Access to certain ARVs is a problem in China, including some important 1st line drug dosages, many important 2nd line drugs, 3-in-1 ARV fixed-dose combinations and paediatric formulations. More than three months ago, MSF wrote to some of the producers of these drugs – Abbott, Boehringer Ingelheim, Bristol Myers Squibb (BMS), GlaxoSmithKline (GSK), Gilead, and Merck – urging the companies to make their products available in China, and to market them at affordable prices. (Copies of the letters can be found at www.accessmed-msf.org). However, to this date, with the exception of GSK (Gilead, Roche and Merck only acknowledged receipt), MSF has not received any reply to these letters.
Abbott has registered lopinavir/ritonavir (Kaletra), but not marketed it in China, meaning that the drug is, practically speaking, not available to patients. MSF urges Abbott to sell the drug at the price offered to developing countries of 500 USD/per patient/year (ppy).
Boehringer Ingelheim has registered nevirapine suspension (Viramune), but not marketed it. Lack of nevirapine suspension makes treatment of children very difficult, as adult tablets have to be broken to approximate the proper dosage. MSF urges the company to market nevirapine suspension at 17.50 USD per 240 mL bottle.
BMS has registered stavudine (Zerit) 30mg and 40mg, but not marketed these dosages. The only formulation available is 20mg, which increases the pill burden for adults (>60kg) from two to four capsules per day. For adults <60kg, who are the majority of our patients in China, it is impossible to construct the recommended dosage of 30mg with only 20mg capsules. Stavudine syrup and the 15mg dosage have not been registered or marketed, making treatment of children extremely difficult. Enteric-coated didanosine (Videx EC) is registered in China but also not marketed. MSF urges BMS to apply for registration (if not yet done) and market stavudine in all its dosages, and to market these drugs at affordable prices. We also urge BMS to market enteric-coated ddi at the same price as in sub-Saharan Africa (0.764 USD per unit).
Gilead has neither registered nor marketed tenofovir (TDF) in China. Recently, Gilead announced a list of developing countries where they were applying for registration for TDF, but China is not included. We urge Gilead to apply for registration and market TDF (Viread) at the best price offered to developing countries (208 USD ppy).
GSK has chosen to register but not market lamivudine 150mg (Epivir), lamivudine oral solution, and zidovudine 100mg (Retrovir). Zidovudine 300mg tablets and oral solution are neither registered nor marketed. This situation makes it very difficult to build any first line treatment and greatly complicates the treatment of children. Although GSK responded to this letter at a meeting held in Brazil in July, their replies were not satisfactory. MSF urges GSK to apply for registration (where necessary) and market these products at the same prices as offered to least developed countries.
Merck has recently informed us that efavirenz 50mg (Stocrin) has arrived in China, but the price has not yet been set. We urge Merck to market this product at 0.113 USD per tablet.
In order to provide quality treatment and care to people living with HIV/AIDS, it is urgent that we have the right tools available, in the proper dosages and formulations. We urge the companies to provide a written response to our inquiries as soon as possible, as currently there are many patients in China who are unable to access proper medical treatment as a result of the decisions the companies have made.
The situation in China is but one example of what is happening in many other countries – companies' offers to discount AIDS drugs are illusory if the drugs are not registered and marketed in the countries where they are needed. Companies are failing to meet their stated commitments to "providing HIV care products at a loss (Abbott)," "working together to make HIV/AIDS care available and affordable (BI)," "extending and enhancing human life (BMS), "providing HIV care products at a loss (Gilead)," "making medicines and vaccines available at preferential prices (GSK)," and selling "our current HIV/AIDS medicines in the poorest developing countries and those hardest hit by the HIV epidemic, at prices where Merck will not profit (Merck)." MSF urges these companies to make good on their commitments.
The prices we request are the ones offered by companies to developing countries and published in the MSF report Untangling the web of price reductions: a pricing guide for the purchase of ARVs for developing countries, 8th edition, June 2005)