GRIPS Discussion Paper 13-07
The success of the industrial development policy in the
pharmaceutical industry in Bangladesh
National Graduate Institute for Policy Studies
7-22-1 Roppongi, Minato-ku,
Tokyo, Japan 106-8677
The success of the industrial development
policy in the pharmaceutical industry in
Md. Nurul Amin1 and Tetsushi Sonobe2
1. National Board of Revenue, Bangladesh, 2. National Graduate Institute for Policy Studies, Japan
While there are scores of excellent studies on failed industrial policies, studies of
successful cases of industrial development are much fewer. This paper reports a case
study of the successful development of the pharmaceutical industry in Bangladesh and
the critical roles played by the country's National Drug Policy established in 1982 in
boosting this development. This paper attempts to explain how badly the markets for
drugs in developing countries in general fail in providing essential drugs for the poor,
what characterize the National Drug Policy as an industrial policy, how the policy
addressed the market failure problem, why the policy did not cause serious government
failure problems, and how successfully this industry has since been growing.
Promoting industries and creating jobs, if successful, would boost economic
development and thereby support state building. While politicians and bureaucrats are
aware of how important industrial development is, they are unaware of how to facilitate
it. In the international development cooperation community in developed countries
and international organizations, the commonly accepted view until recently was that
industrial policy would not work because market failures prevent industrial
development from occurring and, hence, it would be too difficult for the developing
countries, especially current low-income countries, to address the failures without
causing serious government failures. Thus, policymakers in developing countries could
not receive encouragement or useful suggestions for industrial development from this
More recently, there has been a sea change. Major publications by international
organizations, such as the World Bank's World Development Report 2013 and the
African Development Bank and the OECD Development Centre's African Economic
Outlook 2012, emphasize the importance of creating jobs and generating incomes
through improving productivity in the industrial sector. Also, symposiums and
conferences on the same issues abound. This change is encouraging for the people of
developing countries longing for industrial development. This, however, is just the
beginning of the accumulation of knowledge necessary for providing a scientific
foundation for the prescription and implementation of a strategy for industrial
development. Considerable further research on industrial policy is clearly warranted.
This paper reports a case study of a successful industrial policy which was
proclaimed and enacted by the government of Bangladesh three decades ago. One
reason why we focus on a successful case and not failures is that there are already
scores of excellent studies on failed industrial policies, such as Balassa (1971),
Bhagwati (1978), and Krueger (1978), just to name a few.1 These studies have made it
clear how government interventions that are intended to protect and promote industries
can aggravate the dysfunction of markets, create hotbeds for corruption, and widen the
gap between the rich and the poor.
A major message of economics is that government interventions enhance
economic development only when they address market failure problems. Of course,
market failures do not necessarily call for government intervention as they may be
mitigated by grassroots non-market institutions based on the community mechanism or
other mechanisms, as Greif (2006), Williamson (1985), Hayami and Godo (2005) and
other prominent economists argue. Still, grassroots efforts are likely to solve market
failure problems only partially because of the transaction costs and leave room for
government interventions. From studies of failed industrial policies, it is impossible to
learn whether government interventions are doomed to fail or whether they can succeed
in correcting market failures if designed and implemented appropriately. Studies of
successful cases of industrial development are expected to illustrate how market failures
are mitigated without causing serious government failures and what the effective
division of labor among markets, non-market institutions, and the government is.
Successful cases, however, are much fewer. Although Baer (1972) and Chang (2003)
among others argue that almost all of today's developed countries used protection and
promotion policies to develop their industries when they were in their developing stages,
such experiences in the West in the remote past may be difficult to apply to today's
developing countries. More useful references would be the more recent experiences in
high-performing Asian countries.
This paper deals with the successful development of the pharmaceutical industry
in Bangladesh and the critical roles played by the country's National Drug Policy
established in 1982 in boosting this development. One might wonder why the
pharmaceutical industry, which seems to be a capital-intensive, high-tech industry, can
be developed in a low-income country like Bangladesh. A short answer is that the
pharmaceutical industry in this country specializes in the production and sale of generic
drugs, which is neither capital-intensive nor high-tech. This paper attempts to explain
how badly the markets for drugs in developing countries in general fail in providing
essential drugs for the poor, what characterize the National Drug Policy as an industrial
policy, how the policy addressed the market failure problem, why the policy did not
cause serious government failure problems, and how successful the development of this
industry has been since 1982. While the government intervention was reduced over
time, this industry in Bangladesh has continued to grow in size, improve product quality,
and enhance productivity. This paper offers hypotheses on what features of the private
sector has made this sustained growth possible, while deferring the empirical test of the
hypothesis to a companion paper, Amin and Sonobe (2012).
2 The successful growth of the industry
Pharmaceutical firms in developed countries undertake R&D activities to develop new
drugs and test them for approval. These high-tech activities require enormous inputs
of capital and the efforts of a number of highly skilled, professional pharmacists,
biochemists, and other experts. After the drugs' patent expires, however, other
pharmaceutical firms copy the drugs at much lower development costs. Although the
regulatory body in each country examines whether the copied drug is identical to the
original drug in dose, strength, safety, and efficacy, the period needed for its approval is
much shorter. While drugs have both trade names made by sellers and generic names
that indicate their active ingredients, such copies are usually called by their generic
names. Probably this is why they are called generic drugs. The pharmaceutical
industry in Bangladesh has focused on the production and sale of such generic drugs.
This industry in Bangladesh, moreover, has relied on the import of the most
important material, that is, active pharmaceutical ingredients (API), which are available
from the firms that invented the original drugs as well as the producers of generic
versions of the active ingredients in developed countries, India, China and a few other
countries. With active ingredients being purchased, the remaining production process
involves mixing them with other ingredients that make it easy for the human body to
absorb the active ingredients and serve some other purposes, followed by pressing the
mixed substance into tablets and packaging and shipping them. Such manufacturing is
not high-tech. It is only very recently that some of the pharmaceutical firms in
Bangladesh have begun producing generic versions of API.
