Ever since the Thai military coup, Health Minister Mongkol Na Songkhla has undertaken a coup of his own.

He issued compulsory licenses for two AIDS drugs - Merck’s efavirenz and Abbott’s Kaletra - as well as the Plavix bloodthinner marketed by Sanofi-Aventis and Bristol-Myers Squibb. In doing so, he caused a furor - the US Trade Rep placed Thailand on its Priority Watch list and big pharma took a beating because Abbott looked like an insensitive bully by playing hardball. More recently, he threatened to issue compulsory licenses for cancer-fighting drugs unless prices are slashed, although Novartis has offered to provide Gleevec for free if Thailand backs off plans to make a generic.

Now, though, Mongkol’s term will end after Thailand finally holds a general election on Dec. 23, and it remains unclear whether government policy toward pharma and patents will remain the same, Asia Sentinal writes. Certainly, drugmakers outside and inside Thailand may welcome the end of Mongkol’s reign atop, but AIDS groups will miss him. In a strange set of circumstances, the coup that toppled former Prime Minister Thaksin Shinawatra allowed Mongkol, a doctor and career bureaucrat, to take a position normally reserved for politicians.

“Mongkol was under huge pressure from industry and from other ministers to stop his efforts,” Paul Cawthorne, who heads Doctors Without Borders in Bangkok, tells the Sentinel. “But the guy was determined. He knew where he wanted to go and what he wanted to achieve. It was a very fortunate set of circumstances.”

So what happens next? Will Thailand’s elected leaders follow the policy set by the non-elected government? Most analysts doubt that any party will reverse what Mongkol achieved over the past year, but they also doubt that the next minister will be as aggressive.

Thawat Suntrajarn, director-general of the Disease Control Department, tells the Sentinel that “the next government should follow this policy and not turn it back. It’s useful for all the patients. I’m sure it will continue.”

Thaksin resisted issuing compulsory licenses because he was intent on signing a free-trade deal with the US. But provisions related to compulsory licenses, data exclusivity and patents proved a key sticking point in the negotiations, which stalled indefinitely after the coup.

The Democrats, the main opposition under Thaksin and one that could worm its way into a coalition, have said they support compulsory licenses for essential drugs. The front-running People’s Power Party, comprised of former Thaksin loyalists, has repeated the same thing. Other parties hedge on the issue, saying that it depends on the circumstances during the next administration.

“Foreign pharmaceutical companies have no votes in the election, so parties have no incentive to come out on their side,” a Western diplomat who follows the issue closely tells the Sentinel.

“I went and saw (Democrat leader) Abhisit (Vejjajiva) speak to a business forum in which he said the party would seek better ways to improve access to medicine besides compulsory licenses, and a week later he talked to public health NGOs (non-governmental organizations) and said the opposite,” the diplomat adds. “My guess is they are pandering to both audiences, and then whatever parties get in will keep the current compulsory licenses and quietly let the issue go away. For this government, the issue was mostly personality-driven; there wasn’t anyone else who necessarily cared.”

Cawthorne and other HIV/AIDS activists are hoping that’s not the case, although they realize the great amount of pressure that will face Thailand’s next health minister. “My guess is there will be lots of lobbying from both sides,” he says. “We’ll just keep our fingers crossed.”