Her work in pushing Thailand to make affordable drugs has made her a heroine for activists in Bangkok, but now Dr Krisana Kraisintu has set her sights across the seas  to share this technology with African countries similarly affected by the HIV/Aids pandemic.

The mission of Dr Krisana, head of the state drug-makers research and development wing, is technology transfer from Thai laboratories to African countries  Ghana, Zimbabwe, Nigeria, Kenya and Cameroon  at minimal cost and with no mark-up for profit.

Since early April, Thailands Government Pharmaceutical Organisation (GPO), which she is part of, has been producing generic medicines, including the worlds cheapest anti-Aids drugs, at rock bottom prices.

These antiretroviral (ARV) drugs cost 20 baht (about US 45 cents) a tablet, which means that the monthly dosage for patients costs 1,200 baht (US$27).

And now that Thailand is keen on sharing knowledge with African countries, the slightly greying, bespectacled and, at times, jocular Dr Krisana has been described by some in Bangkok as a one-woman-effort to research, investigate and lay the groundwork to help African countries produce their own generic anti-Aids drugs.

We will give them the formula we used to produce generic anti-Aids drugs and provide staff training for our African counterparts in Thailand, says the 50-year-old lead researcher at the GPO.

My aim is to keep costs low. We are not getting money from this so there is no question of profit, Dr Krisana explains in an interview. This is for a humanitarian reason. We are a developing country and we want to help similar poor, developing countries in Africa.

Best available

Anti-retroviral (ARV) drugs are the best available medicines to slow the production of HIV, which causes Aids. In developed countries, the availability and use of ARV and drugs for HIV/Aids-related infections have helped curb Aids mortality.

But this has not happened in the developing world  home to 95 percent of all deaths to date due to Aids  mainly because of a serious lack of access to medication. Less than five percent of those needing HIV/Aids treatment in developing countries have access to these drugs.

Part of the reason for this lies in the patents that big pharmaceutical firms hold on HIV/Aids drugs, which tends to make their cost higher than drugs where generic alternatives exist or are possible. Just on April 22, the World Health Organisation endorsed the inclusion of Aids drugs in its essential medicines list.

Africa is the worst hit by the HIV/Aids pandemic, since it is home to more than 25 million of the worlds 40 million people living with HIV. HIV/Aids is the leading cause of death in sub-Saharan Africa.

In Zimbabwe, more than 25 percent of adults have HIV, UNAIDS figures say. In the other countries expected to use Thai technology in fighting HIV/Aids, the HIV prevalence rate ranges from 3.6 percent in Ghana to 14 percent in Kenya.

Thailand has one million of its 60 million people infected with HIV, and over 300,000 have died from the pandemic. It is one of the worst hit by the pandemic in South-east Asia, but the number of new HIV cases have been falling in recent years.

The first country due to benefit from the Thai governments South-South cooperation with Africa is Ghana.

Production of the generic drugs will start no sooner the governments of Thailand and Ghana sign a memorandum of understanding on this initiative. This document is currently with the health authorities in both countries.

Confident

Dr Krisana says she is confident that the production facilities and staff in the West African country can deliver the first line of Ghanas anti-Aids drugs within four to six weeks of the inking of the agreement.

Groups like the international medical aid agency Medecins Sans Frontieres (Doctors Without Borders) see Thailands initiative as a political act full of defiance. After all, the African mission will be a litmus test of such technology transfers in face of pressure from the pharmaceutical industry, which holds patents for anti-Aids drugs.

This first step will serve as a catalyst, says Paul Cawthorne, whoheads the Thai office of Doctors Without Borders. Dr Krisanas commitment to transfer the technology for generics is unique.

She is not afraid to go against the pharmaceutical industry, adds Paul Toh, an advisor at the Southeast Asia and Pacific regional office of the United Nations Joint Programme on Aids (UNAIDS) in Bangkok. Her programme for Africa bears this out.

But already, there is discomfort from powerful quarters about Dr Krisanas work in making publicly available the worlds cheapest anti-Aids drug and her pledge to give Africa the technology to do likewise.

US embassy officials in Bangkok have visited her office twice recently, says Cawthorne. We are concerned that they will apply pressure on her on behalf of the pharmaceutical industry.

Joseph Yun, economic affairs counsellor at the US embassy, says of Washingtons view of Dr Krisanas plans for Africa: There is no problem producing generic drugs to help African countries as long as the intellectual property issues are taken care of.

He explains that the generic drugs to be produced cannot have components protected by patents in either Thailand or Ghana: If they are free of patents on both ends, it is fine.

The seeds for Dr Krisanas project were planted a year ago, during a meeting with a public health expert from Cameroon attached to the World Health Organisations Africa division.

Survey facilities

By July 2001, she had begun the first of a few trips to Africa to survey the available facilities that could be converted to drug producing centres. Zimbabwe and Ghana were on her initial itinerary.

In order to keep costs down, I stressed on the countries using existing facilities for this effort than new buildings, she says.

That was followed by a survey of the drugs under patent in the countries she visited. She was guided by the principle that for anti-Aids drugs to be produced, they could not have patents in the African country of production and in Thailand.

Subsequently, she began lobbying the suppliers of the raw materials for anti-Aids drugs in South Korea and India to drop their asking price evenfurther to make ARV drugs more affordable.

African patients have a right for health care. And if they need medication, we have to give it at a price they can afford, Dr Krisana asserts. The suppliers have agreed to provide the required quantities at rates less than what they give us.

This would mean that generics such as Didanosine and Stavudine, two of the drugs needed by HIV patients as part of a three-drug cocktail they have to take twice a day, would be available at around 60 percent of their price in Thailand.

Didanosine is sold at US62 cents a tablet in Thailand and Stavudine, US77 cents.

Thailands sharing of its know-how in battling HIV/Aids with African countries, would boost the global campaign over the last 14 months to push down the prices of anti-Aids drugs.

It will assert that the health of African people matters more than profits, Dr Krisana points out. The pharmaceutical industry will have to accept that.