Still it is astounding that Bangladesh, one of the least developed countries in the
world, has its own pharmaceutical industry. Just before the National Drug Policy was
launched in 1982, Bangladesh had 166 approved drug firms, of which about 80 were in
operation. Many of them were microenterprises producing folk medicine, and others
were small-scale subcontractors for multinational firms.2 Although the number of firms
in operation was large, the total production of drugs in the country, even including the
output of the local subsidiaries of the multinationals, met only 35 percent of the
domestic demand for drugs. The situation is different now. There are more than 250
approved domestic firms, of which more than 170 are in operation. They meet 97
percent of the domestic demand for drugs. The domestic production of drugs has been
growing rapidly in recent years, as shown in Figure 10.1 (We are now updating the data
and the next two sentences may be adjusted accordingly). In this figure, the bar chart
indicates the sales revenue of this industry in million dollars, and the line chart indicates
its annual growth rate from 1981 to 2001. Since 2007, the annual grow rate has been
over 15 percent per year, a pace at which revenue doubles in five years.
Bangladesh is known for its well-developed export-oriented garment industry.
Compared with garment production, generic drug production is scientist-, skilled
worker-, and capital-intensive. It is reasonable to ask whether the country has a
comparative advantage in this industry. The answer is definitely affirmative because
the industry recently began exporting their products to other countries without being
subsidized by the government. The export destinations include not just other
low-income countries but also middle-income countries in Asia, Latin America, and
Southern Europe, and more recently developed countries including the United States,
where the safety regulation is the most stringent in the world.
One might think that such phenomenal growth of an industry in a low-income
country is not possible if it is not led by multinational firms. The reality in Bangladesh
is that while multinationals dominated the country's market for drugs earlier, they have
been marginalized since the 1980s. Table 10.1 shows the names and ownership types
of the ten largest drug firms in terms of sales on the Bangladesh market in 1985 and
2011. While most of the top ten firms were the subsidiaries of renowned
multinationals in 1985, all the top ten firms are domestic firms owned and operated by
Bangladeshi capital and managers in 2011. The multinationals' local production
accounts for only 10 percent of the total drug consumption in this country now. Thus,
it is not an exaggeration to say that the domestic drug industry in Bangladesh has
successfully developed and is rapidly growing.
Still one may wonder whether the rapid growth of this industry has made any
contribution to this low-income country if the industry is not much labor-intensive.
Indeed, the employment size of this industry is estimated to be less than 100,000
persons, which is not comparable to the employment of four million persons by the
export-oriented garment industry. Nonetheless, it is likely that the growth of the
pharmaceutical industry has exerted considerable impacts on the welfare of people of in
Bangladesh. This is because the increased supply of generic drugs due to the growth
of this industry is likely to have reduced the prices of drugs drastically, thereby making
drugs accessible for increasing portions of the population. If drugs were freely traded
between countries and sold in a perfectly competitive market, the price of each drug
would be by and large the same in all countries, and considerable increases in drug
supplied from a small country like Bangladesh to the market will not have any
significant impact on the price. In reality, however, drugs are not freely traded but are
subject to approval and licenses and other forms of regulations in almost all countries
because drug firms, both local firms and multinationals, attempt to differentiate
products and to set prices strategically to each national market. It may well be that
drug prices vary across countries widely, and that the development of the
pharmaceutical industry in a country, especially that of domestic firms, has substantial
impacts on the domestic prices of drugs.
To investigate this, we gathered fragmented information on changing drug prices
from 1981 to 2012 in Bangladesh and also the current prices in some other countries.
The results are shown in Tables 10.2 and 10.3, which deserve a detailed explanation.
In Bangladesh, the pharmaceutical industry manufactures more than 500 generic drugs
for 6,200 registered brands in over 10,000 different forms of dosages and strengths. In
addition to this immense diversity, what makes inter-temporal comparisons of drug
prices difficult is that the importance of a drug changes over time because new
substitutes are developed and because drug resistance may occur. We decided to focus
on the top selling drugs in the years 1985, 2000 and 2011 as well as on representatives
from different therapeutic classes and picked up ten drugs that have been used since the
early 1980s or even earlier (which are referred to as "older 10 drugs") and another ten
drugs that were introduced to the Bangladeshi market in the mid-1990s or later ("newer
10 drugs"). Of these 20 drugs, 13 are included in the list of the country's "essential
drugs," which is defined by the World Health Organization as drugs satisfying the
healthcare needs of the majority of the population. Our older 10 drugs include nine
essential drugs and our newer 10 drugs include four essential drugs. The older 10
drugs were also included in the 30 important drugs listed in a book authored by
Zafrullah Chowdury (2010), who is a freedom fighter, medical doctor, civil society
activist, and one of the masterminds of the National Drug Policy. His book is our
source of information on the drug prices as of 1981 and 1991.
Table 10.2 presents the real retail prices of the ten older drugs in 1981, 1991,
2001, and 2012 and those of newer drugs in 1996, 2001, 2006, and 2012. To calculate
the average price of each drug in 1996, 2001 and 2006, we collected the retail prices of
all firms producing the particular drug for a particular dosage, mentioned in the first
column, from different issues of QIMP (Quick Index for Medical Preparations). The
numbers in the table are real retail prices in Bangladesh Taka deflated by the consumer
price index. The data on the retail prices in 2012 were collected through our own
survey of 10 pharmacies or drug stores.3 It should be clear from the table that the retail
prices of these life-saving drugs have been drastically lowered. The prices of some of
the older drugs, such as Atenolol (a drug for hypertension), Chloroquine (an
antimalarial drug), Mebendazole (an antiparastic drugs), and Rifampicin (an antibiotic)
in 2012 are only one-fourteenth to one-fortieth of their prices in 1981.
The reduction in drug prices is not unique to Bangladesh because new drugs are
developed one after another to substitute or replace older drugs, however. Thus, the
question arises as to whether the price reduction has been more drastic in Bangladesh
than in other countries. Table 10.3 compares the current retail prices of drugs in
Bangladesh, Sri Lanka, India, the Philippines, Indonesia, and the UK in 2010 to 2011.
Sri Lanka and India are selected because they are located in the same region as
Bangladesh. Sri Lanka is known for its free provision of public medical services and
for its aggressive approach to reducing drug prices, which the country started as early as
the 1970s. India is known for its thriving industry manufacturing generic drugs and
generic APIs. In the table, Southeast Asia is represented by the Philippines and
Indonesia. Both countries are more dependent on drugs produced by multinationals
than the three countries in South Asia, but the Philippines was more active in reforming
its pharmaceutical sector than Indonesia. As a representative of the developed
countries, we select the UK, which is home to some renowned multinational drug firms.
