Ford Nathan, Wilson David, Costa Chaves Gabriela, Lotrowska Michel, Kijtiwatchakul Kannikar
Médecins Sans Frontières, 522 Mooban Nakorn Thai 14, Ladphrao Soi 101/1, Bangkok 10240, Thailand.
AIDS. 2007 Jul;21 Suppl 4:S21-9. doi: 10.1097/01.aids.0000279703.78685.a6.
ANTIRETROVIRAL ROLLOUT IN BRAZIL AND THAILAND: Brazil and Thailand are among few developing countries to achieve universal access to antiretroviral therapy. Three factors were critical to this success: legislation for free access to treatment; public sector capacity to manufacture medicines; and strong civil society action to support government initiatives to improve access. LOCAL PRODUCTION OF AFFORDABLE, NON-PATENTED DRUGS: Many older antiretroviral drugs are not patented in either country and affordable generic versions are manufactured by local pharmaceutical institutes.
EFFORTS TO ENSURE ACCESS TO EXPENSIVE, PATENTED DRUGS: Developing countries were not required to grant patents on medicines until 2005, but under US government threats of trade sanctions, Thailand and Brazil began doing so at least ten years prior to this date. Brazil has used price negotiations with multi-national pharmaceutical companies to lower the price of newer patented antiretrovirals. However, the prices obtained by this approach remain unaffordable. Thailand recently employed compulsory licensing for two antiretrovirals, obtaining substantial price reductions, both for generic and brand products. Following Thailand's example, Brazil has issued its first compulsory license.
Middle-income countries are unable to pay the high prices of multinational pharmaceutical companies. By relying on negotiations with companies, Brazil pays up to four times more for some drugs compared with prices available internationally. Compulsory licensing has brought treatment with newer antiretrovirals within reach in Thailand, but has resulted in pressure from industry and the US government. An informed and engaged civil society is essential to support governments in putting health before trade.
巴西和泰国的抗逆转录病毒药物推广：巴西和泰国是少数实现抗逆转录病毒疗法普及的发展中国家。这一成功有三个关键因素：免费治疗的立法；公共部门生产药品的能力；以及强大的民间社会行动，以支持政府改善药物可及性的举措。
许多较老的抗逆转录病毒药物在这两个国家都没有专利，当地制药机构生产出了可负担的仿制药。
直到2005年，发展中国家才被要求授予药品专利，但在美国政府贸易制裁的威胁下，泰国和巴西至少在此日期前十多年就开始这样做了。巴西通过与跨国制药公司进行价格谈判，降低了较新专利抗逆转录病毒药物的价格。然而，通过这种方式获得的价格仍然难以承受。泰国最近对两种抗逆转录病毒药物采用了强制许可，大幅降低了仿制药和品牌产品的价格。以泰国为榜样，巴西已颁发了首个强制许可。
中等收入国家无力支付跨国制药公司的高价。通过与公司谈判，巴西某些药物的支付价格比国际价格高出四倍。强制许可使泰国能够获得较新的抗逆转录病毒药物进行治疗，但导致了来自制药行业和美国政府的压力。一个知情且积极参与的民间社会对于支持政府将健康置于贸易之前至关重要。
