For too long Africans have been dependent on aid and medicines from the West, argues the author of this article, but Brazil, India, China and South Africa (BRICS) are emerging as dominant players in Africa’s health markets. In the late-1990s, Brazil played an instrumental role in shifting the paradigm of healthcare and human rights when it challenged the World Trade Organisation (WTO) and its intellectual property regime. Brazil violated a WTO clause to provide antiretroviral drugs and to lower their price. This reaffirmed medicine as a fundamental human right. While many drugs continue to be developed in the West, India has stepped in to manufacture generic medicines for the world's poorest countries. Through low-cost support and commodities, India has filled a gap in the global market. China has an increasing role to play in the global health arena. It invested $36.1 billion in 2011 in research and development, placing the country in a position to become a major player in healthcare innovation. Additionally, given the sheer scale of industry and financial resources available, China has the capacity to develop and supply HIV drugs and technologies to meet the needs of the African epidemic. The departure of traditional international funders like the United Kingdom and the United States presents an opportunity for new sources of engagement with the growing BRICS economies. Investing in the health of Africa will fuel development, enhance diplomacy and build South-South solidarity, the author argues.
Health equity in economic and trade policies
In this article, the author discusses the ramifications of a 2013 legal battle in the United States that ended with the court ruling unanimously that human genes cannot be patented. He argues that the implications of this ruling are far-reaching in terms of public health and equity. He views the case as an example of how societal inequality is a result not just of the laws of economics, but also of how we shape the economy through politics, including through almost every aspect of our legal system, in this instance intellectual property regimes. The right to life and right to health should not be contingent on the ability to pay. He also argues that some of the most iniquitous aspects of inequality creation within our economic system are a result of ‘rent-seeking’, namely profits, and inequality, generated by manipulating social or political conditions to get a larger share of the economic pie, rather than increasing the size of that pie. The world’s poorly designed intellectual property system encourages pharmaceuticals to pursue such rent seeking. And while advocates of intellectual property rights emphasise their role in promoting innovation, the author counters that most key innovations in history were motivated by the quest for knowledge, not financial gain. He provides evidence that the patent actually prevented the development of better tests, and so interfered with innovation.
After an impressive acceleration in growth and poverty reduction since the mid-1990s, many African countries continue to register robust growth in the aftermath of the global financial crisis. Will this growth persist, given the tepid recovery in developed countries, numerous weather shocks, and civil conflicts in Africa? This paper "stress tests" African economies. The findings indicate that Africa's long-term growth is fairly impervious to a prolonged recession in high-income countries. Growth is, however, much more sensitive to a disruption of capital flows to the region, and to internal shocks, such as civil conflict and drought, even if the latter follow historical patterns. The broad policy implication is that with proper domestic production conditions African countries can sustain robust long-term growth. Because of the economic dominance of the agriculture sector and the share of food in household budgets, countries will need to increase the resilience of agriculture and protect it from unfavorable climate change impacts, to prevent food insecurity.
According to the latest edition of MSF’s report on HIV treatment price and access issues, the price of first- and second-line anti-retrovirals have declined due to increased generic competition, while third-line regimens remain “exorbitantly priced”. For newer HIV medicines, including integrase inhibitors, generic competition is mostly blocked because of patents, and these drugs are more expensive as a result. MSF finds that patents remain a barrier on newer drugs and in middle-income countries, but some countries are using World Trade Organisation-sanctioned flexibilities to issue compulsory licences to increase access to the medicines. Flexibilities are built in to the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). MSF has proposed patent opposition (when applications do not meet a country’s patentability requirements) and the issue of compulsory licences in the interest of public health, as ways to bring prices down further. Additionally, MSF claims that free trade agreements continue to pose a threat to access, pointing to the European Union-India Free Trade Agreement and the Trans-Pacific Partnership Agreement as examples of agreements with “harmful provisions”.
Much has been written about Africa’s so-called ‘resource curse’, whereby natural resources disrupt an economy and create incentives for wide-scale corruption and even conflict. The effects of the resource curse need not, however, be viewed as inevitable, the author of this article argues. Political choice is key. Botswana has used its mineral wealth to develop into a stable, middle-income country. More recent producers such as Ghana, Liberia and Sierra Leone appear to be making good governance decisions so far. Emerging markets, especially China, continue to ramp up demand for the continent’s commodities, offering a once in a millennium opportunity for African governments to lift millions of people out of poverty. African leaders and the international community, big business and civil society must assume responsibility, the author argues. The most practical and credible form of becoming ‘transparent’, she says, is the Extractive Industries Transparency Initiative (EITI), which requires governments to explain clearly and openly the revenues flowing from its extractive sector so that any party can see how much the country in question receives from oil, gas and mining companies. So far, ten African governments have been judged compliant.