We collected data on the prices of 10 drugs selected from the 20 drugs listed in Table 2
in Bangladesh, Sri Lanka, and the Philippines through surveys.4 For India, Indonesia,
and UK, data were taken from the Current Index of Medical Specialities (CIMS), the
Indonesian Index of Medical Specialities (MIMS), and the British National Formulary
It is evident that there is no integrated world market for drugs in which the law
of one price holds true. Instead there are segmented national markets for drugs. It is
also evident from Table 10.2 that almost all of the medicines are sold at the lowest price
in Bangladesh, except for Cefixime, which is sold at a slightly lower price in the other
two South Asian countries. The prices of the other medicines are lower in Bangladesh
by 5 percent to 1500 percent. Thus, the prices of important drugs are exceptionally
low in Bangladesh. By contrast, drug prices are much higher in the Philippines,
Indonesia, and UK. The results of the price comparison may lead one to imagine that
drug prices are higher in countries which are dependent on multinationals for the supply
of drugs and are taking no countermeasures toward high drug prices supplied by
multinationals. Obviously, it is more difficult for patients in developing countries to
pay for drugs than patients in affluent countries.5 Nonetheless, Table 10.3 indicates
that the prices are lower in the UK than in Indonesia for seven drugs out of the ten.
These results present clear evidence of market failures, the issue to which we will turn
in the next section.
We conclude this section by mentioning the increasing affordability of
life-saving drugs for ordinary people in Bangladesh. In this country, real wages for
unskilled workers have increased gradually for the last three decades. The real wage
of the lowest-paid unskilled government worker (i.e., grade 20th) has increased 2.4
times since 1981.6 Thus, affordability, measured by the drug prices relative to the
unskilled labor wage, has been improved even more drastically than the real prices of
drugs have been lowered. Thus, the development of the pharmaceutical industry is not
an insignificant matter but a major achievement of the Bangladeshi economy.
3 Market failures and earlier reform attempts
In 1978, the United Nations Children's Fund (UNICEF) and the World Health
Organization (WHO) jointly hosted an international conference in Alma-Ata, USSR and
declared "Health Care for All by 2000." The declaration views health as a fundamental
human right and asks all governments to formulate national policies, strategies, and
action plans. To achieve the goal of health care for all, making essential drugs
affordable to the poor was considered to be essential.7 Much to the disappointment of
the signatory countries including Bangladesh, however, the Alma-Ata declaration was
completely ignored by drug firms in the world. Why do firms not respond to the
demand by the international community? Is it difficult for the government to force
firms to lower prices? This section reviews the major reasons why this is so and the
countermeasures actually attempted in some countries.
The first reason is that drug firms claim that their pricing is appropriate in view
of the need to cover the high cost of developing new drugs. Berndt et al.
estimate the cost of launching a new drug to market to be 360 million USD. Patent
protection, which creates a monopoly lasting for a few decades artificially, has been the
incentive device encouraging drug firms to develop new drugs. Although alternative
incentive mechanisms are being proposed, none has so far been implemented on a large
scale to reconcile the two conflicting aims of keeping drug prices low and encouraging
drug firms to develop new drugs.
Secondly, it is difficult to educate consumers (or patients) and medical doctors to
be more price-sensitive buyers of drugs, or to put it in technical terms, to make the
demand for drugs more elastic with respect to prices. The less price elastic the demand
is, the higher the monopoly price, compared with the unit production cost. The
demand for drugs is made less elastic by the fact that "the menu of drugs is so vast and
complex that few physicians can inform themselves fully about the available
alternatives" (Scherer, 1993, p. 98). The problem is aggravated by the possible moral
hazard problem arising from the fact that while it is doctors who choose drugs, they do
not pay for the drugs. To inform doctors about the usage and efficacy of drugs,
pharmaceutical firms employ a large number of medical representatives and dispatch
them to doctors, but it is ambiguous how effective this service is.
Thirdly, drug firms differentiate their products from other products to make the
demand for drugs even less elastic, thereby strengthening their price setting power. An
integral part of product differentiation is the creation and proliferation of brand names
put on essentially the same products. In the 1970s, the Sri Lankan government
decided to reduce the number of imported drugs because the country was faced with a
severe foreign currency shortage and because the country was heavily dependent on
imported drugs. The government could easily reduce the number of imported drugs
from 4,000 to 2,100 and then to 600 because many drugs were essentially the same as
other drugs (Chowdhury 2010; Reich 1995). Similarly, when the government of
Bangladesh started the reform of the pharmaceutical sector in 1982, it banned 1,655
drugs out of the 4,340 registered drugs as either harmful, useless, or therapeutically
ineffective drugs. Although the above mentioned medical representatives may help to
mitigate the information problem, they are also used to imprint brand names in doctors'
minds, strengthen their brand loyalty, and keep the price of each differentiated product
A common policy tool to reduce monopolistic prices for the government is to put
a price ceiling. While this sounds straightforward, its proper implementation requires
appropriate information on the costs of production and distribution, which is difficult to
obtain due to drug firms' complicated information manipulation (e.g., Laffont and Tirole
1993). In many developing countries, the subsidiaries of multinational firms or their
local subcontractor import active ingredients and other materials. Although the
custom office should have information on the prices of such intermediate inputs, the
reported prices may be much inflated, and such price information may not be used by
government bodies (e.g., Lall 1973; Peralta, Wauthy, and Ypersele 2006). The capacity
of the government to set an appropriate level of price ceilings would also depend on
how abundantly the country is endowed with human resources with expertise in
pharmacy, which could provide sensible advice for the government.
In 1971, the Sri Lankan government mandated that brand names be replaced by
their corresponding generic names in the sale and prescription of drugs. The expected
effect of this action is to make product differentiation difficult, thereby making drug
demand more elastic. The government also mandated that all imports of finished
drugs and raw materials be purchased through international tender by the newly
established State Pharmaceutical Corporation (SPC). These reforms met with fierce
opposition, however. Major multinational firms initially ignored the SPC and
continued to sell drugs through their marketing channels. In response, the SPC tried to
procure generic drugs from the socialist countries in Europe by amending the country's
patent law. This move was blocked chiefly by the pressure from the governments of
the home countries of the multinationals.
Opposition was also expressed by medical doctors and pharmacists probably
because of their misunderstanding about the safety of generic drugs, their habit of using
brand names in prescription, and their loss of direct and indirect benefits that they had
received from the importers and multinational firms, such as free samples and
promotional materials. Wealthy people and intellectuals who were loyal to
well-known brands were dissatisfied with the abolition of their favorite branded drugs.
