Medecins sans Frontieres (Doctors without Borders), as the world largest medical-relief agency, would like to take this opportunity to voice our support for the minister.

What the public-health minister has done is use legal means, in accordance with both Thai and international law, to override patents on three life-saving drugs; efavirenz, produced by Merck as Stocrin; lopinavir/ritonavir, produced by Abbott as Kaletra; and clopidogrel, produced by Sanofi-Aventis and Bristol Myers Squibb as Plavix.

This means the Public Health Ministry will be able to use lower-cost generic versions of these expensive drugs for patients covered by government health-insurance schemes. That will enable more Thai citizens to access these life-saving drugs without bankrupting these schemes, which provide access to free healthcare for millions of Thais.

The most vitriolic opposition to the move comes from powerful pharmaceutical lobby groups within the US that argue Thailand is "stealing" their assets and will treat Thai patients with inferior-quality "copycat" drugs. They also argue the public-health minister has "broken" World Trade Organisation (WTO) rules by not entering into prior negotiations with the drug companies on a "fair" price for these drugs. Even worse, they try to argue that the Trade-Related Aspects of Intellectual Property Rights (Trips) agreement relates only to a limited scope of diseases, including Aids, malaria and tuberculosis.

The move to issue these compulsory licences is said to be worrying "key players in the financial and capital markets around the world" and threatening to put the country at risk "of becoming an outcast in international trade".

Now let us look at the facts.

The public-health minister has broken no WTO rules, and his actions are in line with recommendations made in a World Bank report released last year titled "The Economics of Effective Aids Treatment". The report suggests compulsory licences as one option to reduce the financial burden of treating tens of thousands of people with HIV.

The government plans to import generic drugs from India that are coming from an approved source of guaranteed quality.

Public Health Ministry officials have regular meetings with pharmaceutical companies to negotiate the price of the drugs they want to purchase from these companies. If a company holds a patent on a drug such as Kaletra, which afforded Abbott sales of US$1.1 billion (Bt39.36 billion) last year, then the ministry has little bargaining power to get a lower price. By using Article 31 of the WTO's Trips agreement, the ministry is able, legally, to circumvent the patent, look for a generic product on the open market and need only ensure that "the right holder shall be informed promptly".

The declaration issued in 2001 by the WTO Ministerial Conference in Doha states the "... we affirm that the Agreement can and should be interpreted and implemented in a manner supportive of WTO Members' right to protect public health and, in particular, to promote access to medicines for all".

The use of compulsory licences is not an attempt "to force the pharmaceutical giants to the negotiating table", but rather to open up markets to generic competition and thereby push prices down to affordable levels for all developing countries.

Once again, Thailand can lead the way in showing developing countries it is possible to offer their people access to medicines for all. If this brave attempt fails, the multinational companies will have a stranglehold on the lives and well-being of millions of poor people, and no other developing country will dare use their right to issue a compulsory licence.

The public-health minister is a man of principle who is putting the rights of all Thai citizens to access life-saving medicines before commercial interests.

At the moment, the pressure on the minister to step back and bow to political pressure is enormous, and he deserves the support of not only the Thai public, but also the international community.

Paul Cawthorne is head of Medecins sans Frontieres' Thai mission.

Paul Cawthorne

Special to The Nation