`Medicines for All', the Pharma Industry and the Indian State

Author(s): S SRINIVASAN
Source: Economic and Political Weekly, Vol. 46, No. 24 (JUNE 11-17, 2011), pp. 43-50
Published by: Economic and Political Weekly
Stable URL: https://www.jstor.org/stable/23018245
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 INSIGHT

'Medicines for All', the Pharma

and givers. The only equitable solution in
a country like ours is free healthcare of the

Industry and the Indian State

same standard, to all. The question that
would arise would be: why should the rich
get free treatment? Our answer is that except
for the very rich and the creamy layer of
S SRINIVASAN
the middle class, almost everybody else is
likely to court impoverishment when faced
When we consider that with critical health conditions. It is in the

expenditure on medicines
in India accounts for 50% to
80% of treatment costs, affordable,
India's
pharmaceutical success has
and the poorest person should get the
garding healthcare which are interests of the poor that the relatively
Theregaining
areincreasing
a fewcurrency:
articles
good of faith re well-off, and the middle class are given
quality healthcare should be accessible, access to publicly provisioned healthcare,
and available to all in need as this would in the long run ensure quality
care. The real rich can look elsewhere if

same quality of healthcare as the richest

clearly not translated into they find it inconvenient to use the public
person. Obviously in India this would be healthcare system. Of course, people with
availability or affordability of better incomes will have to contribute
seen as a daydream. But in even the so
medicines for all. As partcalledof
developed economies, except the more by way of taxes, etc.
Universal Access to Healthcare,
us, free quality healthcare is a reality with Even if we do not have a free universal

nobody having to pay at the point of ser

good quality healthcare should healthcare system in a couple of years,
vice and nobody denied free healthcare. movement towards achieving it must
be accessible, affordable, and
A major component of healthcare is begin. The easiest way to restore faith in
available to all in need. Providing
medicines. In India, research studies show the system is to stock quality medicines at
quality medicines to all - that
free
expenditureat on medicines accounts all levels of public healthcare.
for 50% to 80% of the total cost of treat
the point of service - in all our
Cost of Free Medicines
ment. In addition patients end up paying
public facilities is an achievable
for a variety of tests. The significant issue here is that of the
task. This article estimates the
Ironically, the Indian pharmaceutical cost of provisioning free medicines. Our
cost of providing free and quality industry is seen as a success story; and it is estimates show that it will cost the central

medicines at all levels of public
healthcare and offers suggestions
on how this can be done.
Some of the arguments in this paper were
presented at a meeting of the High Level
Expert Group of the Planning Commission in
December 2010 and elsewhere. Comments
from Anant Phadke and T Srikrishna and
indeed so in comparison with most devel and state governments around Rs 30,000
oping economies with the possible excep crore per year if medicines are given free
tion of China. India's pharma success - to all from the primary to tertiary levels,
currently selling Rs one trillion worth of subject to various assumptions. A recent
active pharmaceutical ingredients (apis) study by Gupta et al3 estimates the cost to
and formulations annually - has given it be Rs 33,546 crore. We give the details of
the title of "pharmacy of the world".1 This our estimate in Annexure 1 (p 50).
success is attributed, among other reasons Four aspects must be looked at to en
to India's process-patent-only-regime for sure that the system does not work at
medicines post the Patents Act, 1970. cross purposes:
The irony, and the tragedy, of course is • Restrict the list of medicines available
that this success has not translated into
in this country to essential medicines. The
current National List of Essential Medi
availability or affordability of medicines
for all.2 What can be done to provide cines (nlem 2003) and who's Model List
(2010) have around 350 medicines. This
medicines in all our public facilities espe
can be increased to 500 to include medi
cially to the poor? The response of policy
makers is akin to the discourse in the issue cines for rare conditions and unnecessary
fixed dose combinations and drugs of
of right to food and subsidised food for the

constant education from lawyers Leena
Menghaney and Kajal Bharadwaj on
intellectual property issues are gratefully
acknowledged.
S Srinivasan (sahajbrc@gmail.com) is with
LOCOST, Vadodara and with the All-India
Drug Action Network and Medico Friend Circle.
poor. They have come up with targeted doubtful or no value can be removed.
schemes which suffer from disagreement • Price regulation of all these medicines.
over who should be targeted, what should be • A national vaccine policy to regulate the
the extent of free care, which pre-existing entry of new vaccines as also in the Ex
disease conditions should be exempted and panded Programme on Immunisation (epi).
how to deal with the potential hazard of the • Proactive use of Trade Related Aspects
system being exploited by healthcare seekers of Intellectual Property Rights (trips)

Economic & Political WEEKLY HTTT] JUNE 11, 2011 VOL XLVI NO 24 43

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INSIGHT

supply of drugs by the National Rural

working capital from the district adminis
flexibilities including issue of compulsory
licences on patented drugs that aretration.
high The 20% margin on the procure Health Mission (nrhm) programme. In
ment
priced and/or are not easily available. prices takes care of the deed
overheads. the pharma trade in Assam is look
Suppliers are mostly well-known compa
Needless to say, action and regulation ing forward to the day when the current
on other unethical practices endemic to
nies quoting state health minister - whose zeal is seen
much lower prices for the dis
trictalso
the pharmacy scenario in India would as the cause - will step down or lose his
administration (Table 1). It does not
reachby
help. For instance, incentives to doctors ministerial berth even as the traders
out to the primary health centres
are hoping that the nrhm will not get
(phcs) however. Most importantly, the ini
way of drug promotion; the "cut" practice
tiative in both these districts was taken an
by doctors,4 laboratories, cat scan centres, byextension.
an ias officer and collector Samit Sharma, What will happen to the pharma sector
etc. The professional medical associations
like the Indian Medical Association (ima),
who in India in the event of full-scale restruc
is a paediatrician by training. A tribute
to the effectiveness of these efforts is the
the Indian Association of Physiotherapists turing and price regulation? Certainly
(iap), the Federation of Obstetric of generic drugs at these prices by other there will be a shake out with perhaps
saleand
Gynaecological Societies of India private
(fogsi),retail pharmacies in Chittorgarh some of them even deciding to shut shop
the Pharmacy Association, and the who put up hoardings to announce the since there will be no free rides to the
Medi
others, of generic medicines (see also bank thanks to overpriced, irrational
cal Council of India (mci), among availability
the1 and 2). The Rajasthan govern medicines and fixed dose combinations
Tables
must also act in convergence with
above objectives. ment has announced free medicines for (fdcs). The marketing expenses of these
companies will decrease unless they end
all in all the government facilities from
Availability of Medicines 2 October 2011 on the lines of the tnmsc,up spending more on product differentia
Two remarkable attempts, amongwith
halfSharma
a now heading this effort. tion of the same essential drug - that is
dozen, to make medicines availableWhat
and can the rest of India's publicone company claiming their generic prod
affordable have been those by thehealthcare uct is superior to that of the competitor.
Tamil system learn from these expe
Nadu Medical Services Corporation The number of retail pharmacies will also
riences? The major lesson is that the pub
come down as the retail trade will not be a
(tnmsc)5 and the ones at Chittorgarh andlic health system can deliver given appro
Nagaur districts.6 The former has attained priate leadership and political will. Indeed
money spinner, at least in the short run. In
the medium and long run, sales may pick
a level of stability though it probably has bulk formulation suppliers in Assam com
its share of critics. Its strength lies in the plained to this author and his colleaguesup if some retail outlets are contracted to
rock bottom low prices at which essentialthat the offtake of bulk formulations have provide and not sell medicines and as access
to government provisioned healthcare
medicines are procured, and a high de fallen in recent years, because of free
gree of transparency in the procurementTable 1: Comparison of Chittorgarh,TNMSC Procurement Pricesand Retail Market MRPs
and related operations. It supplied about 270Generic Nameof Drug Unit Chittorgarh Tender MRP Printed on TNMSC Prices
Rate (Rs) Pack/Strip (Rs) 2010-11 (Rs)*
drugs in 2007-08 as per its essential drug(1) (2) (3) (4) (5)

