Asian of the Year: The Medicine Maker

July 12, 2008

by Ashok Mahadevan

 

Krisana Kraisintu has fought tirelessly to get her generic AIDS and malaria drugs to the people who need them most Krisana Kraisintu, on her way to an orphanage in southeastern Thailand where most of the kids are HIV-positive, is growing testy. She wants to treat them to Dunkin’ Donuts. But despite keeping a sharp lookout since leaving Bangkok nearly three hours earlier, we haven’t found a DD outlet.

 

“Won’t other donuts do?” I ask Kraisintu as we near the orphanage.

“No,” says the renowned Thai pharmaceutical chemist. “Dunkin Donuts are sweet. They’re colourful. The kids love them.”

 

 

Suddenly a Tesco Lotus supermarket appears. Kraisintu rushes in, finds a Dunkin’ Donuts and buys four big boxes crammed with donuts.

We arrive at the orphanage just before lunch. Kraisintu carefully arranges the boxes on a table, and turns around as the kids start filing into the dining room.

We arrive at the orphanage just before lunch. Kraisintu carefully arranges the boxes on a table, and turns around as the kids start filing into the dining room.

A tiny girl in a grey dress runs up and flings her spindly arms around the chemist’s ample waist. Kraisintu fondles her head and murmurs endearments. “Nuj was abandoned in front of this orphanage when she was a baby,” she tells me. “She’s HIV-positive and brain-damaged. She looks very young, but she’s actually around 10.”

 

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With Nuj in tow, Kraisintu wanders the room, chatting to the kids who are noisily tucking into their lunch of fish, curry and rice. A boy introduces himself as Tor and says he’s seven years old. “I’ve been here for a month,” he tells Kraisintu. “Is this your first time?”

“No,” she replies, “I’ve been here many times.”

Indeed she has. Coming here is a tonic for Kraisintu – the medicines that she developed are part of the reason these children are alive and perky. But each visit to the orphanage is also a painful reminder of the price Thailand has paid for not allowing widespread access to low-priced AIDS medicines until five years ago.

Although international pharmaceutical companies began manufacturing effective AIDS drugs in the 1990s, they were so expensive that the Thai government couldn’t afford to provide them to poor patients. Only the rich could buy them. That is part of the reason more than 450,000 Thais died of AIDS.

 

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But in 2002, thanks in large measure to Krisana Kraisintu, Thailand started mass producing inexpensive AIDS medicines. Death rates plummeted. Today, Thailand has one of the best public AIDS treatment programmes in the developing world, with most poor patients getting free medicine.

Thais are not the only beneficiaries of Kraisintu’s vision and dedication – her drugs are used to treat poor patients in Laos, Cambodia and Vietnam too. And she has devoted the last five years to helping Africans battle AIDS, and another major killer – malaria.

Says former Thai senator Jon Ungpakorn, ‘’Krisana is a humanitarian who uses her skills to serve the needs of the global poor.'’

Kraisintu didn’t plan on a career in pharmacy. Passionately fond of the arts, she wanted to be a conductor. But with her grandfather a traditional medicine practitioner, her father a doctor and her mother a nurse, family tradition required she apply for medical college. But she narrowly missed qualifying and had to settle for pharmacy.

 

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As a child Kraisintu was deeply influenced by her grandmother, a Buddhist nun. ‘’She’d sit outside the house and buy all the wares of the vegetable vendors who went by so that they didn’t have to walk all the way to the market,'’ Kraisintu says. ‘’She often told me, ‘If you have the opportunity to do good, you should.’ ‘’

While she was studying for her pharmaceutical chemistry degree, Kraisintu regularly travelled to remote hill districts giving villagers vitamin tablets that she and other students had made in the lab. After getting her doctorate in the UK, Kraisintu returned home to Thailand in 1981. She taught pharmaceutical chemistry for three years, then joined the publicly owned Government Pharmaceutical Organization (GPO). In 1989 Kraisintu was chosen to head its newly created research and development institute. She was 37.

A hard-driving, no-nonsense leader, Kraisintu quickly developed inexpensive drugs for diseases ranging from hypertension to diabetes. The medicines were cheap because they were generics of drugs first made by established multinationals. Making these generic drugs, as they’re called, was legal since the patents on the originals had expired. Although not technically difficult, the process involves extensive research and testing to discover the right combination of ingredients.

In 1992, with AIDS spreading rapidly in Thailand, Kraisintu decided to make generic versions of AIDS drugs known as antiretrovirals (ARVs). She was especially interested in zidovudine, a drug that reduced the chances of pregnant HIV-positive women passing the virus to their children.

She immediately ran into opposition. Zidovudine, originally developed to combat cancer, is highly toxic, and Kraisintu’s colleagues didn’t want to work on it. ‘’They felt I’d poison them,'’ she recalls.

She knew that provided proper precautions were taken, handling the chemicals to make zidovudine was safe, so she worked alone. Wearing a mask, gloves and goggles, she’d start at 5.30am, seven days a week. For six months she analysed drugs and experimented with formulations. Once her colleagues realised that she remained in good health, they began helping her.

In 1995, Kraisintu produced her first generic zidovudine capsules – at one-fifth the cost of the branded original. It was the developing world’s first generic ARV.