The propaganda campaign conducted by the multinational firms was successful in
fueling the confusion and misunderstanding about the safety of generic drugs. The use
of generic names was required also in Pakistan in 1971, in India in 1981, in the
Philippines in the 1990s and some other countries, but these reform attempts were all
short-lived due to protests from multinational firms and physicians (Reich 1995;
Chowdhury 2010). The Sri Lankan government went further than these countries and
established the SPC, and this step seemed successful because in 1972, SPC saved about
40 percent of the payment for imported drugs and materials compared with the previous
year (Lall and Bibile 1978). Still the policy was so unpopular that it was watered
down considerably in subsequent years.
Thus, the market for drugs is associated with a composite of market failures,
including the indivisibility due to high development costs, asymmetric information, and
coordination failure, which are epitomized by the high prices of drugs. Consumer
activists in both developed and developing countries have long been criticizing drug
multinationals, but they have seldom been successful in changing the behaviors of
multinationals. Neither mass media nor professionals such as medical doctors and
pharmacists are highly motived to fight against the monopolistic power of drug firms,
especially multinationals. It seems that the problem cannot be solved without the
government's well designed actions.
4 The national drug policy of Bangladesh
After gaining independence in 1971, Bangladesh experienced famine, acute poverty,
and political turmoil in the 1970s. When Lieutenant General Ershad gained power in a
bloodless coup in March 1982, the country was still in the middle of the process of state
building. It was this new government that declared the new law called "the Drug
(Control) Ordinance, 1982" and the National Drug Policy (NDP), a set of policy
measures to secure access to essential drugs for all. This benevolent policy could not
immediately win the approval of the people of Bangladesh, even though they had
suffered from the high prices of important life-saving drugs. Instead the major
newspapers regarded the policy as a harebrained populist policy improvised by the
military government and as doomed to be crushed by pressure from abroad. Indeed,
the US ambassador came to Ershad immediately and began bringing relentless pressure
on the Bangladesh government to reverse the decision, according to Chowdhury (2010).
The ambassadors from the UK and Germany soon followed her lead. Their pressure
included the threat of stopping assistance from their countries to Bangladesh.
Similarly, the multinationals threatened explicitly to stop the supply of medicines to the
The National Drug Policy was well thought out, however. It was carefully
crafted by an expert committee consisting of Professor Nurul Islam of Dhaka University,
Zafrullah Chowduhry, and other six professionals, such as military surgeons, with
considerable experience and expertise. After being appointed by the government to be
committee members, they reviewed the drug situation and the healthcare needs in the
country and also the reform experiences of other countries, such as Pakistan, Sri Lanka,
and India. Their proposal of the National Drug Policy was swiftly accepted by the
government on May 29, 1982. The following description of the events related to this
policy and the major contents of the policy are based on our interviews with Zafrullah
Chowduhry, Samson H. Chowdhury, the founder of the largest pharmaceutical firm in
the country, and other few persons who were engaged in this industry and witnessed
how events unfolded in those days, as well as Chowdhury (2010).
Less than three months after the coup, Ershad visited the US to meet with
President Reagan. Ershad also met with Vice-President Bush, who suggested that
Ershad review his drug policy with the help of "independent US scientists" who would
visit Bangladesh soon (Chowdhury 2010, 105). Ershad agreed with Bush without
knowing that Bush was a shareholder of some pharmaceutical firms based in the US.
When a four-member team of "independent US scientists" visited Bangladesh, the
health minister, Dr. Shamsul Haq, requested the US embassy for their CVs. Although
his request made the US ambassador furious, the health minister finally obtained the
CVs of the co-called "independent scientists" and found that they were executives and
employees of large pharmaceutical firms.
As in Sri Lanka and other countries, the multinational firms succeeded in
influencing physicians, pharmacists, and the public through propaganda campaigns.
The looming skepticism among the public, together with the threat from the
multinationals and the disapproving attitude of the donor countries, made Ershad less
willing to move ahead on the drug policy, according to Chowdhury (2010). To
encourage Ershad, the members of the expert committee explained the reason why the
multinationals would never withdraw from the Bangladesh market. The expert
committee designed the new policy, taking into account the reactions of the
multinationals and the public. Their policy attempted to extract part of the
monopolistic profits that the multinationals had taken away from Bangladesh, but the
expert committee was fully aware that the Bangladesh market had to remain attractive
for the multinationals. Further, the committee anticipated the propaganda campaign
run by the multinationals, the reactions of the donor countries, and the attitude of the
Ingredients of the NDP
Under this policy, the government designated the set of essential drugs, mandated the
use of generic names, enhanced the public awareness of generic drugs, and had a
price-cap regulation. The committee, however, was aware that a more drastic measure
was needed to achieve the policy goal of ensuring favorable access to essential drugs.
As such a measure, Sri Lanka created a state-run monopoly on importing and
distributing drugs through international tender. This socialist approach was not
acceptable for Ershad, who was looking toward the US.8 Nor was it effective in
fighting against the propaganda by the multinationals because it would not create any
supporters, that is, individuals who would directly profit so much from it as to side with
the government, as the Sri Lankan experience had indicated. Probably we should also
mention, although we do not know whether or not the committee considered this point,
that the Sri Lankan approach could come to a miserable end, if implemented in a corrupt
country like Bangladesh.9
Instead, the expert committee intended to promote the local production of drugs
by local firms owned by Bangladesh capital and operated by Bangladesh managers.
Although there were many such firms, they ran tiny businesses. The new policy was
intended to promote them and new entrants by using three aggressive measures. The
first measure was to prohibit the multinational firms from selling antacids (which
prevent acidity in the stomach) and vitamins and asked them to instead concentrate on
the development and production of innovative, sophisticated and high-tech products,
such as antibiotics. Antacids and vitamins were relatively easy for local firms to
produce. The markets for these drugs were fairly large, probably accounting for 16
percent of the whole domestic market for drugs in terms of sales value in those days,
according to our interview with Dr. Chowdhury on January 15, 2011.
The second measure was to restrict the import of substitutes for the finished
drugs and intermediate inputs that were produced by two or more local firms. This
measure would be as powerful as the first measure. Take the Ventolin Inhaler as an
example. This is a drug for respiratory diseases, whose generic name is salbutamol.
Before the National Drug Policy, this product was imported by its inventor
GlaxoSmithKline (GSK) from outside Bangladesh even though GSK had a production
facility for other products in Bangladesh. Ventolin Inhaler was one of the top selling
drugs in Bangladesh, accounting for 15 percent of GSK's sales revenue in Bangladesh.