list (edl) with 21 fast moving drugs accountAlbendazole tab IP 400 mg 10 tablets 11.00 250.00 4.62

ing for 80% of its procurement budget. It Alprazolam tab IP 0.5 mg 10 tablets 1.40 14.00 0.45

also had 322 "specialty" drugs - out of Arteether2 ml Inj 1 injection 9.39 99.00 9.71 for80mg per vial
which 10 drugs accounted for 85.6% of theAmylodipine tab 5 mg 10tablets 2.50 22.00 0.42 for 10 tabs of 2.5 mg
lOtablets 1.20 35.00 0.50
budget and one - Temozolamide Caps - for Cetrizine 10 mg
52.00 370.00 8.77 for 250 mg injection
52%. The tnmsc system services all levelsCeftazidime 1000 mg 1 injection
lOtablets 18.10 170.00 2.30 for 10tabsof10mg
of care. The patient does not have to payAtorvastatin tab 20 mg
Diclofenac tab IP SO mg lOtablets 2.20 25.00 0.63
for these drugs7 which are available only
Diazepam tab IP 5 mg lOtablets 1.90 29.40 0.47
through the government health system.
Amikacin 500 mg 1 injection 6.95 70.00 6.78
In the Chittorgarh district and Nagaur *For similar strengths and pack sizes unless indicated otherwise, accessed 29 April 2011.
district models, the drugs are available atSource: Prices in Columns (3) and (4) from Samit Sharma's presentation, July 2009, and websites cited, op cit. Source for TNMSC
prices: http://www.tnmsc.eom/tnmsc/new/html/pdf/drug.pdfandhttp://www.tnmsc.com/tnmsc/new/html/pdf/spldrug.pdf
the district hospital levels at the retail level
as well through a series of retail shops run Table 2: Comparison of Chittorgarh Procurement Prices and Printed MRP
Drug Manufacturing Name Given by Company Ingredient Name of Rate at Which Drug Is Rate at Which Drug Is Sold
by the government cooperative set up for Company (Brand Name) Medicine (Generic Name) Purchased bythe Chemist to the Customer
(Printed MRP)
the purpose. The above poverty line (apl) (Stockist Price) One Injection

Cadila Amistar500 Amikacin 500 mg 8.00/ 70/

patients have to pay for the medicines.
German Remedies Amee500 Amikacin 500 mg 8.00/ 70/
Any user outside the system could also
Wockhardt Zekacin 500 Amikacin 500 mg 9.90/ 70/
access these medicines at the same low
Alembic Amikanex500 Amikacin 500 mg 8.22/ 64.25/
prices from the generic shops retailing
Intas Kami 500 Amikacin 500 mg 8.13/ 60/
these at various places in the district. Unichem Unimika500 Amikacin 500 mg 7.80/ 72/
The system runs on a 30-day credit
Raribaxy Alfakim 500 Amikacin 500 mg 8.50/ 70/

from the suppliers, with the provision for

Cipla Amicip500 Amikacin 500 mg 7.42/ 72/

returning unused medicines, with no

Source: Samit Sharma's presentation, July 2009, and websites cited, op cit.

