Amid few manufacturers of these expensive drugs, public health groups are noting that the government’s plan to provide so-called second line of AIDS drugs is far too limited to have any significant impact in India.
On 1 December, which was World’s AIDS Day, Union minister for health and family welfare Anbumani Ramadoss had announced that government programmes will include second-line treatment from January. To be administered to those AIDS patients who have developed resistance to first line of drugs, these drugs will be given out only to below poverty line (BPL) patients from Chennai and Mumbai to begin with, and cover 2,000 people in 2008. In April, the number of centres will be extended to 10.
India is estimated to have 2.5 million HIV-infected people, of which 400,000 require treatment. The government, through National AIDS Control Organization (Naco), provides first-line drug regimen such as zidovudine, lamivudine, statuvudine and efavirenz to 110,000 people.
“Covering 2,000 (people) is like a joke in the face of 2.5 million infected people. There is a need to scale it up and provide universal access to these drugs,” said Chinkholal Thangsing, Asia-Pacific bureau chief of AIDS Healthcare Foundation, which provides second-line regimen to 30 patients. Thangsing estimates that drug cocktails that involve second regimen, cost Rs60,000-80,000 every year per patient compared with first-line drugs that cost Rs8,400-Rs24,000 each year.
According to Dennis Brown, UNaids country coordination for India, about 2-5% of the AIDS patient population develops resistance to the initial line of drugs and need the next level of stronger, more effective drugs. This means up to 20,000 people could be requiring second-line drugs such as tenofovir, atazanavir, indinavir, ritonavir and lopinavir, which are up to 10 times costlier.
These drugs are made mostly by multinational drug makers such as Bristol-Myers Squibb Co. and Abbott Lab. Inc., with just three Indian companies—Cipla Ltd, Emcure Pharmaceuticals Ltd, and Ranbaxy Lab. Ltd—making them. This makes the drugs much more expensive than if many manufacturers were producing them.
Chan Park, policy adviser to legal activists, Lawyers’ Collective HIV/AIDS unit, said: “It is a long-awaited welcome announcement, but the coverage is limited and not nearly enough. Our survey shows that most families on government ARVs (anti-retrovirals, a class of drugs) earn Rs2,000-3,000 a month. So, it is not just the BPL families who will find it unaffordable.”
Park added India needs more makers of non-patented drugs in the fray to drive down prices, but also noted “these drugs are newer and many have pending patent applications on them.”
Damodar Bachani, joint director, ARV therapy in Naco, while noting there is a shortage of makers of second line drugs in India, said the initial 2,000 target is “just the beginning,” and it could be reviewed and increased. He recalls how Naco’s entry into first line ARVs brought prices crashing to $1 (Rs39.40) a day and, over time, he expects the same to happen in second-line drugs.
The only other way, said Bachani, is “to increase procurement so that rates as low as $500 per patient per year, can be negotiated.”