CMAJ • July 31, 2007; 177 (3). doi:10.1503/cmaj.1070071.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Reforming Canada's Access to Medicines Regime

Laura C. Esmail, MSc

PhD Candidate, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.

In his recent CMAJ commentary, Amir Attaran significantly downplayed the importance of exceptions in patent law that permit generic drug production.1 It is misleading to talk about the number of pharmaceutical patents in developing countries without mentioning the fact that India manufactures and provides the majority of the developing world's affordable generic medicines and well over 50% of its generic antiretroviral therapies.2 Now that India must provide 20 years of patent protection on pharmaceuticals, it is uncertain where, and to what extent, affordable generic versions of patented drugs will be produced.3 Given this grim prospect, abandoning Canada's Access to Medicines Regime would be shortsighted and careless. Attaran's all-or-nothing approach dismisses any role for Canadian generic drug manufacturers and fails to acknowledge the uncertainty in future sources for affordable, generic products.

Attaran is correct in stating that Canada's generic drug industry will have difficulty competing against pharmaceutical manufacturers in newly industrialized countries,1 but it is too early to dismiss the Access to Medicines Regime in its entirety. First, many critics argue that Canada should instead incorporate clear commercial incentives into the regime to encourage production of Canadian generic drugs.4 Second, recent evidence suggests that Canadian products can still be competitively priced. Last year, Apotex manufactured a fixed-dose combination antiretroviral product intended for shipment under Canada's Access to Medicines Regime and announced that it can offer the product to Médecins Sans Frontières at $0.39 per pill, a price comparable to that offered by Indian generic drug manufacturers.5

Finally, Attaran mentioned that poor countries are not using compulsory licensing but failed to mention one of main reasons for this: developing countries face formidable political pressure when trying to use such options, as illustrated most recently in Thailand.6,7 In the context of this political reality, bold amendments to the Canadian legislation would give developing countries much-needed support for their legal right to take advantage of flexibilities in patent law to address their nations' public health needs.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Attaran A. A tragically naive Canadian law for tragically neglected global health. CMAJ 2007;176(12):1726-7.[Free Full Text]
  2. Médecins Sans Frontières. Examples of the importance of India as the "pharmacy for the developing world." Geneva: Médecins Sans Frontières Access to Essential Medicines Campaign; 2007. Available: www.accessmed-msf.org/prod/publications.asp?scntid=29120071111256&contenttype=PARA& (accessed 2007 Jun 25).
  3. Radhakrishnan P. India and second-line ART: evaluating the way forward. Indian Network for People Living with HIV/AIDS (INP+). Chennai (India): Indian Network for People Living with HIV/AIDS (INP+); 2007. Available: www.law.fsu.edu/gpc2007/materials/18%20FINAL_INP_March20.pdf (accessed 2007 Jun 25).
  4. Cohen JC, Esmail L. Will Canada have the guts to fulfill its promise to the world's poor? Globe and Mail. 2007 Jan 30. Available: www.theglobeandmail.com/servlet/story/RTGAM.20070130.wcomment0130/BNStory/National/home (accessed 2007 Jun 25).
  5. Remarks by Jack Kay, President and Chief Operating Officer, Apotex Inc. Evidence of the Standing Committee on Industry, Science and Technology. Ottawa: House of Commons, 2007 Apr 23. Available: http://cmte.parl.gc.ca/cmte/CommitteePublication.aspx?SourceId=203549&Lang=1&PARLSES=391&JNT=0&COM=10476 (accessed 2007 Jun 26).
  6. Steinbrook R. Thailand and the compulsory licensing of efavirenz. N Engl J Med 2007;356:544-5.[Free Full Text]
  7. Improving access to second-line antiretrovirals. Lancet 2007;369(9570):1320.[Medline]




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