As a university law lecturer, Nat is struggling to make ends meet. Her monthly salary of 33,000 baht is only a fraction of the cost of the super-expensive cancer drug she has been taking.
In August 2022, Nat (real name withheld) was diagnosed with lung cancer. Living in Nongkhai, where the provincial hospital has only one oncologist, initially, she did not know what type of lung cancer she had.
Only after her family arranged to have further lab tests in Bangkok, paying out of their own pocket, did she learn her type of cancer is called Anaplastic Lymphoma Kinase (ALK) positive. And the cost of the targeted therapy drug is 112,400 baht a month.
After the first year, a pharmaceutical company offered Nat a discount. For a 12-month supply, she has to pay for eight months, and the rest would be considered "free".
In other words, since the second year of her diagnosis, Nat has been paying an average of 74,000 baht a month under the Independent Processing Service (IPS) programme with that drug company.
Even with this substantially reduced price and financial support from her family, Nat found the monthly drug bills an ever-harder burden to bear. Unlike in the old days, new generations of university lecturers like Nat are no longer government officers and are thus not entitled to medical benefits.
I share her feelings. In early 2014, I was diagnosed with stage-four lung cancer. Thanks to my oncologist's arrangement, I have been on a target therapy drug under the Compassionate Use programme, which has enabled me to survive until now. That would have been impossible were I to pay for the expensive drug myself.
Several years ago, my late older brother, also a lung cancer patient but of a different type from Nat's, had to sell his house to pay for the target therapy medicine, which cost him 239,000 baht a month. He had to move to live with his son's family before succumbing to the disease finally.
Living near the Lao border, Nat recently learned from her aunt in Vientiane that there is a "medicine" (name withheld) that looks like her cancer medicine, touted to cure all kinds of cancer and much sought after by Chinese and Vietnamese patients.
For a while, she toyed with the idea of switching to this much cheaper drug. Researching further, Nat learned the drug from Laos is bogus or unlicensed, manufactured in Sri Lanka. Her oncologist advised her to stick with the original drug.
Nat does not know how much longer she can shoulder the pricey drug before going bankrupt. What about countless other patients who cannot even afford a lab test to identify their type of cancer cells, let alone pay for the exorbitant target therapy drugs and thus end up with chemotherapy, which is a non-targeted treatment? Chemotherapy comes with multiple side effects.
Despite their life-extending potential, the targeted therapies are not covered by our government's sponsored Cancer Anywhere scheme. Nor are they provided by the Universal Health Coverage, which offers only a limited number of drugs under the National List of Essential Medicines.
According to the International Agency for Research on Cancer, under the World Health Organization (WHO), in 2022, there were 183,541 new cancer cases in Thailand, and the number of death tolls was 118,829. It was predicted that there would be a 50% increase in incidence by 2045. Every year, Thailand pays billions of baht for the imported cancer drugs.
The prospect for cancer patients looks dim. Yes, there are several research trials on new medicines recruiting patients, but very few Thais can read English to tap into this resource. What about cancer patients uniting themselves to push for a public policy change for affordable drugs?
Considering their daily struggle with the symptoms, spending hours waiting for their medical appointments at a hospital, on top of earning a living and raising their families and money to pay for the drugs themselves; the possibility of such a grassroots movement is small.
One idea of solution revolves around the government using Compulsory Licensing (CL) and other negotiation mechanisms to have drug prices lowered. Under the Doha Declaration, developing countries may resort to producing affordable drugs for patients in critical need. In 2006–2008, the late Dr Mongkol Na Songkhla, as public health minister, successfully pushed through this CL channel for drastic price reduction of drugs for HIV, cardiovascular and cancer diseases. Dr Mongkol's courage and political will, and strong support networks among the HIV patients at the time, continue to be an inspiring model. Will the current officials in charge of public health policy have similar vision and bravery to intervene on behalf of patients with cancer and other debilitating diseases?
Curiously, in September 2020, the Petroleum Authority of Thailand (PTT) announced a big joint project with the Government Pharmaceutical Organization (GPO) to set up a multi-billion-baht factory to produce cancer medicine. The original timeline was that construction of the factory to be located in Rayong would begin in 2022, and the manufacturing and commercial distribution of medicine could transpire by 2027. Such an initiative by the PTT looked commendable and should be emulated by other large conglomerates to show their social responsibility. However, I tried to contact several PTT staff, and no one appeared aware of the existence of the project, let alone its progress.
Alternatives to help patients like Nat to survive include promoting the GPO to conduct more research and development of cancer drugs that would be affordable and meet the WHO prequalification schemes of bioequivalence and bioavailability. Another option is to explore the possibility of importing cheaper but effective generic drugs from India and have the GPO prove its bioequivalence. Several Indian pharmaceutical firms have made use of international treaties like the Doha Declaration provision on CL to develop cancer medicines that have saved numerous patients medically and financially. After all, drugs are essential goods and should not be a vehicle to drive people to despair and bankruptcy.
Supara Janchitfah is an award-winning journalist and former Bangkok Post reporter. The article is published to mark World Cancer Day on Feb 4.