By this time the Thai government had started an AIDS treatment programme. Using  branded zidovudine, it could afford to help only a small number of patients. Despite the potential to reach many more people, the government didn’t switch to Kraisintu’s generic version. Moreover, the GPO’s top brass decided not to make generic AIDS drugs on a large scale.

 

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Kraisintu was undaunted. ‘’If I feel something is not fair, I have to fight,'’ she says. She produced as many capsules as she could in her lab, then told sympathetic journalists that the government was buying branded zidovudine at many times the price of her identical product. Thai AIDS activists also rallied to her cause. Eventually, the government relented and purchased her capsules. 

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Kraisintu was also developing a generic version of the ARV didanosine (ddI), which slows down the spread of HIV in the body, created initially by the US government’s National Institutes of Health. But in January 1998, just as she was about to start production, the American pharmaceutical company Bristol-Myers Squibb (BMS) obtained a Thai patent for ddI in tablet form. BMS threatened to sue GPO, and Kraisintu had to give up her plans. She could only make ddI in powder form, a poor alternative since it produced side effects such as irritation to the stomach.

Large-scale production of Kraisintu’s generic ARVs began only after a government audit in 2000 revealed that even her laboratory’s modest output of AIDS drugs was selling at a profit. Soon after, Kraisintu scored another breakthrough by developing GPO-vir, a pill combining three key generic ARVs that, until then, were administered separately.

 

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The combination pill had to be taken only twice daily – instead of other six-pills-a-day regimens – and it was 18 times cheaper. As a result, more than three-quarters of the 100,000 people being treated for AIDS in Thailand now take Kraisintu’s three-in-one cocktail.

In late 2002, Kraisintu received a call from the owners of a factory in the Democratic Republic of the Congo (DRC). Many of their employees were dying of AIDS – could she make GPO-vir for them? Kraisintu, who had been eager to help African countries tackle their many health problems, agreed.

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Since then she has spent most of her time in Africa. With her help, Tanzania began producing a generic version of the antimalarial drug artesunate in September 2003. The generic ARV factory in the DRC, which Kraisintu designed from scratch, started manufacturing less than three years later.

She has also helped Tanzania produce a generic ARV and trained hospital staff in four West African countries to make artesunate suppositories, a treatment that she developed for children with severe malaria. In addition, she has helped turn a moribund pharmaceuticals factory in Mali into the first sub-Saharan facility to produce anti-malarial tablets on an industrial scale.

Africans love her for her warmth – and respect her for her strictness. In Tanzania, they call her Simba Jike, Swahili for lioness. Kata Data Alhousseini Maiga, a government official in Mali, was so moved by Kraisintu’s concern for his countrymen that he told her, ‘’People like you will be in Paradise.'’

Kraisintu resigned from the GPO in 2002 and became an independent consultant. She comes from a wealthy family – one of her cousins owns five five-star hotels in Phuket – so she does not charge for her services and sometimes even pays for her own expenses.

 

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Despite her well-to-do background, Kraisintu lives in a  modest two-bedroom Bangkok apartment and drives a seven-year-old Honda. But she has one expensive indulgence: she likes to eat papayas grown in Dutch greenhouses. ‘’They’re much sweeter than Thai papayas,'’ she says.

It’s September 2007, and Kraisintu is sitting in a Bangkok meeting room with four officials of the Mae Fah Luang Foundation, a charity named after the Thai king’s mother. The officials want to work with Kraisintu to set up a factory that would make inexpensive drugs to fight malaria in Myanmar and the Indonesian province of Aceh.

Kraisintu watches the foundation’s presentation quietly, occasionally doodling on the pad before her. Once it is over though, and she starts talking, her presence dominates the room.

She speaks politely, frequently making jokes and without ever raising her voice. But her message is blunt. Malaria is much less prevalent in Myanmar and Aceh than in Africa. ‘’Of Tanzania’s 35 million people, 95 per cent have malaria,'’ she says. Build the factory in Africa, she says, and send whatever’s needed in Southeast Asia from there.

 

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Kraisintu also tells the officials that they should provide artificial limbs to the large number of people in Central Africa who’ve lost their legs to land mines.

The officials were shocked by the high incidence of malaria in Tanzania. But very quickly they begin talking enthusiastically about the good they could do so far from home.

Kraisintu’s exhortation has borne fruit. In the very near future, the foundation will fly four doctors from Burundi to Thailand for prosthetics training. ‘’We’ve chosen physicians who are themselves handicapped because they’ll be more empathetic,'’ she says.

 

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Kraisintu, who will turn 56 next month, seems full of energy, but her close friend Achara Eksaengsri says she works too hard and gets too little rest. Isn’t it time she took it easy?

Instead of answering, Kraisintu smiles and talks about the Mali pharmaceutical factory she revived in 2006. When she arrived, it was in bad shape. Nobody knew how to operate the factory’s sophisticated analytical instruments. Components were scattered all over the place.

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Kraisintu spent two weeks painstakingly helping the staff assemble the instrument and training them to use it. When she had finished, Gaussau Traore, the quality control chief, hugged her. ‘’You’re like God for us.'’ he said. ‘’Thank you for making us feel once again like capable human beings.'’

 

 

Kraisintu pauses, then says: ‘’This is my happiness in life.'’

– Reader’s Digest (January 2008)

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