When Thailand scrambled two years ago to fight the H1N1 pandemic that spread quickly across the world, health authorities hit a roadblock faced by many developing countries: they couldn’t afford enough vaccines without breaking their budget.
Thailand is about to change that with two drug production plants expected to go onstream in 2011 and 2012 that will provide affordable medicines as well as independence from Western pharmaceutical giants during crises.
One plant will manufacture essential medicines while the other will produce seasonal and pandemic flu vaccines for its 65-million strong population, making Thailand one of a handful of countries in Asia building their vaccine-making capability.
In Asia, Japan and South Korea have well established vaccine makers, while China and India are fast becoming substantial vaccine producers manufacturing vaccines against tuberculosis, measles, hepatitis, Japanese encephalitis, rubella, mumps, rabies, pertussis, tetanus, typhoid and influenza.
Like most developing countries in the world, Thailand realised its vulnerability in 2009 when rich nations snapped up as many H1N1 swine flu vaccines as Western pharmaceutical giants could produce.
That forced the World Health Organisation to step in and obtain pledges from countries and partners to donate vaccines to around 100 low- and middle-income countries.
“During the H1N1 pandemic (in 2009), we tried to get money from our government to buy vaccine from Western pharmaceuticals,” said Witit Artavatkun, managing director of Thailand’s Government Pharmaceutical Organisation (GPO), which will manage and operate the two plants.
“But 600 million Thai Baht ($19.6 million) bought us only 2 million doses, and we have 65 million people. The gap is huge.”
The new vaccine plant in Saraburi will employ Russian technology, which was transferred under an umbrella WHO project initiated in 2006 to boost global flu vaccine production capacity, particularly in countries lacking in such technology.
“The plant will be completed in 2012 and produce vaccines for pandemic flu and seasonal flu. It is for national security, not commercial reasons. We produce to cover our population in times of pandemics,” Witit said in an interview.
The vaccine plant will manufacture a trial H1N1 vaccine once it is up and running, and launch its seasonal flu vaccine by 2015.
“We will use the H1N1 as a platform … If we are hit by a pandemic (flu virus) that is a totally different (strain), we can make use of the same process (production chain),” he said.
GPO plans to distribute pandemic vaccines free to Thais in future while seasonal flu vaccines will cost substantially less than imported vaccines.
RAISES PRODUCTION OF ESSENTIAL CHEAP GENERICS
Healthcare is a hot issue in Thailand, a country with wide wealth disparity. While the richest 20 percent of its citizens command 58.6 percent of the wealth, 26.5 percent live on $2 a day, according to the World Bank.
The country is headed for elections in July and its medical and healthcare sectors are closely watching what key candidates have to offer to improve healthcare.
Thailand’s total healthcare expenditure made up 4.3 percent of its GDP in 2009, compared with China’s 4.6 percent and Vietnam’s 7.2 percent.
“What’s the use of a government that doesn’t take care of healthcare or education?” said Saree Aongsomwang of the Foundation for Consumers.
Former premier Thaksin Shinawatra, who was ousted in a military coup in 2006, is remembered even by his critics for implementing a universal healthcare insurance scheme in 2001, which made basic treatment accessible to the poor.
Thailand’s healthcare was given booster shots in 2006, 2007 and 2008 by the military-led government when it defied big foreign business and issued “compulsory licences” covering two drugs for AIDS, one for the heart and four for cancer.
These licences allowed the state to override patents held by foreign drugmakers and produce the drugs locally or import cheap generic versions of these medicines.
By end-2011, GPO will bring onstream a large drug production plant that will churn out these essential medicines, including anti-AIDS drugs efavirenz and lopinovir/ritonavir, and drugs for diabetes, hypertension, heart disease, hepatitis, renal failure, psychosis and intestinal diseases, Witit said.
Efavirenz, known by its brand Stocrin, is produced by Merck Sharp & Dohme, while Abbott Laboratories produces lopinovir/ritonovir under the brand Kaletra.
Located in Rangsit, 40 km (25 miles) from Bangkok, the new drug plant will have a production capacity of 10 billion tablets a year, or double the combined capacity of GPO’s string of small plants in Bangkok city now.
“We have a lot of diabetes, hypertension, renal failure. The number of patients is increasing,” Witit said.
“We are interested in exporting (generic drugs) … right now we export small amounts to Laos, Cambodia, Myanmar. In future we hope to export to ASEAN countries, the emerging markets with half a billion people,” he said.
BRACES TO TACKLE CHRONIC DISEASES
Since it began importing cheaper generic AIDS drugs from India, Thailand has been saving 200 million baht each year which it uses on other patients, like those with renal diseases, said Pongsadhorn Pokpermdee, health economist and a deputy of the public health office of Nongbualanpoo, a northeastern province.
But while everyone has access to basic healthcare, health expenditure is low at $168 per head a year and Thais still need to pay out of pocket for more sophisticated treatment and advanced drugs. China spends $177 per capita on healthcare, Cambodia $42, Malaysia $336 and Japan $3,321.
Sunchunee Narkdee, a 32-year-old renal patient in Thailand, spends her entire monthly wage on dialysis treatment twice a week.
“The Thai princess subsidizes two-thirds of the cost of dialysis treatments at the centre I go to,” said Sunchunee who has to fork out a hefty 8,000 baht each month for medical bills. Her family helps her out with half that amount.
“Other hospitals are more expensive and some patients can’t afford it at all so they just stop treatment and wait to die.”
Health activists are urging the government to expand its list of free services and essential drugs to cover some cancers and other chronic diseases.
“The government should prioritise expensive, essential drugs that are covered by patents and issue more compulsory licences,” said Saichol Saradatta of the Cancer Patients Network.
But Pongsadhorn, who has worked for a year with other experts to cut the price of cancer drug rituximab, is not optimistic that more such licences will be issued.
Rituximab is sold under the brand Rituxan by Roche Holding AG (ROG.VX) and Biogen Idec Inc to fight lymphocytic leukemia.
“The government is concerned about (the backlash) on Thai exports,” Pongsadhorn said.
($1 = 30.560 Thai Baht)
(Editing by Sugita Katyal)