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 INSIGHT

becomes near universal. Many of them Several

will government committees have The question of "what will we do for
commented on the wide differences and
attempt to promote ayurvedic and herbal r&d for new drugs" has to be confronted
products, hoping that there will be no
high prices within India - though they do
head on but more creatively, r&d funding
not term it a market failure (see Box).10
price and other regulation on these. Many for new drugs15 will have to be seen as part
companies will diversify into biologies Some
and questions need to be clarified.of a larger national innovation policy with
vaccines and of course focus on exports. companies have the freedom to makethe clear understanding that Indian
Will It
is here that the government of Indiaother
couldmedicines - otherwise rational, me
pharma companies will work jointly with
too ones - in the post-Universal Access
pitch in with funds for r&d of useful drugs the government to discover new drugs for
scenario?
for the national scenario, prize funds for conditions that are relevant to India/third
Following the experience of
innovation and related activities. National Institute of Clinical Excellence world. The policy should also envisage uni
versities working on basic research.16
(nice) in the uk, we are tempted to suggest
Price Regulation that pharma companies can make and
Those Indian pharma companies who want
That price regulation in some form is es even sell them as long as they are rational
to plough their own furrows on r&d must
sential is now accepted in much of the lite (to be decided by the Drug Controller
also be encouraged to do so. One thing
rature and in practice. Most advanced General of India). However, only those
however is clear - making the patenting of
"free market" economies have some form drugs will be reimbursed by the govern
publicly funded research mandatory will
of price regulation/subsidy/reimbursement ment (or an autonomous designated body
not result in quality r&d per se.17
schemes.8 The Indian pharma formulations like, say, an Universal Access to Health The other issue is the carrot often dan
industry is characterised by wide-ranging Corporation) which are in the govern
gled by the Indian pharma lobbies like
Indian Drug Manufacturers Association
prices for the same product and high profits, ment list of reimbursable drugs.14 But then
apart from marketing and selling unnec India is not the uk. We will have to deal whenever such discourse takes place. They
essary combinations. Our analysis showed with the formidable capacities of the Indioffer to supply all the medicines required
that more than 60% of the top-selling 300 an companies to lobby for their products.by the state and central governments free
drugs which accounted for nearly 80% of So all things considered it is preferable toor at the tnmsc prices. The quid pro quo is
the retail sales are not to be found in the have only a restricted list (the 500 mole"non-interference" especially in matters of
national essential drug list. There are alsocules alluded to before) which would be
pricing. However, this will not work be
other ironic consequences due to susceptilicensed for manufacture and/or marketcause (a) it is difficult to regulate, manage
ble users making decisions in distress anding in India. India however needs an
and morally justify such vastly different
out of ignorance. Often, these decisionsequivalent of the nice. prices in the same country to the middle
are taken on the "advice" of prescribers,
and due to the "marketing" efforts of com Box 1: Some Recommendations from Select Committee Reports
panies - called asymmetry by our econo The report of the Standing Committee on Chemicals & Fertilisers, 2005-06, Lok Sabha observes:11
The Committee's examination revealed that though, there is a provision that a strict watch will be kept on the
mists. As a result, the costlier versions of
movement of the prices and the government may determine the ceiling levels beyond which increase in prices
the same drugs are bought more, and ir would not be permissible, this provision has seldom been applied. In this context, some of the state govern
rational combinations sell more because the ments have also informed that when the cases of high prices of anti-cancer drugs, antibiotics, nutraceuticals
and cetrizine were referred to the National Pharmaceutical Pricing Authority (NPPA), the latter conveyed its
doctor prescribes them. We have discussed
helplessness in curtailing the high prices. The Committee are unhappy over this unsatisfactory state of affairs
this elsewhere in detail.9 Tables 3 and 4 and desire that the situation should be remedied forthwith. They, therefore, recommend that for the category
(p 46) as also Tables 1 and 2 make the of drugs for the same therapeutic use, the government should determine a reasonable ceiling beyond which
increase in prices may not be allowed.
price distortions clear. Collectively it qual
ifies as a market failure - in the sense that Draft Pharmaceutical Policy 2006 (hereafter the draft policy)12
much of the intended clientele is left im All 354 drugs in the National List of Essential Medicines 2003 (354 drugs with formulations of specific strengths
numbering about 663 excluding exemptions) would be brought under price control. This is in addition to the
poverished after buying India's modern
existing list of formulations of 74 drugs.
medicines, or worse cannot afford to buy
the medicines prescribed, illustrating the Department-Related Parliamentary Standing Committee on Health and Family Welfare,
August 201013
classic Indian descriptive metaphor (also
34 One option for making available affordable medicines put forth before the Committee was to cap the profit
witnessed in the food sector) - "sitting on
margin of all medicines irrespective of whether they are under DPCO or not. This step would do away with the
the banks of the Ganga, yet thirsty". It is need of monitoring prescriptions, identifying the manufacturers supplying low-priced medicines and without
not a failure if one compares these prices to any need to prefer generic over branded products. If fixation of MRP is done by NPPA based on a fair, transparent
system keeping interests of all stakeholders in mind nearly all issues on pricing would get resolved.This system is
international prices of medicines, especially
already in vogue in many other fields such as electricity rates, bus and taxi fares, interest rates, insurance
the Hiv-related medicines. In fact inter
premium just to mention a few. Lastly, with the floating of an open tender in the market, all drug manufacturers/
national civil society acolytes of India'sstockiest would come forward with the offer of lowest possible rates...
pharmacy prowess see the low prices of36 The committee is, however, of the considered view that given the current ground realities in the country
where more than 80% population is dependent on private medical care and nearly 45 crore people live below
hiv medicines here as a triumph of thethe poverty line, the most effective and direct approach would be to put a blanket cap on profit margins of all
market. The collateral fallout is an inter medicines across the board. Medicines are the only item where the decision to buy is not taken by the purchaser

esting phenomenon: local predators arebut by a third party, i e, the doctor. Therefore, if prescribers and producers join hands and take advantage of a
patients' helplessness, only the State can stop them.
viewed as saints abroad.

Economic & Political weekly 0353 june 11, 2011 vol xlvi no 24 45

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 INSIGHT

class constituency, who may haveaccess

to buyto insurance schemes, etc.measure
Indeed the goal of universal access and
the medicines or to justify it before the
one same quality of healthcare for all. Its pas
ju see government doctors advising
can
diciary, if nobody else, and (b) it would in to buy "better" medicines from
patients sage through
the Parliament will also be diffi
cultwould
nearest retail pharmacy. And (c) this
effect translate and be perceived as "sarkari" since mps would want to know what

medicines for the poor; and costly,therefore

quality negate the basic premise ofif the private players renege or if
happens
medicines for those who can afford or have in health and postpone bythe
equity a long
low prices agreed upon do not turn out to
Table 3: Highs and Lows in Cancer Drug Prices be feasible down the line or even within the
Drug Name Highest Price Firm Lowest Price Firm
contracted period. These are not concerns
Letrozole2.5 mg (10 tablets) 1,986 Novartis 60 Hetero
that can be laughed away for this is pre
Imatinib400 mg (10 tablets 41,152 Novartis 3,000 Glenmark

22,282 4,485
cisely what happened with the vaccine
Nozolamide 250 mg (5 capsules) Dr Reddys Sun

Pemetrexed 500 mg (vial) 73,660 Eli Lilly 11,990 Glenmark commitments made by private vaccine
Exemestane25 mg (30 tablets) 4,315 Pfizer 1,290 Natco manufacturers after the infamous closure of
Source: "NPPA Study Finds Huge Gap in Cancer Drug Prices", Joe C Mathew in Business Standard, New Delhi, 31 October 2010. the vaccine public sector units (psus) by the

Table 4: Difference in MRPs of LOCOSTand Retail Market Brands

No NameofDrug Strength L0C0ST MRP Brand Name and Manufacturer Per MIMS (December 2008) Lowest MRP To L0C0ST MRP (%)
1 Albendazoletabs 400 mg Rs 14.85 per strip of 10 tabs Albezole- Khandelwal Rs 12.00 per tablets 65
Combantrin-Pfizer Rs 14.83 per tablets
Nemozole-IPCA Rs 9.75 pertablets
Zentel -GSK Rs 17.00 pertablets
2 Amlodipinetabs 5 mg Rs 3.70 per strip of 10 tabs Amlodac - Zy - Alidac Rs 15.10 per strip of 10 tablets 408

