Indian pharmaceutical company Cipla has halted production of its child-friendly antiretroviral HIV treatment Lopinavir (ABT-378) due to the failure by the Government’s Health Ministry to clear payments relating to its programme for helping to treat the disease. This has led to the signing by 637 children aged between 3 and 19 of a letter to Prime Minister Narendra Modi requesting his urgent support to resolve the matter.

The market leader in the region, Cipla is the only manufacturer of the drug, meaning it is now no longer available in retail markets.

The letter states that “the pharmaceutical company Cipla has in various forums cited delay in payments by the national programme for the HIV medicines by several years and even non-payment of its dues in many cases. Profits on child doses of HIV medicines are small and delayed payments are having a chilling effect on the ability of the National AIDS Control Organisation (NACO) to convince the company to participate in the bids it invited annually.”

This is not the first time the company has been confronted with obstacles in working with the government; in 2014 the Health Ministry failed to pay the company for consignments, though it has continued to participate in government tenders.

Cipla CEO Umang Vohra stated in emails to patient activist Loon Gante that “Cipla has always stood for the patients — not just in India but also all the world. Quite naturally, we also expect that issues regarding payments are also addressed expeditiously.”

Gangte himself noted that he had been informed by the company that “we should ensure payment for any future procurement of the medicine from Cipla,” adding “I would like to tell you that the community is in no position to do so. We can neither force the government nor donors like the Global Fund. But at the end of the day, we are the ones who are hit by these shortages and stock-outs.”

While Cipla has not directly addressed the matter, it appears that the company plans to hold its ground on this issue until all outstanding payments are settled by the Indian Government or Global Fund. This could have heavy implications for those left without treatment, but the problem may not simply go away once the bills are cleared; as the letter states: “We humbly request you to in the meantime look into the matter of HIV drug stock out in general and in particular paediatric HIV medicines to ensure that they are not merely exported but also actually available to the children in this country.”