Wednesday morning, July 4th.  Independence Day in the United States.  But as I’m not in the United States, I take it as a regular work day and will instead take some local holiday in exchange.  Not to be completely unpatriotic, Kobfa and I meet up for a return trip to Sunrise Tacos.  The first and second visits in late May were very tasty but there were still some gaps, mostly in terms of the quality of the tortillas and the heat (or lack thereof) in the hot sauces.

Sunrise Tacos is within walking distance of my apartment and all the way down Soi Asoke I was looking at the sky, wondering just how many minutes I had left before the coming storm would completely break loose.  Thankfully, I made it to the covered walkway leading from the Asoke BTS station towards Times Square.  Just as I took the above picture, it started sprinkling and that turned to a downpour in a matter of seconds.

By the time Kobfa arrived less than ten minutes later, the energy of the storm had dissipated and the rain had stopped.  It is amazing to me how much rain is dumped in such a short time.

At Sunrise Tacos, we placed our order and dove into a basket of chips and guacamole in order to discover whether the most critical problem had been addressed: tortilla quality. 

In my previous visit  I had found the tortillas to be too thick and quite tough.  After writing on this site, I received a message from Greg Lange, “Food Taster/Owner” of Sunrise.  He explained that they were working to resolve this issue with the help of a tortilla making machine, to get the desired thinness. 

The basket of chips and guacamole were the real test and Sunrise Tacos passed with flying colors: the chips are much lighter and crispier now, with none of that “I’m fighting to take a bite” that I previously experienced.

Greg also addressed my concern that John’s Hot Sauce – ostensibly the spiciest on the menu – wasn’t spicy at all.  In response to customer feedback, they added John’s Super Hot Sauce which I can gladly report has the right degree of heat to complement the smokey carne asada and tasty chicken.

So the good news is not only that we have a 24-hour taqueria conveniently located on Sukhumvit, but it is now serving really good food that is worthy of at least one weekly lunch in my schedule.  Yeah!

Now if they’d just get fish tacos and quesadillas on the menu, I’d be super happy.

The big news of the day was not the improvements made at Sunrise Tacos, no matter how tasty they may be.  The real news was the talk given at the Foreign Correspondents’ Club by Dr. Mongkol na Songkhla, Thailand’s Minister of Public Health.

Dr. Mongkol is the man who gives Big Pharma the shivers because he mounted a bold campaign to secure cheaper generic drugs for the country’s poor.  When two years of negotiations with drug manufacturers were unsuccessful, he announced the issuing of compulsory licenses for three highly-profitable HIV-related drugs.  At this point, one of the licenses, for the first line anti-retroviral drug Efavirenz, has been issued.  Two additional drugs for non-HIV conditions are set to be added to the list shortly.

The background on compulsory licensing

As a member of the World Trade Organization, Thailand is obligated to abide by the rules and regulations in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). TRIPS sets a minimum international standard for forms of intellectual property such as patent pharmaceuticals.  Compulsory licensing is a flexibility of TRIPS that permits all member countries to manufacture generic alternatives of patented pharmaceuticals to increase accessibility to affordable medicine.

The debate is around whether Thailand, as a middle-income country, really needs CL.  The pharmaceutical countries argue that their intellectual rights are being violated and that they will suffer financially.  “We won’t make enough money to research new drugs!” they claim. 

Thailand’s universal healthcare system is one of the country’s strengths, but Dr. Mongkol argues that the country lacks affordable access to high priced antiretroviral HIV treatment and medications for priority health conditions such as cancer, hypertension, and heart disease, for a large number of very poor patients.

Defending the policy

Dr. Mongkol defends his government’s contentious policy by explaining that the people who will benefit from these generic drugs – the poorest of the poor – are people who could never have afforded the brand-name drugs in the first place.  And, he adds, the people who can afford the brand-name drugs will not switch to generics, which have the reputation of not being as good*.  So, he reasons, the pharmaceutical companies shouldn’t lose out on any income.

*This seems to be a point of difference from what I’ve experienced in the United States, where generic drugs are pharmacologically the same as brand-name drugs.

Additional healthcare concerns

In either case, Dr. Mongkol spent the evening responding to questions from the audience, including a large contingent of local HIV/AIDS activists who, while full of praise for the doctor calling him their “hero”, had questions about why government policy still treats those who acquired HIV through intravenous drug use more as criminals than patients.  (Below, Dr. Mongkol speaks with local activists after the event, about their ideas for additional government actions.)

Dr. Mongkol responded fairly to those questions and explained that there are a number of changes to the laws that his team has proposed and he expects many of them to be passed into law in the next month or so. 

Questions were also raised about why the government doesn’t spend more of its HIV-related budget on prevention instead of treatment.  Currently, it is reported that only about 10% of the budget is spent on prevention efforts, which if done properly can have the effect of significantly lowering cases in the future.

Examples of harm prevention methods include education, the distribution of “female condoms“, clean needle exchange programs for IV drug users, and in the case of the Netherlands and other countries, decriminalization of small quantities of drugs.

This is where, as with many countries, good public health policy runs afoul of social mores.  Dr. Mongkol was pragmatic, explaining that he doesn’t think Thai society as a whole will be accepting of some of those methods.  Even things like women insisting that their husbands use condoms is a tough sell, even though 60% of the women who are HIV infected in Thailand were infected by their husbands.  (Thailand is a country where philandering husbands is a recognized, if not often discussed, part of life.)

One person Dr. Mongkol has working with him is Senator Mechai Viravaidya, Thailand’s famous “Mr. Condom” who is heading up the National AIDS Committee, pictured left. 

Senator Mechai is founder and head of the Population and Community Development Association (which runs, among other things, the Cabbages and Condoms restaurants – the Hard Rock Cafes of the population development community) and has long been the country’s most progressive voice in issues of both population control and, in the past two decades, HIV prevention.

Because of his history as being the most outspoken man, and the most respected one, on these issues, Senator Mechai is in a position to push public opinion forward more effectively than working directly through the Ministry of Public Health.

Conclusion

The talk was very interesting and informative, not only because it gave me much more insight into the issue of compulsory licensing that has caused such a stir in the past few months, but also because it gave me much more respect for at least one part of the Thai government.  After having listened to Khun Sittichai, the Minister of Information and Communication Technology, speak last week in paternalistic tones about how the government, and specifically himself, knew best for the country, it is refreshing to hear a Minister speaking openly and honestly and carefully considering the feedback of not only world opinion but most importantly, of his citizens.