Amlopres-Cipla Rs 36.86 per strip of 15 tablets

Calchek- IPCA Rs 22.50 per strip of 10 tablets
Lama -Stadmed Rs 15.03 per strip of 10 tablets
Myodura - Wockhardt Rs 15.45 per strip of 7 tablets
3 Amoxycillin caps 250 mg Rs 12.50 per strip of 10 caps Amoxil - Zydus Cadila Rs 18.60 per strip of 6 capsules 248
Amoxivan - Khandelwal Rs 33.00 per strip of 10 capsules
Biomoxil-Biochem Rs 37.73 per strip of 10 capsules
Loxyn - AFD Rs 35.50 per strip of 10 capsules
MOX- Ranbaxy Rs 67.50 per strip of 15 capsules
Novamox-Cipla Rs 65.00 per strip of 15 capsules
4 Amoxycillin caps 500 mg Rs 22.00 per strip of 10 caps Amoxil - Zydus Cadila Rs 35.40 per strip of 6 capsules 268
Amoxivan - Khandelwal Rs 65.00 per strip of 10 capsules
Biomoxil - Biochem Rs 68.17 per strip of 10 capsules
Loxyn - AFD Rs 38.33 per strip of 6 capsules
MOX-Ranbaxy Rs 120.80 per strip of 15 capsules
Novamox-Cipla Rs 48.95 per strip of 6 capsules
5 Atenolol tabs 50 mg Rs 4.25 per strip of 14 tabs Aten - Zydus Cadila Rs 30.71 per strip of 14tablets 647
LONOL- Khandelwal Rs 27.50 per strip of 14 tablets
Tenolol-IPCA Rs 32.35 per strip of 14tablets
Tenormin - Nicholas Piramal Rs 40.00 per strip of 14 tablets
6 Diazepam tabs 5 mg Rs 1.70 per strip of 10 tabs Calmpose - Ranbaxy Rs 22.00 per strip of 10 tablets 823

Placidox-Lupin Rs 14.00 per strip of 10 tablets

Valium - Nicholas Piramal Rs 23.00 per strip of 10 tablets
7 Enalapril Maleate 5 mg Rs 4.40 per strip of 10 tabs Ena-5-Stadmed Rs 19.00 per strip of 10 tablets 431
Enace - Nicholas Piramal Rs 25.85 per strip of 10 tablets
Envas- Cadila Rs 46.07 per strip of 15 tablets
Nuril-USV Rs 25.00 per strip of 10 tablets
8 Fluconazole caps 150 mg Rs 31.25 per strip of 10 caps Forcan-Cipla Rs 34.51 per capsules 1,104
Syscan -Torrent Rs 41.00 per capsules
9 Glibenclamidetabs 5 mg Rs3.35 per strip of 10 tabs Daonil - Aventis Rs 9.00 per strip of 10 tablets 262

Euglucon - Nicholas Piramal Rs 8.80 per strip of 10 tablets

10 Metformin tabs 500 mg Rs 5.20 per strip of 10 tabs Glyciphage - Franco Indian Rs 17.25 per strip of 10 tablets 138

Walaphage - Wallace Rs 7.20 per strip of 10 tablets

11 Diclofenac tabs 50 mg Rs 3.00 per strip of 10 tabs NAC - Systopic Rs 16.00 per strip of 10 tablets 533

Tromagesic-Themis Rs 3.15 per strip of 10 tablets

Voveran - Novartis Rs 34.70 per 15 tablets
12 Paracetamol tabs 500 mg Rs 3.80 per strip of 10 tabs Crocin-GSK Rs 16.50 per strip of 15 tablets 165

Calpol - GSK Rs 10.50 per strip of 10 tablets

Malidens - Nicholas Piramal Rs 9.60 per strip of 10 tablets
Pacimol-IPCA Rs 6.30 per strip of 10 tablets
13 Rifampicin caps 450 mg Rs 34.50 per strip of 10 caps R-CIN — Rs 42.39 per strip of 10 capsules 122

Rifamycin - Biochem Rs 59.18 per strip of 10 capsules

Rimactane - Novartis Rs 22.90 per strip of 4 capsules
14 Salbutamoltabs 4mg Rs 1.90 per strip of 10 tabs Asthalin -Cipla Rs5.21 per strip of 10 tablets 109

Salmeplon - Khandelwal Rs2.08 per strip of 10 tablets

The prices of the other brands were taken from MIMS, December 2008.
LOCOST prices are from January-March 2009 price list. The situation has not changed much in the two years since.

