Retired teacher Salmi* spends up to RM400 a month for her medication to keep her diabetes and hypertension under control.
Needless to say, the current hue and cry about the possible rising prices of medication should Malaysia sign the Trans-Pacific Partnership Agreement (TPPA) has not been good for her health.
"RM400 might be nothing to some people, but it is around one-third of my pension. I will not be able to manage if my medication bill goes higher," says the now stressed 63-year-old.
Although the Government currently provides free treatment and medication at its hospitals, she says she still has to purchase her medication herself as they are not provided by the hospital and those that are, do not "agree" with her.
"I get side effects like nausea and gastric, so I have no choice but to buy another medicine that suits me," she adds.
Salmi uses a combination of branded and generic medicines to keep costs down.
What worries her most, however, is the uncertainty.
"To be honest, I don't really understand the issue. I'm scared to wake up one day and read that the prices of medicine have gone up. I'll have problems then," she says, adding that she hopes the Government can provide more information so that she can at least prepare herself.
According to Society of Active Generation Elders (Sage) president Chin Sek Ham, 72, despite the free outpatient treatment at government hospitals and clinics for senior citizens aged 60 and above, many are struggling to cope with their medical expenses.
"For many senior citizens, their pension and savings do not increase while the value of their ringgit has shrunk over the years, so many are struggling to keep up with the rising prices of things. Just to get medical treatment and medicine is expensive," he says.
Impact of TPPA
Chin, who concedes that he is not fully aware of the TPPA, is also worried about its impact. Especially, as he claims, since the prices of medicine are already high here compared to our neighbouring countries and other developing countries.
"Even before we go into this agreement, the Government needs to look at the prices of medicine in the country to make it more affordable for retirees.
"There is already monopoly and some issues in the system. And while there is a subsidy from the Government right now, it is not enough to help senior citizens.
"Maybe, senior citizens can be given a discount in pharmacies like what is practised in the United Kingdom and United States; that will really help them," he says.
Based on the information available on the TPPA, Chin says there is indication that it may not be good for senior citizens, particularly as the ageing population grows by the day, and their life expectancy is extending.
"The Government needs to source for cheaper medicine for senior citizens and underprivileged members of society," he says.
The World Health Organisation defines generic medicine as a pharmaceutical product - usually intended to be interchangeable with an innovator product - that is manufactured without a licence from the innovator company and marketed after the expiry date of the patent or other exclusive rights.
Generic drugs contain the same medication, dosage and efficacy that is comparable to branded drugs. They are said to be as effective as branded drugs which cost more due to the high cost of research and clinical trials incurred before they are certified as safe for public use.
Branded drugs have a 15-year patency right, during which no generic equivalent are allowed to be in the market.
Due to the high cost of branded medication - sometimes three or four times more than the generic version - it is used alongside generic medicine in the care of patients by hospitals around the world.
In Malaysia, generic drugs purportedly make up 80 per cent of the medicine provided in the country.
Prof Dr Tengku Aizan Hamid, director of the Institute of Gerontology at Universiti Putra Malaysia, also believes that the TPPA may not affect the rich and the majority of middle income earners but in the long run, will affect the poor and senior citizens.
She points to India where the people still use a lot of generic medicine, and from where Malaysia imports most of its generic drugs.
"What's important is the content of the active ingredients that are in the medicine, not the brand," she says, stressing that the Government must safeguard the interest of its citizens.
If the government hospitals are forced to cut down the use of certain medications so as to contain the cost of drugs, it will affect the older people who will then have to purchase the drugs themselves from private suppliers.
"Now, the prescribed drugs usually come from government hospitals. Most private hospitals go with branded drugs," Dr Tengku Aizan notes, adding that she hopes the Government would provide more details on the issue.
The TPPA is an initiative to establish a comprehensive Free Trade Agreement (FTA) to ensure greater market access for trade and investment to participating members. The agreement currently involves 12 countries, including the four countries that Malaysia has yet to sign an FTA with, namely the US, Canada, Peru and Mexico.
The International Trade and Industry Ministry (Miti) has already come out to give an assurance that the issue of medicine and healthcare is high on their agenda at the TPPA negotiations, which Malaysia has been a part of since 2010.
However, the shroud of secrecy around the negotiations has led to speculations from various groups including stakeholders, which is causing confusion and alarm among the public.
