Margaret Chan Director General, World Health Organization Dear Dr Chan, 5 February 2007 We represent people living with HIV/AIDS and their advocates around the world who are fighting for access to affordable treatment for HIV. We are extremely disappointed by your recent comments to the Royal Thai Government, regarding compulsory licensing, that you feel "we have to find a right balance for compulsory licensing. We can't be naive about this. There is no perfect solution for accessing drugs in both quality and quantity" (Bangkok Post, 2 February 2007, "WHO raps compulsory licensing plan Govt urged to seek talks with drug firms"). We are writing to request that you reconsider your comments regarding the Thai government’s decision to issue a compulsory license for the production or importation of three drugs, two for treating HIV/AIDS. You have been entrusted, in your position as director general of WHO, to work for “the attainment by all peoples of the highest possible level of health.” We believe that your comments last week do not reflect this mission, and in fact work against it. We expected that you would have congratulated Thailand for its efforts, completely legal under WTO rules, to increase public health and access to medicines for its people. As you know, TRIPS grants the right to countries to act in the interests of public health and override the monopoly power that a patent grants a company. As reaffirmed in the Declaration on the TRIPS Agreement and Public Health, each WTO member "has the right to grant compulsory licences and the freedom to determine the grounds upon which such licences are granted" (Article 5(b)). Also, according to the TRIPS agreement Article 31(b), as well as Thai law, a compulsory license for government use does not require prior negotiation with the patent-holder. You mention finding a “balance” issuing compulsory licenses. While this may sound reasonable on the surface, surely you are aware that the pharmaceutical companies have time and again shown that they are only committed to maximizing their own profits. In the case of Kaletra, one of the three drugs for which Thai authorities issued a compulsory license, Abbott (which produces Kaletra) pursues a deeply cynical and profiteering marketing strategy within the US that was recently revealed by internal company memos (see Wall Street Journal, 3 January 2007, "Inside Abbott's tactics to protect AIDS drug"). In July 2006, Abbott announced a new “discounted” price for Kaletra in developing countries such as Thailand, but the price (US$2200/year/person) still includes more than 300% profit margin and would create undue financial burdens on the Thai government’s universal treatment program, making this program financially unsustainable. Your predecessor at the WHO, Dr Lee Jong-wook, led a bold and courageous campaign to treat 3 million people with HIV/AIDS by 2005. Though the campaign failed to reach this goal, it proved to the world that effective AIDS treatment can be provided in the developing world, and helped create the momentum to produce affordable generic medicines to carry out that treatment. These generic medicines are today keeping millions of people alive, and providing hope to millions more. We need you, as a world leader in public health, to take the lead and keep the spirit of Dr Lee’s initiative alive by supporting all possible efforts to provide more affordable and effective treatment to people living with HIV/AIDS in developing countries, especially the promotion of generic competition, which has proven over and over to be the most important factor in decreasing the cost of medicines. The Thai government’s actions are keeping Dr. Lee's initiative alive. We urge you to use your position to support the health of all people living with HIV/AIDS by publicly endorsing the Thai compulsory licenses rather than criticizing the legal actions of a sovereign nation. Best Regards, The International Treatment Preparedness Coalition and its members: Cc: Country Representatives, WHO National Offices Peter Piot, UNAIDS Kevin DeCock, WHO HIV/AIDS Director