46 june li, 2011 vol xlvi no 24 0353 Economic & Political weekly

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 INSIGHT

then union Health Minister A Ramadoss. biotech drugs is sought to be moved to

ever present threat of these being intro
It is also unclear how the numerous players the department of biotechnology (dbt)
duced in the retail market first followed by
will divide the cake of government supply. thus moving it out of the purview of drug
the vaccine manufacturer lobby's attempt
to conduct "demonstration projects" toprice regulation too which is currently un
Regulating Vaccines universalise them through the public der the department of pharmaceuticals,
and Biotech Products
health system. These concerns again areministry of chemicals and fertilisers. In
The current trend - backed and initiated not theoretical and have been discussed,
fact, biotechnology is the new sacred cow
by the influential Bill Gates among othersin the context of the hpv vaccine, in this
that has to be given a long rope as the older
- is to advocate vaccines for many of the
journal earlier.21 ones like (the departments of) atomic
health problems facing the developing As regards biologies, it is debatable energy and space lose their sheen.23
world. Indeed it is good to have a cure, whether the optimism or for that matter,
Box 2: Cost of Treatment with Biotechnology
the high prices are justified (see Box 2).based Drugs24
and a vaccine, if we could, for say, hiv. But
when supply of clean water and food is the Avastin (or Bevacizumab of Genentech/ • Abciximab (antianginal, Eli Lily): Rs 39,480 for a
60 kg man per day
Roche, a drug used to treat various can
solution, why resort to vaccines? If vaccine
• Epoeitin alfa (Wepox/Wockhardt, Treatment of
cers, including colorectal, lung, and kid
manufacturers had their way, 54 vaccines anaemia of chronic renal failure): Rs 10,200 for 8
ney cancer) extends the life of a cancer
would enter India. However our perform weeks for a 60 kg man and
• Rs 1,912 to 11,475 per week for a 60 kg man
ance with epi itself is very poor. Full impatient by a few months. Here is what one thereafter
munisation - bcg, DPT3, 0PV3, Measlesindustry researcher has to say, • Interferon alpha-2a (Roferan-A/Nicholas Piramal)
was 66% maximum, probably significant .. .the hype (in the western biotech industry) used in types of leukaemia: Initial therapy costs
of Rs 43,552- Rs 1,30,656, then maintenance
ly lower in 2008.18 Table 5 shows the kind would have us believe that it is a roaring therapy costs of Rs 1,06,158- Rs 3,18,474 (6-18
of markups prevalent in vaccines since success. Financially this is certainly not the months cost)
case. The top 2 or 3 companies account for• Etanercept (Enbrel/Wyeth) -in severe arthiritis:
there is no price regulation.
most of the revenues, and just a few years Rs 18,131 per week of therapy which has to be
A national workshop of academicians and ago it was estimated that the industry as a taken long-term.
concerned health activists which met in whole has lost $100 billion since its incep
June 2009 proposed a draft national policy.19tion in the 1970s (The Economist, 2006). AreCompulsory Licences
these disastrous financial figures compen
As the draft vaccine policy points out, Much has been written on using compul
sated by overwhelming medical success? It
sory licence (cl) as a means of promoting
The choice of which vaccine to give (or not does not appear so. One of the most well
to give), target population, and mode of ad known biologies is Avastin, used to treat generic competition. India's Patents Act
ministration (dosage, schedule, interval be various cancers, which had revenues of $5.7
provides25 for it under Sections 84 (if initi
tween doses, intramuscular or intradermal, billion in 2009 (Allison 2010). This extends
ated by a private party), 92 (notification by
etc), are important policy decisions that life by a couple of months (Shaffer 2010).
government that a cl needs to be issued
must be guided by a strong scientific ration Medically speaking one might well describe
ale, after wider scientific debate in the coun Avastin as a qualified success and yet it
for public non-commercial use, national
try, with rigorous inputs from multicentric is one of the blockbusters of the emergency or extreme urgency), 92A (cl
industry.
field epidemiology, irrespective of whether Undoubtedly there are biologies that do a lotfor generic exports) and 100 (for govern
it has been proven in populations abroad... of good, especially for certain patients (and,
ment use). Nothing much has been done in
Combining any uip (Universal Immunisa financially for certain companies), but that is
this regard in India in terms of using these
tion Programme) vaccine with any non-uip not the whole picture.22
provisions. Thailand, Malaysia, Indonesia,
vaccine needs rigorous scrutiny and public
debate. Other combinations must be proven In any case it is illogical to keep Cameroon, Eritrea, Zambia, Zimbabwe,
these
biotech
to be equivalent to or more effective and safer drugs out of the purview of the
Ghana, Mozambique, Ecuador, Brazil, Italy,
than single vaccines before adoption.20 Drugs and Cosmetics Act. All biotechCanada and Israel, have been far more
drugs are overpriced and there is nocourageous in issuing cls despite the per
Costs, efficacy and effectiveness are ob
price regulation. In fact the regulation ceived
viously very important especially with the of strategic vulnerabilities of some of
them with respect to the western govern
Table 5: Difference in Vaccine MRPs and the Prices for Physicians
Vaccine Constituent Vaccines MRP in Rupees, Price Offered to Discount in Percentage ments where the principal big pharmaceu
2008(A) Physicians in Rupees (A-B) Margin of Profit
Rupees (B) for the Physician
tical companies are located. India is one of
(A-B)*100/B
the few countries where issuing cls for
Pentaxim Diphtheria, Tetanus, acellular pertusis, local manufacture is meaningful, because
inactivated poliomyelitis vaccine,
2,066 1,446 620 42.9 Indian industry has the capacity to back it
Haemophilus influenzae b conjugate vaccine

Imovax polio Inactivated Poliomelitis vaccine 365 280 85 30.4 up by actually manufacturing the drugs so
Tripacel Component pertusis, Diphtheria and tetanus toxoids 1,211 762 449 58.9 licensed. Also, there are at least a couple of
Okavax Varicella vaccine 1,468 986 482 48.9 drugs for which a cl initiated by the gov
Avaxim80 Hepatitis A vaccine 952 665 287 43.2 ernment would be of use to the hiv patient
TetractHib Diphtheria, Tetanus, pertusis, Haemophilus community at large - for instance, Ralte
influenzae b conjugate vaccine 504 305 199 65.2
gravir, Etravirine, Rilpivirine, Maraviroc -
ActHib Haemophilus influenzae b conjugate vaccine 426 251 175 69.7
all useful in the new types of resistant
Source: Lodha, Rakesh and Anurag Bhargava (2010): "Financial incentives and the Prescription of Newer Vaccines by Doctors in
India", Indian Journal ofMedical Ethics, January-March, VII: 1. strains of hiv. To that one can add pegylated

Economic & Political weekly 0353 june 11, 2011 vol xlvi no 24 47

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INSIGHT

failures of health markets, continue toproducts imported from countries like

interferon (for chronic hepatitis c), a patent
granted despite post-grant opposition; and (or fail to clearly speak up against)India/China. But they are actually pro
espouse
trips plus (more than that required by
sorafenib tosylate (useful for renal cancer), tecting their turf from Indian generics and
erlotinib (useful in lung cancer) - the measures. These include: data excluhence their (western pharma's) own bot
trips)
sivitya - in bilateral Free Trade Agreementstomlines. Competition has been elevated
patent-worthiness of the last two is still
matter of dispute in the courts.26 (ftas); the attempts to derail Section 3d ofto an economic war of attrition and a war
There has been a most encouraging
the amended Patents Act 2005 of India;28
by all means fair and foul, including creat
"Note on cl" by the Department of against
Indus border measures proposed on ing trade barriers gift-wrapped in the lan
trial Policy and Promotion (dipp)27 of the
Anti-Counterfeit guage of intellectual property (ip) protec
Trade Agreement (acta);29
2010. the conflating and clubbing oftion, quality and protection of invest
government of India around July against
From what one can discern the matter is issues of intellectual property with publicments. Many international civil society
advocates of access to medicines (from the
likely to be stymied by those in the Indianhealth issues relating to issues of quality
cabinet who think issuing cls will sendof drugs under the guise of the who us, eu, South America and Africa) are
the "wrong signal" to those interested inbacked International Medical Products aghast at their own governments acting as
investing in this country. India does notAnti-Counterfeiting Task Force (impact);
accomplices of the commercial agenda of
need foreign direct investment (fdi) in theand of late, investment measures in bilat
big pharma and continue to be at the fore
eral ftas being secretly negotiated
pharma sector and issuing of cls would be - of countering the harmful effects of
front
well within trips provisions, the Dohanotoriously the investor-to-tate dispute
these newer barriers to cheaper generics.
Agreement and the so-called August 30settlement provisions.30 "If you cannot beat the competition, buy
provisions. All these are settled matters it out" is another popular strategy. Thus at
internationally, with maybe differences in'Counterfeit'
Charges least six major Indian pharma companies
particularities. Likewise the market quaUnfortunately these efforts are madehave
by been partially and completely bought
market ideologues in the Indian cabinet,the European Union/American govern over with at least four others having major
including the respected economist primements at the behest of the big pharma marketing tie-ups with multinational cor
porations (mncs). This trend does not
minister, despite the accepted wisdomlobbies ostensibly to protect their peoples
augur well for the health security and
about inherent asymmetries and potentialfrom harmful, spurious, and "counterfeit"

MAHATMA GANDHI UNIVERSITY

SCHOOL OF INTERNATIONAL RELATIONS AND POLITICS
PRIYADARSINI HILLS P.O, KOTTAYAM, KERALA -686560

NOTIFICATION

Applications are invited for the following Post Graduates Programmes in the School of Internatio
Politics, Mahatma Gandhi University.