One of the main concerns for people is the reported push by the US for measures that will increase patent applications and extend patent life of pharmaceutical products. This will limit and prevent the parallel import of generic medicines, severely curtailing people's access to affordable medication.
According to Miti, the TPPA can give Malaysia access to new markets and boost the country's economy.
Dr Yeah Kim Leng, group chief economist of RAM Holdings, points out that if Japan becomes a member, the TPPA will emerge as the world's largest trading bloc.
"With some exceptions, given that tariffs are already relatively low for most of the member countries, the benefits from the lowering of tariff barriers for Malaysia will not be as substantial as those from trade facilitation, where the biggest gains will come from reducing non-tariff barriers and improving customs, logistics and business efficiencies. Such facilitation will boost trade creation and investment flows among member countries," Dr Yeah explains.
Trade creation when counted with increased investment flows, as well as the dynamic spill-overs from trade openness and economic integration, far outweigh the negative impacts on selected uncompetitive domestic industries that will be exposed to more intensive competitive pressures, he adds.
Noting the initial negative impact of the trade agreement, Dr Yeah nevertheless believes they can be mitigated with the right measures.
"Adjustment and other support programmes, carve-outs, hold-out periods and other provisions can be designed to mitigate the initial adverse effects of the affected consumer or producer groups," he stresses.
Still, he cautions, such programmes should be well targeted, timely as well as temporary, so that they do not create "another set of distortions in the relentless drive towards making the overall economy more dynamic, competitive and resilient."
According to Dr Yeah, Malaysia is not alone in its anti-TPPA sentiments.
"Similar to what we are experiencing in Malaysia currently, there are lobby groups in countries such as the US and Australia that have been equally vitriolic in their anti-TPPA campaigns, railing against the secrecy of the negotiations as well as various non-trade issues relating to patents and copyrights, food and product standards, professional licensing and immigration, government procurement, and many others," he says.
However, having forged many bilateral and multilateral agreements, he feels Malaysians should trust our expert trade negotiators to maximise the benefits of TPPA while minimising the costs as well as ensuring that the long-term gains more than exceed the short-term pain.
Alif Zainal Abidin, of PT Foundation, definitely hopes so.
As he puts it, it is a matter of life and death for more than 80,000 Malaysians living with HIV/AIDS (PLHIV).
"The availability of generic medicine has helped many people living with HIV/AIDS stay healthy and carry on a normal life. It has given them a chance to contribute to society and the country. But without medication, they will just get sicker and weaker and end up in hospital when they are on their deathbed," says the manager of the MSM POZ Programme, which is a peer support programme for PLHIV.
He highlights that the HIV/AIDS medication is already a burden, cost-wise, on many.
A person with HIV has to fork out around RM950 a month for a cocktail combination of medication (which the government is subsidising for many), and he or she will have to take it daily, for life.
Without generic medicine, the cost will be pushed up to thousands.
"Your tendency not to go for medication is higher if the medicine is expensive. Many of those most at risk cannot afford medication, so if the prices of medicine go up, they will delay their medication/visit to the hospital, complicating their health problem further as their body grows weaker and they are left vulnerable to various infections," he stresses.
Adds Alif, since generic HIV/AIDS medication became available in Malaysia around 2000, the death rate among people living with HIV/AIDS has gone down.
"It's giving the people with HIV a better chance of living longer and better lives, allowing them to help contribute to the country's economy."
From 1986 to September 2011, Health Ministry statistics show there have been 93,827 HIV infections. A total of 2,465 new infections were detected for the first nine months of last year. From that figure, some 86,622 HIV cases involved individuals aged between 20 and 49, the prime working age.
Pressure from pharmaceutical companies, should Malaysia fail to negotiate for generic drugs in the TPPA, will also lead to a burden on the Government, Alif says.
"In the long run, if the pharmaceutical companies play on the game of patent, the ones who will suffer will be the people.
"Without generic medicine, how long can the Government subsidise medicine and provide free medication for those most at risk of HIV/AIDS? Even now, it is already a cost burden," he says.
Alif, who attended the session for stakeholders with Miti yesterday on the sidelines of the TPPA negotiations in Kota Kinabalu, urges the Government to listen to their concerns.
"It's clear that the pact is good for us, it is good for economic growth. But we are not talking about the short run, we are talking about the long run.
"We have been working hard to help those living with HIV/AIDS and show them that the disease is not a death sentence.
"But if we sign the TPPA, it will cut their access to treatment. The death toll will go up."
*Name has been changed