After the NDP was implemented, four local firms began producing and marketing
copies of this drug. Because of this second measure, their entry resulted in the
restriction on GSK's import of the original drug and induced GSK to enter into a toll
manufacturing arrangement with one of the four imitators (i.e., GSK asked one of the
imitators to produce the drug as a subcontractor for GSK). Once the market knew that
the drug was produced by the domestic imitator, the advantage of GSK as the inventor,
such as the consumers' perception of superior quality, over local firms disappeared, and
the local firms captured large shares of the market for this drug easily.
The third measure for the promotion of the local drug industry was to prohibit
those multinational firms without any production facilities in Bangladesh from
marketing their products produced by other firms on a toll manufacturing basis. As a
result, such multinational firms were forced to establish their own factories in
Bangladesh, and local firms working for these multinational firms as subcontractors lost
customers. Thus, immediately after the policy was proclaimed, these subcontractors,
who were central players in the association of local drug producers, were strongly
opposed to the policy. Not long after, however, they learned that a window of lucrative
profit opportunity would be opened only if they produced antacids and vitamins and
imitated the multinationals' products. Thus, they became staunch supporters of the NDP
even though they would not really welcome the price cap regulation.
It was no wonder that the multinational firms and the governments of their home
countries were outraged by these blatantly aggressive measures, which were intended to
substitute the products of the multinationals with the products of the local firms.10 These
measures were similar to the measures implemented under the name of the
import-substitution industrialization strategy in a number of developing countries in the
1960s and 1970s, which turned into a complete fiasco in most countries. Why did the
policy that failed to promote industries in many countries succeed in boosting the
development of the local drug industry in Bangladesh?
Why the NDP succeeded in industrial promotion
To answer this question, we conducted a survey of 148 drug producing firms, together
with interviews with persons who played important roles in creating the National Drug
Policy and who witnessed the events unfolding in those days. In our firm survey,
which was essentially a census of drug firms in operation, we met with the top decision
maker of each firm. As soon as we started these information gathering activities, we
noticed an interesting phenomenon that began immediately after the proclamation of the
National Drug Policy. It was the massive shift of managers, engineers, and skilled
workers from the multinational firms to local firms. We first recognized that there
were a number of top managers who used to work at the local subsidiaries of the
multinational firms. Thus, we gathered information on the occupational backgrounds
of the top managers and employees and found that 32 out of the 148 top managers had
prior experience of working at a pharmaceutical multinational firm, that the percentage
is nearly 50 percent if we focus on the relatively advanced 67 firms, and that 14.5
percent of employees of these 67 firms used to work at a multinational firm (Amin and
According to our interviews with elderly respondents, the shift of human
resources from the multinationals to the local firms began immediately after the
National Drug Policy was proclaimed, thus confirming that the policy played a critically
important role in the development of the local drug industry. The shift has continued
to date, but the number of persons moving from the multinationals to the local firms has
been decreasing over time because the presence of the multinationals in this sector has
been declining. The literature on international economics abounds with empirical
studies of the impact of foreign direct investment on the development of local industries
in the host country (e.g., Kokko 1994; Kokko, Tansini, and Zejan 1996; Audretsch
1998; Aitken and Harrison 1999; Griffith, Redding, and Reenen 2003; Javorcik, 2004;
Lipsey and Sjoholm 2005). These studies attempt to substantiate or refute a
hypothesis that the operation of multinational firms stimulates the development of local
industries because advanced knowledge of production technology, management, and
marketing is transferred from multinational firms to local firms. These studies expect
that knowledge is transferred when employees who have acquired advanced knowledge
while working at multinational firms move to local firms, even though knowledge
transfer may also occur through other channels (e.g., Görg and Stroble 2005; Balsvik
2011). The empirical results are mixed, however. Some studies find that foreign
direct investments have favorable impacts on the development of local industries and on
the productivity of local firms. Many studies, however, find that such impacts are
negligible or non-existent.
In the case of the pharmaceutical industry, multinational firms operate in almost
every country and have local production facilities in a number of developing countries,
including low-income countries. Still, local drug industries were developed only in a
small number of developing countries and no country classified as least developed
countries, except for Bangladesh. How can the mobility of labor from multinationals
to local firms play a critically important role in successful industrial development?
Presumably, the answer lies in the remarks of the elderly respondents. According to
them, not a few Bangladeshi employees of the multinational drug firms occupied
important positions, such as the head of the product development, production, quality
control, marketing and senior manager of general management, already in 1982, and,
hence, they had hands-on knowledge and experience in pharmaceutical production,
marketing, and management. Thus, as soon as they moved to local firms, they could
produce the same product as the multinationals produced if the local firms had
machinery of the same quality, and they could sell the product at least in the same way
as and possibly in a better way than they did at the multinationals.
When we asked ourselves why local employees could occupy high positions in
the multinationals, the answer was already obvious to us because almost every top
manager we met was a graduate of the faculty of pharmacy, the University of Dhaka.
Amazingly, Bangladesh began pharmacy education at the university level as early as
1964 with 20 students.11 We met with two of these first batch graduates, who were
executives at two of the largest local pharmaceutical firms in the country, and learnt that
they and their classmates joined multinational drug firms, were promoted to important
positions, and moved to local firms at varying times after the NDP was implemented.12
As shown in Table 10.4, the opportunity for pharmacy education has been
expanding rapidly in Bangladesh. In 1969, the university started a master's program in
pharmacy. In 2003-2004, the faculty was expanded and turned into three departments;
that is, Department of Pharmaceutical Technology, Department of Clinical
Pharmacology, and Department of Pharmaceutical Chemistry, each conferring master's
degree, M. Phil., and Ph.D.13 Currently, there are six public universities and 21 private
universities offering undergraduate and graduate courses in pharmacy and having 2,267
approved seats. Needless to say, the operation of pharmaceutical firms requires other
expertise, such as bio-chemistry, microbiology, engineering, and business administration.
Bangladesh has offered favorable access to higher education in these subjects and
expanded the opportunity for such education rapidly, compared with other developing
Between 1964 and 1982, a pool of human resources with expertise in production,
management, and marketing of drug firms was built up in Bangladesh. Before 1982,
such human resources were not working at local drug firms, which were tiny in size and
equipped poorly with machinery. They were working at multinational firms, which
paid much higher salaries and provided better work environments. By working at the
multinational firms, they could acquire a broader range of knowledge and advanced
expertise. It is easy to imagine that if there had not been these human resources, the
National Drug Policy would have been just one of the numerous failed attempts of
Of course, human resources were not the only factor needed for the development
of the local drug industry. Investment in machinery was definitely needed.