1. M.A Public Policy and Governance

2. M.A Politics and International Relations

3. M.A Politics and Human Rights

4. M.Phil in Politics and International Relations

Admission is based on the marks of qualifying examination, entrance test and interview.

The last date for receiving the applications in the office is 21 June, 2011. Application form and other de
be downloaded from the university website www.mquniversity.ac.in.www.sirpmgu.in

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48 june li, 2011 vol xlvi no 24 B353 Economic & Political weekly

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 INSIGHT

(Vadodara/Bilaspur: LOCOST/JSS), also available Richard R Nelson, Bhaven N Sampat and Arvids A
pharma self-sufficiency of India or for the Ziedonis (2001): "The Growth of Patenting and
online at: http://www.scribd.com/my_document_
many countries counting on India as the
collections/2879052 and http://www.scribd. Licensing by US Universities: An Assessment of
com/my_ document_ collections/ 2474529 the Effects of the Bayh-Dole Act of 1980", Research
pharmacy of the world. The sooner the
io The Sandhu Committee Report of 2004, the Policy, 30: 99-119
government takes measures to stem the easy 18 See for immunisation coverage figures for 2008:
earlier Drug Price Control Review Committee
http://www.searo.who.int/vaccine/LinkFiles/
Report of 1999, and a Task Force appointed by the
pickings that home grown drug companies
PMO EPl2oo8/Indiao8.pdf, accessed 29 April 2011.
in 2005 and chaired by Pronab Sen from the
have become, the more hopeful we canPlanning
be 19 Y Madhavi et al (2010): "Evidence-based National
Commission, the Commission on Macr
oeconomics and Health 2004, etc, - all have en Vaccine Policy", Indian J Med Res, May, 131: 617-28.
of realising dreams of universal accessdorsed
to price regulation of drugs. 20 There is another recent draft at the behest of the
healthcare. One can only hope for a iishift
Recommendations/observations of the Committee, government that is doing the rounds and that
Para 10 in "Availability and Price Management of negates this sound principle, inter alia.
in the mindsets of those in power to effect
Drugs and Pharmaceuticals". Seventh Report,
21 Sarojini N B, Sandhya Srinivasan, Madhavi Y,
the change. Those without access to medi
Standing Committee on Chemicals and Fertilisers, Srinivasan S and Anjali Shenoi (2010): "The HPV
2005-06, Fourteenth Lok Sabha, Lok Sabha Secre Vaccine: Science, Ethics and Regulation", Eco
cines in India and elsewhere expect it as a New Delhi, September 2005.
tariat, nomic & Political Weekly, 27 November, XLV: 48.
12 The draft policy had several other recommenda
matter of human right and entitlement. 22 Personal Communication from industry observer
tions but it was quietly shelved because of opposi and researcher Gayatri Saberwal, 29 April 2011.
tion from India's pharma industry on the price The citations in the quote refer to the following:
NOTES regulation aspects. "Profitless Prosperity". The Economist. 379, 63 (22
i For some reasons not analysed sufficiently, India
13 "On Issues Relating to Availability of Generic, April 2006); Allison, M "Avastin's Commercial
dominates the formulations market internation Generic-Branded and Branded Medicines, Their March Suffers Setback", Nature Biotechnol, 28,
Formulation and Therapeutic Efficacy and Effec 879-80 (2010); and Shaffer, C "Pfizer Explores Rare
ally and China dominates the API market.
tiveness" (Presented to the Rajya Sabha on 4 Au Disease Path". Nature Biotechnol, 28,881-82 (2010).
2 See Sakthivel Selvaraj and Anup K Karan (2009):
gust 2010) (Laid on the table of the Lok Sabha on
23 The Draft Biotechnology Regulatory Authority of
"Deepening Health Insecurity in India: Evidence
4 August 2010). India Bill 2009 also has the by now infamous
from National Sample Surveys since 1980s", Eco
14 Ruth R Faden and Kalipso Chalkidou (2011): clause, Section 63, that proposes imprisonment
nomic & Political Weekly, 3 October, XLIV: 40.
"Determining the Value of Drugs - The Evolving and fine for anyone who "without evidence or
3 Narendra Gupta (2010-11): "What It Costs to Pro
British Experience", N Engl J Med, 7 April, 364 scientific record misleads the public about safety
vide Medicines to All Sick Persons in India", MFC
(14). As the authors point out, "Contrary to some of GM crops". No soft-pedalling of the law here.
Bulletin, August-January, Issue 342-43.
reports, NICE has no authority to restrict access - Space and Atomic Energy - presumably one can
4 Can be curtailed possibly by spelling out reim British law mandates only that the NHS provide 'mislead' and get away to some extent.
bursable costs of each test and diagnostic proce funding to cover recommended drugs. Nor 24
is Figures courtesy Anurag Bhargava, 2008.
dure - assuming we are talking of a universal NICE responsible for setting drug prices. In the 10
access system that will specify reimbursable costs 25 Section 84 - CLs initiated by generic companies who
to 15% of cases in which it recommends against
to private practitioners. can apply when (a) the reasonable requirements
providing access to a drug because of poor cost
5 See www.tnmsc.com for latest procurement of the public with respect to the patented inven
effectiveness or clinical effectiveness, stakehold
tion have not been satisfied or (b) it is not availa
prices of TNMSC, accessed 29 April 2011. Also, ers regularly exercise their right to appeal the de
S Srinivasan (1999): "How Many Aspirins to the ble to the public at a reasonably affordable price
cision and are sometimes successful. (Roughly
and (c) the patent is not being worked. The grant
Rupee? Runaway Drug Prices", Economic & Politi 30% of the NICE recommendations are appealed,
cal Weekly, 27 February-5 March.
of CLs to competitors such as generic companies
and roughly 10% of the appeals result in substan
can be an effective measure to make patented
6 See: Low Cost (Generic) Medicines Initiative, tial changes to the recommendations.)" Thanks to
