of AZT or zidovudine, which is important in reducing mother-to-child transmission. (An HIV positive woman who becomes pregnant will take zidovudine to reduce the risk of passing on the infection.) Zidovudine became available at one-fourth of the cost of the branded product.

Krisana went on to produce a generic version of another antiretroviral, didanosine, and still later came up with “GPO-VIR,” a combination of several antiretrovirals, at a cost 18 times cheaper than branded versions. Thailand’s GPO now produces enough GPO-VIR to treat 150,000 patients a year, not just in Thailand but in neighboring Cambodia, Laos and Vietnam.

Krisana did not stop here. She went on to help the war-torn Democratic republic of Congo to set up a factory to produce generic antiretrovirals. I first read about her because of her work in Tanzania, where she upgraded an old pharmaceutical factory so it could produce affordable antiretrovirals as well as anti-malarials.

At the end of the month Krisana will be one of several outstanding Asians receiving a Ramon Magsaysay Award. There’s a bit of painful irony here because the Philippines is still waging a tough war to bring down drug prices. The Philippines has among the most expensive medicines in the region and the situation had become so serious that legislators finally had to pass a Universal Access to Medicines Law last year. The law has many provisions, including government entering into a compulsory licensing agreement with manufacturers for public health reasons. The law also allows the President to impose a maximum retail price on essential medicines, which she did recently for 21 medicines.

The larger multinational companies have fought the law every step of the way, and now that it has been passed, they continue to file lawsuits to delay full implementation. Pfizer has been the most hostile, refusing to reduce prices on any of its drugs.

In contrast to an entire country held hostage by drug companies, we see too how one person, Thailand’s Krisana Kraisintu, can make a tremendous difference for people with HIV/AIDS, not just for her own Thailand but for many countries including two halfway across the world.

Because we are so import-dependent for our medicines, we are vulnerable to blackmail by the companies, who are constantly threatening that price controls might mean drug supplies drying up.

We might want to explore our own version of Thailand’s Government Pharmaceutical Organization. Now, if we could just clone this one tough woman, Krisana.

Jewels of the Forest

This has nothing to do with pharmaceuticals and AIDS but I did want to plug an ongoing photo exhibit at our National Museum set up by the Wild Bird Society of the Philippines. Many of the photographs were previously exhibited at UP’s Vargas Museum but the museum exhibit also has preserved (the word “stuffed” always makes me feel uneasy) birds from the museum’s collection. Some people are uncomfortable with the “stuffed” birds, which does take on rather morbid qualities, but it’s also something else to look at the birds up close, with the colors of their plumage close to its natural splendor. You’ll have to go this week because the exhibit ends on August 15. Where’s the National Museum? Take Ayala Boulevard in Manila (the street where you have Philippine Normal University), cross Taft Avenue going in the direction of Luneta and the Agrifina Circle and you’ll find the National Museum’s buildings. The one on the left is where the exhibit is.