According to our investigation, investment in machinery was in many cases financed by
banks. Once it became clear to bankers that the National Drug Policy provided
enormous profitable opportunities for local drug firms and that human resources with
advanced expertise were available, banks were willing to finance fixed capital
investments undertaken by local drug firms.
Thus, the existence of the sizable pool of human resources with advanced
expertise was critical, as our elderly respondents suggested. Another important reason
for the success of the policy to boost the development of this industry dramatically was
that the market failures were so rampant that the drug prices were exorbitant. Since
the prices were initially very high, the local drug producers, many of whom were at that
time subcontractors for the multinationals, found it highly profitable to enter the market
for final products, such as antacids and vitamins, by hiring (or poaching) managers and
specialists from the multinationals at high salaries, when the policy provided them with
the market. The banks accordingly found it profitable to lend money to the local drug
Note that this is just a description of the initial phase of the industrial
development. There remains a question of how the industry could sustain its growth
after its initial success. Answering this question, however, is beyond the scope of this
paper. Amin and Sonobe (2012) use firm-level data to substantiate the hypothesis that
the local drug industry continued to grow in terms of productivity, product quality and
diversity, and operation size because it continued to learn advanced technologies and
management practices from abroad. Indeed, the results of the econometric analysis
indicate clearly that those firms employing highly educated and experienced managers
and specialists tended to learn from abroad actively and grow faster, and that such firms
tended to be led by highly educated and experienced top-managers. In our interviews
with managers at various ranks in such firms, they told us that their firms provided them
with learning opportunities for more than one month in total per year. Such
opportunities take various forms, such as training programs within the firm, short-term
training programs held abroad by international organizations, and study at graduate
schools abroad. Although employees may quit the firm to move to other firms after
receiving training, high-performing firms provide learning opportunities because they
otherwise could not recruit talented managers and specialists. Needless to say, we
should emphasize again that important roles was played also by university education
and multinational firms' training.
It is also noteworthy that rampant rent seeking and corruption did not topple the
National Drug Policy. Although we have no hard evidence for this, we conjecture that
two factors helped to prevent rent seeking and corruption from damaging the policy and
the industry. First, the ultimate goal of the policy was not to promote the local industry
but to reduce drug prices. The government committed itself to this goal and
demonstrated clearly that it could take radical measures to achieve this goal. If the
local firms had pretended that they needed more assistance from the government, the
government might have stopped promoting the local industry and instead tried to find
sources of drugs elsewhere. Second, due to the multitude of market failure problems
in drug markets across the world, drug prices were so high and, hence, the drug business
became so profitable in Bangladesh after the reform in 1982 that the local drug firms
allocated more resources to the drug business itself than to rent seeking activities.
As soon as we started this study, we could fortunately meet with Dr. Zafrullah
Chowdhury at his office. In response to our question of why the expert committee
proposed the promotion of the local drug industry, he said that they were sure that
without industrial promotion, their reform attempt would not be successful as the Sri
Lankan case had suggested. At the time of this interview, we knew little about drug
production because we had not visited any factories yet. We asked him whether it
would be difficult for developing countries to produce drugs, and he replied that it was
not and that the production of drugs was just an extension of cooking if producers are
appropriately trained people. From the next day, we spent many days visiting a
number of drug factories in Bangladesh and understood what Dr. Zafrullah Chowdhury
meant by "extension of cooking" and "appropriately trained people." It is now evident
to us that developing countries can have a comparative advantage in the production of
generic drugs if they have invested in university education in pharmacy, and that this
industry can have sustained growth if it continues to learn from abroad.
The accumulation of general and industry-specific human capital, however, is just
a necessary condition for this comparative advantage to be materialized. There must
be a countermeasure to market failures. If the countermeasure addresses the market
failure problems more directly, the industry is more likely to pick up. The case of the
pharmaceutical industry in Bangladesh illustrates how strong the impacts of such a
countermeasure can be where there are serious market failure problems. As mentioned
in the introductory section of this paper, it is said that even a policy addressing market
failure problems falls short of expectations because any policy intervention is prone to
rent seeking and corruption. The case of the pharmaceutical industry in Bangladesh,
however, suggests that if the market failure problem is really serious, the benefit from
solving the problem is accordingly great, and that the policy intervention can be nicely
designed to distribute this great benefit between the private industry and the public so as
to discourage rent seeking and corruption.
This case also suggests that good design of industrial policy must pay attention to
the political aspects of the market failure problem. Although market failure is an
economic term concerning the efficiency of resource allocation, the correction of market
failure affects the distribution of wealth (such as the extraction of monopolistic profit),
thereby resulting in distributional conflict, which inevitably has a political consequence,
or the political contention of various stakeholders. The continuation of a policy needs
political support from both inside and outside the country. Thus, policy planners, like
the expert committee that designed the National Drug Policy of Bangladesh, should be
able to determine the relationship between particular policy interventions and their
political consequences, including the outcome of contentious politics, and design a
policy that secures enough support.
The excellent analyses of failed cases mentioned above were based on numerous
real incidents of the failed applications of the now notorious import-substitution
industrialization strategy in a number of developing countries in the 1960s and
1970s. This literature has found, among other things, that protectionist policies
make firms very dependent on protection (Soligo and Stern 1965) because these
policies never contribute to the productivity gains of firms (Krueger and Tuncer
1982) and are likely to make firms technically less efficient than export-oriented
policies (Chen and Tang 1987) and to create environments that discourage
productivity gains through learning from abroad (Bruton 1998).
In this paper, a multinational firm is defined as a firm of whose corporate
headquarters is located outside Bangladesh and is in operation in two countries or
Of these ten drug stores, three are located in Dhaka city, four are in its suburb and
three are in a small town called Lalmohan under the Bhola district. Bhola is the
only island district of Bangladesh, located about 150 kilometers south of the capital
On this occasion, special thanks go to Dr. Khondoker Abdul Mottaleb of
International Rice Research Institute (IRRI), Philippines, Mr. Chakra Pani Achariya
and Mr. Thanabalasingam Vinayagathasan, my two fellows in the National
Graduate Institute for Policy Studies (GRIPS), Japan, and Mr. Aminul Haque, a
young pharma graduate for their great support in collecting pharmaceutical price
data from the Philippines, Sri Lanka and Bangladesh, respectively.