drugs affordable and available. However, the pro
Chittorgarh, at http://chittorgarh.nic.in/Generic_ Sunita Sheel for pointing out this report.
visions impose a three-year waiting period from
new/ generic.htm. and http://nagaur.nic.in/ 15 For a spirited summary of the arguments against
the date of the grant of the patent before a generic
GMP.htm, viewed 29 April 2011. Also, S Srinivas high R&D costs, see Donald W Light and Rebecca company can make an application for a CL.
an (2009): "Too Good To Be True But True: Retail Warburton (2011): "Demythologising the High
Sale of Generic Drugs at Low Prices by the Gov Section 92 - Notification by central government
Costs of Pharmaceutical Research", BioSocieties,
ernment in Chittorgarh District", Health Action, in the official gazette that a CL needs to be issued
6:34-50.
September, also in MFC Bulletin, October 2009 16 There is a vast burgeoning literature on pharma for public non-commercial use, national emergency
January 2010.
or extreme urgency. After the notification, the
innovation and desirable policies in a post-2005,
patent controller can grant a compulsory license
7 Maulin R Chokshi (2008): "TN Drug Procurement product patent world, especially on how to use to a generic company so that the drug is made
Model", WHO-SEARO. TRIPS flexibilities, how to get around patenting available to the public at an affordable price.
8 For medicine price mechanisms in other countries, by prize funds, patent pools, etc. The degree of
Section 92A - CL to generic company when another
see Chapter III of the Report of the Drug Price Control their belief in the sanctity of the TRIPS/WTO sys
country wants to import drugs. This provision is
Review Committee, Dept of Chemicals and Petro tem varies and mostly not stated upfront. Never
important, as Indian generic manufacturers play
chemicals, New Delhi, October 1999. For a more theless, see for instance, Joseph E Stiglitz and Ar
a key role in supplying medicines to developing
recent review of these, see: Sengupta, Amit, Reji jun Jayadev (2010): "Medicine for Tomorrow:
countries with insufficient manufacturing capacity.
K Joseph, Shilpa Modi and Nirmalya Syam (2008): Some Alternative Proposals to Promote Socially
"Economic Constraints to Access to Essential Section 100 - Government use licence, which will
Beneficial Research and Development in Pharma
Medicines in India", Centre for Technology and ceuticals", Journal of Generic Medicines, 7 July: apply in situations where the government needs
Development and Society for Economic and So 217-26; and the readable chapter 8 on "A Policy to manufacture, procure, distribute and sell the
cial Studies in Collaboration with WHO SEARO. A Agenda for IP, Access and Innovation" in T Hoen, patented drug on a non-commercial basis.
more recent news item (2011) at "Germany Caps Ellen F M (2009): The Global Politics of Pharma 26 "Two domestic drug makers", according to a re
Drug Prices", Nature Biotechnology, February, 29 (2). ceutical Monopoly Power: Drug Patents, Access, In port in the Business Standard, 3 May 2011 (http://
novation and the Application of the WTO Doha www.business-standard.com/india/news/domestic
For other views, see Gregson, Nigel, Keiron Spar
rowhawk, Josephine Mauskopf and John Paul Declaration on TRIPS and Public Health (Nether -drug-makers-set-to-invoke-compulsory-licensin
(2005):- "A Guide to Drug Discovery: Pricing lands: AMB). And the more legally researched g-route-by-june/434161/), "Cipla and Natco, are
Medicines: Theory and Practice, Challenges and tract by Spennemann, Christoph and Jerome H known to have already written such requests to
Opportunities", Nature Reviews Drug Discovery, Reichman (2011): Using Intellectual Property global pharmaceutical MNCs for such a contract
4 February: 121-30. For a review of the use of evi Rights to Stimulate Pharmaceutical Production in to manufacture an AIDS drug and a cancer drug,
dence in the market approval process, reimburse Developing Countries: A Reference Guide (New respectively. Natco's request for permission to
ment, and price control mechanisms for medicines York, Geneva: UNCTAD, United Nations). To touch manufacture a generic version of cancer drug Sor
and medical devices in Thailand, South Korea, base with Indian reality, see Sudip Chaudhuri, afenib has been rejected by Bayer. Cipla is await
and Taiwan, see Jirawattanapisal, Thidaporn, Chan Park and K M Gopakumar (2010): Five Years ing a response from Merck on AIDS drug Raltgravir.
Pritaporn Kingkaew, Tae-Jin Lee, Ming-Chin into the Product Patent Regime: India's Response The next step, following an unsuccessful attempt
Yang (2009): "Evidence-Based Decision-Making (New York: UNDP). to enter into a contract, will be to apply for a com
in Asia-Pacific with Rapidly Changing Healthcare17 See Sara Boettiger and Alan B Bennett (2006): pulsory licence....three cancer drugs - Nilotinib,
Systems: Thailand, South Korea, and Taiwan", 'Bayh-Dole: If We Knew Then What We Know exclusively marketed by Novartis under the brand
Value in Health, Vol 12, SUP3 [Note(s): S4-S11]. Now", Nature Biotechnology, 24: 320-23. Also see name Tasigna; Sunitinib, marketed by Pfizer as
Thanks to Szymon Jaroslawski for these papers. Bhaven N Sampat. The Bayh-Dole Model in Devel Sutent; and Bristol Myers Squibb's Dasatinib
9 We have discussed this at length in LOCOST (2006): oping Countries: Reflections on the Indian Bill on (brandname Sprycel) - are the other products
A LayPerson's Guide to Medicines: What Is in Them Publicly Funded Intellectual Property. UNCTAD eyed by domestic pharma companies for compul
and What Is Behind Them (Vadodara: LOCOST). ICTSD Project on Sustainable Development on sory licensing opportunities".
And also in LOCOST/JSS (2004): Impoverishing IPRs and Sustainable Development. Policy Brief See http://dipp.nic.in/ipr-feedback/CL-DraftDis
the Poor: Pharmaceuticals and Drug Pricing in India Number 5, October 2009. Also David C Mowery, cussion.doc, accessed 29 April 2011. The DIPP of