Africa is lacking a clear and unified policy in terms of how it relates to China, argue the authors of this opinion piece. He points to China’s lack of respect for human rights and the problem of China issuing loans without conditions. The cooperation between Africa and its economic development partners (EU, China and US) are strategically different, and each is driven by economic self-interests. It is of vital importance therefore, that Africa approves on an equal footing, strategic and most consistent partner (business or otherwise) who recognises, shares and respects its difficult but critical needs be it political, economic or social as well as sovereignty. Africa must necessarily develop a coherent and structured plan in successfully asserting its political, economic and social ties with China, the authors argue. It must avoid repeating some of the mistakes committed in its past relations with its traditional development partners. In the meantime, African leaders must be able to define and formulate strategic and comprehensive policies, individually, for the influx of Chinese investments. For instance, they must exert pressure on China and together, differentiate and separate investments and loans clearly from interest free loans, grants and aid projects.
Combating international tax avoidance and evasion, corruption and weak governance are crucial if Africa's people are to benefit from the continent's vast natural resource wealth, according to former United Nations secretary general and chair of the African Progress Panel Kofi Annan. He pointed out that trade mispricing, or losses associated with the misrepresentation of export and import values, alongside other illicit outflows cost the continent $38.4-billion and $25-billion respectively between 2008 and 2010. Annan called for a rule-based global system on tax transparency to be developed with the G20. All foreign-owned companies should be required to disclose the ultimate beneficiaries of their profits, he said. Switzerland, the UK and the US – all major conduits – should also signal their intent to clamp down on illicit financial flows. He extended this call to players from other developing nations who have become increasingly active in Africa in the oil, gas and minerals realm. Annan called on major investors in African extractive sectors such as China and emerging investors such as Brazil to also engage. He raised concerns over the structure of investment activity by foreign companies operating in Africa, which is characterised by the extensive use of offshore-registered companies and low tax jurisdictions, and in some cases the complex use of shell corporations.
This year’s Africa Progress Report rejects the view that Africa is blighted by a “resource curse” – an affliction that automatically consigns the citizens of resource-rich nations to a future of economic stagnation, poverty and poor governance. Instead, the Panel argues that the malaise that has afflicted natural resource management in Africa is caused by the wrong domestic policies, weak investment partnerships and failures in international cooperation. This will require decisive leadership by African governments, backed by multilateral action and a commitment by foreign investors to adopt best international practices. There is cause for optimism. Global market conditions point to another decade of high prices for natural resources, creating an environment conducive to economic growth. The report argues that improvements in policies, in public finance management and moves towards greater accountability enables Africa to escape the boom-bust cycle associated with past upswings in commodity markets.
The World Health Organisation (WHO) is involved in a debate related to intellectual property rights over a dangerous new pathogen, the Middle East Respiratory Syndrome (MERS) virus. This report records that the virus was sent to Erasmus without authorisation of the Saudi government, which has sovereign rights, and which has criticised Erasmus' intellectual property stance. When Erasmus eventually began sharing the virus, they did so under a material transfer agreement (MTA) with very strong provisions to protect the university’s own intellectual property, prompting objections from some scientists. Erasmus is reported to have submitted a patent application the content of which is unknown, due to normal procedures at patent offices where publication of applications is delayed for six months or more from the time of their submission. The raising of patent and sovereignty issues over emerging viruses at the World Health Assembly suggests that controversies caused by intellectual property claims over newly identified pathogens will continue to occur unless broader solutions are found to allow viruses to be distributed to researchers while protecting sovereign rights, the author concludes.
The TRIPS Council of the World Trade Organisation (WTO) decided on 11 June 2013 to allow Least Developed Countries (LDCs) to delay implementation of the TRIPS Agreement until 1 July 2021. At the end of this period, LDCs can request further extension. The terms of the June 2013 decision this time are better than the terms in the previous extension, granted in 2005, says South Centre. This is attributed to the determination and skill of the LDC Group, led by Nepal, during month long negotiations between the LDC Group and developed country members of the WTO. The new extension period is for eight years, starting on 1 July 2013. This is longer than the seven and a half years transition period provided in the 2005 decision. It is also significantly below what the LDC Group had asked for in its formal proposal IP/C/W/583, in which the Group had requested that the transition period should last so long as the country remains an LDC. The 11 June 2013 decision has also removed the condition introduced in the earlier 2005 decision that LDCs cannot roll-back the level of implementation of the TRIPS agreement that they have already undertaken in their national legislation.