According to WHO (2004) and OECD (2005), medicines account for 25 to 70
percent of overall healthcare expenditure in developing countries and only about 18
percent in OECD countries. Morover, patients in developing countries pay 50 to
90 percent of the medicine costs out of their pocket, but patients in developed
countries pay much smaller fractions because of health insurance (WHO 2004).
This is our calculation based on the relevant National Pay Scales of Bangladesh
(Ministry of Finance Bangladesh 2009; BTCL, 2010).
In 1976, drug consumption was over 50 US dollars per capita in Germany, Belgium,
Switzerland and France, but it was less than one dollar in India and Bangladesh
(WHO 1988, 12-4).
He impressed President Reagan favorably. On October 25, 1983, when they met
again, Reagan wrote in his diary: "He's quite a man & is taking that poverty
stricken land out of statism & into the world of free enterprise. I like him & his
ministers" (Reagan 2007, 191).
Bangladesh has been one of the most corrupt countries in the world according to
Transparency International's Corruption Perceptions Index and other
10 Probably to keep the Bangladesh market attractive for the multinationals and to
help local producers, the price cap regulation was less strict than it could be. The
price cap was a certain percentage over the costs of raw materials and packaging
materials, transportation costs, and duties and taxes. The mark-up rate was 240
percent for the drugs that are technically the most advanced and the most costly to
produce. Four lower mark-up rates were applied to less advanced drugs with the
lowest rate being 50 percent. Later on, in 1994, the government made 117 drugs
(out of 209 drugs designated as essential drugs) subject to price control. For other
drugs, manufacturers were allowed to set their own prices and inform the
regulatory body. More recently, most of these 117 drugs have become obsolete
(UNCTAD 2011), and accordingly the price control has faded.
11 This is based on our interview with Professor Emeritus Dr. Abdul Jabbar, founder
of faculty of pharmacy at the University of Dhaka. August 03, 2011.
12 We interviewed Mr. Amanullah Chowdhury, Executive Vice President and Director
of Rangs Pharma Ltd., on June 04, 2011 and Mr. Lutfur Rhaman, Director
Manufacturing of Beximco Pharmaceuticals Ltd., on January 19, 2011. Both
were first-batch graduates. Mr. Rhaman worked for 15 years in SQUIBB, a
US-based MNC, before he joined BEXIMCO. We also met with several early
graduates, including Mr. Mahbubul Karim, Director Technical Operation of
INCEPTA, who had served in two multinational firms (Sanofi and Novartis) for
about 25 years in many key positions including head of production before he joined
INCEPTA, and Mr. M. Mosaddek Hossain, Managing Director of UniMed and
UniHealth Manufacturers Ltd., who had worked at two multinational firms
(FISONS, and ICI) for about 15 years before establishing his own firm.
13 This is based on our interview on December 3, 2011 with Professor A.B.M Faruque,
Dean of the Faculty of Pharmacy, University of Dhaka, who was a fifth batch
Aitken, B.J., and Harrison, A.E. (1999) "Do domestic firms beneﬁt from direct foreign
investment? Evidence from Venezuela," American Economic Review
Amin, M.N. and Sonobe, T. (2012) An inquiry into the rapid growth of the
pharmaceutical industry in Bangladesh, mimeograph at the National Graduate
Institute for Policy Studies, Tokyo, Japan.
Audretsch, D.B. (1998) "Agglomeration and the location of innovative activity," Oxford
Review of Economic Policy
, 14(2), 18-29.
Baer, W. (1972) "Import substitution and industrialization in Latin Amercia:
Experiences and interpretations," Latin American Research Review
, 7(1), 95-122.
Balassa, B. (1971) The Structure of Protection in Developing Countries,
Johns Hopkins University Press.
Balsvik, R. (2011) "Is labor mobility a channel for spillovers from multinationals?
Evidence from Norwegian manufacturing," The Review of Economics and
, 93(1), 285-97.
Berndt, E.R., Bui, L., Reiley, D.R., and Urban, G.L. (1995) "Information, marketing,
and pricing in the U.S. antiulcer drug market," American Economic Review
Bhagwati, J. (1978) Anatomy and Consequences of Exchange Control Regimes,
Cambridge, MA: Ballinger for National Bureau of Economic Research.
Bruton, H.J. (1998) "A reconsideration of import substitution," Journal of Economic
, 36(2), 903-36.
BTCL (2010) Bangladesh government national pay scales, retrieved November 02,
Chang, H.-J. (2003) "Kicking away the ladder: Infant industry promotion in historical
perspective," Oxford Development Studies
, 31(1), 21-32.
Chen, T.-J., & Tang, D.-P. (1987). "Comparing technical efficiency between
import-substitution-oriented and export-oriented foreign firms in a developing
economy," Journal of Development Economics
, 26(2), 277-89.
Chowdhury, Z. (2010) The Politics of Essential Drugs
(First Reprint ed.), Dhaka:
Directorate of Drug Administration (2008) The Drug Acts and Rules: 1940 to 2006
(Reprinted: April 2008 ed.), Dhaka: Directorate of Drug Administration.
Görg, H., and Strobl, E. (2005) "Spillovers from foreign firms through worker mobility:
An empirical investigation," Scandinavian Journal of Economics
Greif, A. (2006) Institutions and the Path to the Modern Economy: Lessons from
, Cambridge, UK: Cambridge University Press.
Griffith, R., Redding, S., and Reenen, J. V. (2003) "R& D and absorptive capacity:
theory and empirical evidence," Scandinavian Journal of Economics
Hayami, Y., & Godo, Y. (2005) Development Economics: From the Poverty to the
Wealth of Nations
(Third Edition ed.), Oxford: Oxford University Press.
IMS Health (2012) 2011 Top-line market data, retrieved December 01, 2012, from IMS
Javorcik, B.S. (2004). "Does foreign direct investment increase the productivity of
domestic firms? In search of spillovers through backward linkages," American
, 94 (3), 605-27.
Kokko, A. (1994) "Technology, market characteristics, and spillovers," Journal of
, 43(2), 279-93.
Kokko, A., Tansini, R., and Zejan, M C. (1996). "Local technologies capability and
productivity spillovers from FDI in the Uruguayan manufacturing sector," Journal
of Development Studies
, 32(4), 602-11.
Kremer, M. (2002) "Pharmaceuticals and the developing world," Journal of Economic
, 16(4), 67–90.