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INSIGHT

the Government of India administers the Patents recollect that these are at tnmsc rates which are
health, the facilities are geographically acces
Act 1970, the Trade Mark Act 1999, Geographical
sible - which is of course not true generally. very low and are quoted at just above bare costs
Indications of Goods Act, 1999 and Designs Act,
of manufacture. If India's pharma industry sells
2000. It also coordinates issues relating to World (2) Population of Tamil Nadu and India: 7.2 crore
medicines at this rate and only these essential
Intellectual Property Organisation (WIPO) in and 121 crore (2011 provisional census figures).
consultation with other ministries. A departmental medicines at that, they probably will be in a
(3) Tamil Nadu government drug budget for
release of 11 April 2011 clarified, "As the existing
legal framework is comprehensive, government
medicines 2011-12: Rs 142.88 crore out of a to
spot of a bother with respect to sustainability
has decided that there is no need to issue additional and viability. We suggest that the Chittorgarh/
tal health budget of Rs 4,554 crore (Table 6).
guidelines for the issue of compulsory licences". There is a bias in tn government policies of lateNagaur figures, which are on the average 3-4
28 Internationally acclaimed by developing countries times the tnmsc price, are more realistic. Or like
towards tertiary care.
and positive groups as a life-saving measure that
prevents evergreening and frivolous patenting, a Table 6: Amount Budgeted for Supply of Medicines through TNMSC (2011-12)
clause that prevented the product patenting of at Account Head Amount Budgeted Source
least the following drugs after vigorous contesta 2011-12 (inCrore)
tion pre-grant, post-grant: lamivudine/zidovudine
Directorate of public health
(fixed-dose combination); tenofovir (intermediate,
3.00 http://www.tn.gov.in/tnbudget/demands/d1904.pdf
salt and pro-drug forms); darunavir polymorph; and preventive medicine
tenofovir disoproxil fumarate/emtricitabine (co Directorate of medical and rural health services 61.88 http://www.tn.gov.in/tnbudget/demands/d1902.pdf
formulation); imatinib crystalline form; pro-drug
Directorate of medical education 78.00 http://www.tn.gov.in/tnbudget/demands/d1903.pdf
of oseltamivir; crystalline adefovir dipivoxil;
crystalline adefovir dipivoxil; and valgancyclovir. Total 142.88

29 For instance: See chapter 2 (full text at http://

trade.ec.europa.eu/doclib/docs/2oio/ decem (4) We add another 25% (liberal guesstimate) the figures of socially-oriented manufacturers
ber/tradoc_i47079.pdf, accessed 29 April 2011) of
the released text, dated 3 December 2010, pro for medicine supply under other special pro
like locost (prices at www.locostindia.com).
vides for Border Measures in case of all IPRs, not grammes for chronic and endemic diseases like These rates (that of Chittorgarh, locost et al)
only copyrights and trademarks. It also includes tb, malaria, leprosy, hiv, renal problems, car will ensure better accommodation for manu
exports; it also includes in-transit consignments
diovascular diseases, etc. The above total of facturer's overheads and distribution margins/
under customs supervision. We can all anticipate
the effect of these strong border measures on the Rs 142.88 crore will be revised to Rs 178.60 crore. overheads of the supply chain. So we will make
flow of in-transit generic medicines. These meas (5) We also assume that the prescriptions and the above estimate 4 times Rs 7,504 crore that
ures are one-sided and there is little recourse for
treatment are by and large rational in the tn is around Rs 30,000 crore. This figure also is of
review of decisions or appeal against them by
those affected. ACTA ignores and bypasses exist government system - so there is none of the pri
the same order as that of Gupta et al who use
ing multilateral processes provided like WTO and vate sector waste. Or at best negligible. Chittorgarh procurement rates.
the World Intellectual Property Organisation (6) We assume from a calculation of N Lalitha (io) Of course, if the Government of India does
(WIPO), and its enforcement level beyond the
of Gujarat Institue of Development Research not rationalise the kinds of medicines produced
minimum mandated by TRIPS.
See also European Commission (EC)'s comments (personal communication) that the utilisation in in India or regulates their prices, we would
on the "Opinion of European Academics on Anti Tamil Nadu of public health facilities is around suggest then that in this business as usual sce
Counterfeiting Trade Agreement" at http:// 40% - a figure projected for 2005-06 from nss nario, we will require only Rs 7,504 crore plus
trade, ec.eur0pa.eu/d0clib/d0cs/2011/april/tra
doc_ 147853.pdf, accessed 29 April 2011. 60th round figures (January-June 2004). 25% margin for retailer-wholesaler, that is a
30 Investor-to-state" dispute mechanism is basically a (7) Therefore for complete utilisation the to maximum of Rs 9,380 crore: because we expect
provision that can enable EU corporations (as well tal medicine demand would work out to be that some distribution under a universal access
as those of other countries like the US) who qualify framework will still need to be done through
(Rs 178.60 crore x 100V40 = Rs 446.50 crore.
as foreign investors to take the Indian government
to private arbitration panels over domestic health (8) For a population of 7.2 crore, it is Rs private retail pharmacy shops who will retail
62.01
policies like tobacco control legislations, banning per capita. For India's population of 121 crore, these low-priced generics as well as other cost
of dangerous chemicals and measures to reduce this would be Rs 7,504 crore. lier medicines, with the latter being their bread
prices of medicines. Particularly, the tobacco,
chemical and pharmaceutical corporations can (9) This seems a puny figure, but we need to
and butter, and jam, as it is currently.
easily challenge domestic laws and policies to sue
and obtain damages of millions of euros or dollars
against the Indian government through interna
tional arbitral proceedings if their investments LADY SHRI RAM COLLEGE FOR WOMEN
(profits) are allegedly impeded by Indian environ
mental and public health policies and legislation. University of Delhi
Source for this formulation: Briefing Note of Delhi
Network of Positive People (May 2011): "Invest
ment Provisions in the EU-India FTA: Impact on Invites applications for
Access to Medicines" (New Delhi: DNP+).

Annexure 1: Estimating Drug Requirements 2 year Diploma Course in Conflict Transformation &
of India under Universal Access to Health for All
Peacebuilding Program 2011-2012
Assumptions:
(l) We have used utilisation figures of the
The Diploma is open to undergraduate and graduate students,
Tamil Nadu government, from the Tamil Nadu
budget documents, and its procurement agency Armed forces personnel, Civil Servants, NGO Workers, Researchers,
the Tamil Nadu Medical Services Corpora Journalists and Grassroot practitioners.
tion (tnmsc). We do not define utilisation but
we use it here as some rough indicator of the The course is open to both men and women
percentage of total population of the state us
ing the services of the Tamil Nadu public health Application forms can be downloaded from :
system where "using" means attendance at www.lsr.edu.in
an outpatient department per year and/or in
patient services per year when otherwise the
person seeking treatment would have had the Last Date for the Submission of forms - 16th July 20
option to go to the private practitioner/private For Further Information contact: 011-45494949,26434459 & 0999904
sector. We also assume for all those who seek

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