Cablegate: Turkey's Moh Optimistic About New

This record is a partial extract of the original cable. The full text of the original cable is not available.





E.O. 12958: N/A

REF: A: ANKARA 6884 and previous

B: ANKARA 6818 and previous
C: ANKARA 6378

This information is sensitive but unclassified. Please
protect accordingly.

1. (SBU) Summary: Turkish Health U/S Necdet Unuvar
appeared optimistic about his ministry's new
responsibilities after the MOH assumed many of the
programs previously administered by Turkey's Social
Security Commission (SSK). The GOT views these reforms,
and the costs involved with them, as necessary and
manageable when weighed against the increased social
benefits they bring. On the issue of pharmaceutical data
exclusivity, Unuvar and his director generals maintained
their view that Turkey has done more than required on
this issue but pledged diligence when reviewing the final
generic applications to ensure that Turkish law is
followed to the letter. End summary.


2. (SBU) According to Turkish Health U/S Necdet Unuvar,
the GOT supports social security reform not because of
IMF requirements but because Turkey needs it. The
Ministry hopes that the legislation will enable it to
establish an institutional identity and views its passage
in the Parliament as a top priority for January after the
budget is passed by December 31.

3. (SBU) Unuvar said that the draft legislation would
give MOH most of the responsibilities for health issues
formerly held by the Social Security Commission (SSK) and
would establish a universal health insurance system.
This would benefit poorer Turkish citizens by providing
them more options for their healthcare in areas closer to
their homes. Additionally, with this reform the Ministry
hopes to invest in its physical infrastructure, personnel
and equipment.

4. (SBU) Contrary to media claims, Unuvar does not
believe that the MOH's absorption of the SSK hospitals
will create an undue and unmanageable burden on the
Ministry's budget. He acknowledged that the new
pharmaceutical program, in which patients have access to
a wider array of medication, has raised the government's
costs by USD 400 - 500 million. However, according to
Unuvar, the GOT anticipated this increase and can absorb
it within the present budget. (Note: Our understanding
from other sources is that these were serious overruns,
that had to be compensated from other, non-Health
components of the budget or from the revenue side. End
Note.) He argued that the cost of pharmaceutical spending
is not high in comparison to the social benefit it
provides. He noted that finding ways to reduce
pharmaceutical spending is not the MOH's responsibility,
he added, but falls on the reimbursement agencies. These
agencies are striving to find the highest quality
pharmaceuticals for the most reasonable price, he said.

5. (SBU) On the long-mooted creation of Turkish agencies
analogous to the Food and Drug Administration (FDA) and
the Centers for Disease Control (CDC), Unuvar said that
an agency similar to the CDC had been created by decree
at approximately the same time as the CDC (1928), but
that its responsibilities need to be strengthened. With
regards to the FDA, the GOT wants to create an agency
that functions similarly to the FDA but is closer to the
European model and excludes food oversight. He confirmed
that there were plans to move in this direction, but did
not provide a clear timeline.


6. (SBU) The U/S emphasized the GOT's commitment to
international assistance and cooperation. The Ministry
particularly values its participation in the World Health
Organization. The MOH worked quickly to contain the
recent outbreak of bird flu in its southwestern region
(ref A) and would be prepared to work with other
countries closely in the event of a global bird flu
outbreak. He noted that along with the United States
Turkey was the first to respond and has contributed a
large amount of monetary assistance and personnel and
supplies to the relief effort in Pakistan (ref B),
particularly for health care. Finally, Turkey values its
role in the Middle East Cancer Consortium.


7. (SBU) Econ/C raised Turkey's TRIPS obligations to
provide data exclusivity for pharmaceutical products,
saying that while we recognized progress we were
particularly concerned about recent applications by
generic producers to market patented drugs in Turkey (ref
C). Unuvar, allowing Deputy Under Secretary Orhan
Gumrukcuoglu to speak, argued that Turkey has made great
strides in the area of data exclusivity that should be
recognized. He added that according to Turkey's view of
TRIPS article 39/3, developing countries (among which he
apparently includes Turkey) were not given a deadline for
this implementation. He said that Turkey's current data
exclusivity regulations resulted not from their
obligations under TRIPS but from their commitments under
the European Customs Union.

8. (SBU) Speaking about the new pharmaceutical molecules
for which generic applications were filed prior to
January 1, 2005, Gumrukcuoglu stated that the MOH cannot
ignore these generic applications. Gumrukcuoglu
confirmed there were currently 23 applications for
molecules on which foreign countries held patents in
European Union countries. However, the fact that
applications have been filed does not mean that they will
automatically receive approval. Gumrukcuoglu added that
with regards to EU accession, Turkey finds itself in a
more difficult situation than new EU members such as
Poland, Greece and the Czech Republic. These countries,
because they had no customs union with the EU, also had
no previous obligations for data exclusivity for which
the could be "punished." Econ Counselor encouraged them
to follow the letter of the Turkish law (which prevents
generic companies from relying on the files of products
that have not yet been licensed on the Turkish market).
Unuvar reiterated the MOH's desire to uphold Turkish law
and pledged their diligence in reviewing the generic


9. (SBU) Comment: Especially on the issue of data
exclusivity, the MOH representatives repeated their
normal adage of being under-appreciated for what they
have done while receiving international pressure to do
more than was expected from similar countries at the same
time in their EU accessions. U/S Unuvar's demeanor,
though, provides some reason for optimism as he tried to
assure us that, although the GOT must review these
applications under Turkish law, the GOT would ensure that
only those who met the Turkish standards -- if any --
would be approved. While the review process will most
likely take much longer (it has already taken eleven
months), we hope that by registering our concern, in
addition to the objections raised by the EU and by the
research-based companies, the MOH will understand the
broader implications of these last few applications. End

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