Krueger, A. (1978) Foreign Trade Regimes and Economic Development: Liberalization
Attempts and Consequences,
Cambridge, MA: Ballinger for National Bureau of
Krueger, A.O., & Tuncer, B. (1982) "An empirical test of the infant industry argument,"
American Economic Review
, 72(5), 1142-52.
Laffont, J.-J., and Tirole, J. (1993) A Theory of Incentives in Procurement and
Cambridge, MA: MIT Press.
Lall, S. (1973) "Transfer-pricing by multinational manufacturing firms," Oxfor Bulletin
of Economics and Statistics
, 35(3), 173-95.
Lall, S., and Bibile, S. (1978) "The political economy of controlling transnationals: the
pharmaceutical industry in Sri Lanka (1972-1976)," International Journal of
, 8(2), 299-328.
Lipsey, R. E., and Sjoholm, F. (2005) "The Impact of Inward FDI on Host
Countries:Why Such Different Answers?" in T. H. Moran, E. M. Graham, and M.
Blomstrom (eds.), Does Foreign Direct Investment Promote Development?
Washington, DC: Institute for International Economics.
Ministry of Finance Bangladesh (2009) National pay scales 2009, Dhaka: Ministry of
OECD (2005) Drug spending in OECD countries up by nearly a third since 1998,
according to new OECD data, retrieved December 17, 2012, from Organization
Peralta, S., Wauthy, X., and Ypersele, T.V. (2006) "Shoul countries control international
profit shifting?" Journal of International Economics
, 68(1), 24-37.
Reagan, R. (2007) The Reagan Diaries,
New York: Harper Collins.
Reich, M.R. (1995) "The politics of health sector reform in developing countries: three
cases of pharmaceutical policy," Health Policy
, 32, 47-77.
Scherer, F. (1993). "Pricing, Profits, and Technological Progress in the Pharmaceutical
Industry," Journal of Economic Perspectives
Soligo, R., and Stern, J.J. (1965) "Tariff protection, import substitution and investment
efficiency," Pakistan Development Review
, V(2), 249-70.
UNCTAD (2011) Local production of pharmaceuticals and related technology transfer
in developing countries, retrieved October 15, 2012, from The United Nations
WHO (1988) The World Drug Situation, retrieved November 1, 2012, from World
WHO (2004) WHO Policy Perspectives on Medicines — Equitable access to essential
medicines: a framework for collective action, Geneva: World Health Organization.
Williamson, O. (1985) The Economic Institutions of Capitalism: Firms, Markets,
New York: Free Press.
Table 1 Top 10 Pharmaceutical firms in Bangladesh in 1985 and 2011
Top 10 firms in 1985
Top 10 firms in 2011
Source: Author's calculation based on data from IMS Health (2012)
Table 2 Changes in retail prices of 20 important drugs in Bangladesh
Product (generic name)
Real retail price (in Taka)
(a) Retail prices of older 10 drugs
Amoxycillin Cap. 250 mg
Atenolol Tab 100 mg
Chloroquine Tab 250 mg
Diazepam Tab 5 mg
Mebendazole Tab 100 mg
Metronidazole Tab 200 mg
Paracetamol Tab 500 mg
Ranitidine Tab 150 mg
Rifampicin Cap. 150 mg
Vitamin B complex tablet
(b) Retail prices of newer 10 drugs
Albendazole Tab 400 mg
Azithromycin cap/Tab 500 mg
Cefixime susp. 50 ml
Cetrizine Tab 10 mg
Ciprofloxacin eye drop 5 ml
Diclofenac Sodium Tab 50 mg
Glibenclamide Tab 5 mg
Omeprazole Cap 20 mg
Pantoprazole Tab 20 mg
Paracetamol+ Caffeine Tab
Source: The real prices in 1981, 1991, and 2001 are the authors' calculation based on Chowdhury (2010, p101) and different issues of QIMP. The prices in 2012 are taken from the IMS Health (2012). Note: The retail prices are deflated by using the consumer price index.
Table 3 Retail price comparison of selected drugs in selected countries (in USD)
Atenolol (Tab. 100 mg)
Azithromycin (Cap./Tab. 500 mg)
Cefixime (Susp. 50 ml)
Diazepam (Tab. 5 mg)
Glibenclamide (Tab. 5 mg)
Mebendazole (Tab. 100 mg)
Metronidazole Tab 200 mg
Omeprazole (Cap. 20 mg)
Pantoprazole (Tab. 20 mg)
Paracetamol (Tab. 500 mg)
Source: For data on Bangladesh, Sri Lanka, Nepal and the Philippines: the IMS Health (2012). For India, Indonesia and United Kingdom: authors'
calculation based on data from different issues of MIMS Indonesia, Current Index of Medical Specialities (CIMS), and British National Formulary
Notse: Pharmaceutical price data from Bangladesh, Sri Lanka, Nepal and the Philippines are for the year 2012. Data from India for 2011, and
Indonesia and UK are for the year 2010. Price data on the Philippines include data on generic drugs only. n.a. indicates that data are not available.
Table 4 Pharmacy education in Bangladesh, 1964-2011
Number of universities with
Number of approved seats
Source: Bangladesh Pharmaceutical Society.
(accessed October 17, 2011).
Notes: Dhaka University is the first institute offering pharmacy courses since 1964. ‘Number of approved seats' means maximum number of students permitted to be accepted by the respective university.
Figure 1 Pharmaceutical production in Bangladesh: 1981-2010
1981 1985 1990 1995 2001 2006 2007 2008 2009 2010
Sales (million USD)
Sources: (a) For the year 1981, 1985, and 1990- Directorate General of Drug Administration
(DGDA), Bangladesh (Cited in Chowdhury 2010, 99), (b) for the year 1995- IMS Health (2012),
and (c) the remaining of the data are from the survey 2011.
M inistry of M inistère des M unicipal Affairs and Housing et du Logem ent Building and Development Branch Direction du bâtiment et de l'aménagement 777 Bay Street, 2nd Floor 777, rue Bay, 2e étage Toronto ON M5G 2E5 Toronto ON M5G 2E5 Telephone: (416) 585-6666 Téléphone : (416) 585-6666 Fax: (416) 585-7531
Report—HIV Management 2015: THE NEW YORK COURSE Introduction As in each of the past years, the 13th anniversary session of HIV Management: THE NEW YORK COURSE provided attendees state-of-the-art presentations not just on antiretroviral therapy but on a full spectrum of the non-AIDS-defining infectious, cardiovascular, and malignant conditions that now