Chinese economic success is not the product of free market accidental coincidence, according to this article – rather, it is orchestrated by the State through a mixture of nationalism (‘big think’) and pragmatic decisions (disjointed incrementalism) in agriculture, finance and industry. By following the Chinese example, the author argues for Pan-Africanism, a form of ‘big think’. The main obstacle to development in Africa, he argues, may well be how to align the vested, narrow interests of territorially bound rulers with their citizens, whose languages and cultures tend to transcend the colonially determined national boundaries and who are more likely to support development efforts if they are consonant with existing practices and values. The author argues that Pan-Africanism would allow Africa to take advantage of the economies of scale that accrue with larger markets, give Africa better leverage on its natural resources, allow for easier sharing of resources between rich and poor communities and give the continent greater international clout.
Health equity in economic and trade policies
At the United Nations’ meeting on non-communicable diseases (NCDs) in September 2011, heads of state were told that cancers, heart disease and mental health issues were critical to the future of the global economy: NCDs are forecast to cost $47 trillion, or 4% of global gross domestic product (GDP), over the next 20 years. This, the author of this article points out, was the only figure put forward to contextualise NCDs, as the meeting failed to produce any concrete targets, funds and action plan. Although the UN General Assembly called on the World Health Organisation (WHO) to develop a global monitoring framework over the next twelve months, the framework will contain only voluntary targets and there is little in the declaration that is specific on international co-operation or coordination. Most action is for sovereign interpretation and subject to domestic interests. Health system development, the regulation of industry and key interventions across sectors such as education, environment, agriculture, and transport remain areas for intervention at the national level only. While trade issues concerning access to medicines, food regulation and tobacco control are affected by global policy, governments remained divided in their interpretation of such policies. On the one hand, health ministries now recognise the human and economic cost of overt protection of industries but on the other hand, commerce officials continue to promote consumption of goods domestically and internationally with simplistic assumptions about individual and social impacts.
In this paper, the author argues that, in order to ensure food security for everyone, all aspects of the food security supply chain, global governance, investment and trade will need to be addressed simultaneously. For improving global governance, full support should be given to the work of the reformed Committee on World Food Security (CFS). This may involve merging the United Nations (UN) High Level Task Force with the Committee. At the same time, the Committee may need to work more independently of the Rome-based agencies and report to the UN Economic and Social Council with more coordination than has existed so far. To ensure a functional global food supply system, World Trade Organisation members should consider alternative mechanisms for adjusting trade rules and expanding the mandate of the Committee on Agriculture according to the changing global requirements, the article notes. Thanks to many positive developments such as having a reformed CFS, the Global Partnership on Food Security, substantial new funding and a much more coordinated approach, the global community is in a much better position to reduce global hunger. Unfortunately trade rules are not keeping up with other developments the author concludes.
The Medicines Patent Pool, which negotiates voluntary licences for lower pharmaceutical prices, has announced the signing of an agreement with Indian generics producer Aurobindo Pharma Limited to manufacture antiretroviral (ARV) medicines. The Patent Pool has recently come under criticism from AIDS activists concerned about its July 2011 licence agreement with drug company Gilead, and it remains to be seen if this action will address their concerns. The Medicines Patent Pool said that the agreement will enable Aurobindo to manufacture ARVs licensed to the Pool by Gilead Sciences in July. The uptake of the listed ARVs by generic manufacturers will help close the gap between the arrival of new medical technology in developed country markets and its often delayed arrival in developing countries, according to the Pool. In particular, Aurobindo took advantage of a key provision negotiated by the Pool so it can sell the ARV, tenofovir, to a larger number of countries without paying royalties. The arrangement is expected to make it possible for Aurobindo to sell tenofovir to a larger number of countries than before.
In response to the Medicine Patent Pool Foundation’s (MPPF) first voluntary license agreement with pharmaceutical giant, Gilead, the International Treatment Preparedness Coalition (ITPC) and the Initiative for Medicines, Access and Knowledge – both aiming to secure universal access to medicines – called for a meeting with the MPPF, arguing that the agreement represented a setback for universal access. On 2 October 2011, both organisations and members from civil society from the global south met with MPPF and UNITAID in Geneva, and made three demands. First, the agreement with Gilead should be substantially revised or terminated, given Gilead’s bad faith and the controversial terms of the agreement. Second, MPPF should institute an immediate moratorium on negotiations of any new licence agreements with multinational drug companies until such time as standard terms and conditions or a model agreement is agreed to. Third, the current structure of the MPPF needs to be revised, including its governance and administration, goals and mission, and comprehensive reforms must be implemented that are designed to enhance its transparency, accountability and adherence to core principles of health equity.
From 19-21 September 2011, the World Trade Organisation (WTO) hosted Public Forum 2011, where non-profit organisations Knowledge Ecology International (KEI) and IQsensato held a joint panel session on a proposal to the WTO entitled ‘An Agreement on the Supply of Knowledge as a Global Public Good’. The session provided a space to debate the feasibility of adding the supply of public goods involving knowledge as a new category in negotiated binding commitments in international trade. Proposal advocates argue that in the wake of current high levels of knowledge protection in the form of patents, the global community faces an under-supply of public goods, including knowledge. Opening up knowledge as a public good would include developing nations that have hitherto been increasingly excluded from accessing knowledge which has been patented by multinationals and developed nations. Options include collaborative funding of inducement prizes to reward open source innovation in areas of climate change, sustainable agriculture and medicine, and agreements to fund biomedical research in areas such as new antibiotics, avian influenza and the development of an AIDS vaccine.
Aid for trade (AfT) has proved to be largely ineffective in Malawi because it has had limited success in developing the local human and institutional capacity required to enable trade, according to this article. A key contributor to this has been a failure by trade promoters and external funders to identify where Malawi stands on its development curve. AfT solutions have tended to assume that Malawi is on the same point on its development curve as Cambodia, Vietnam, Ghana or Rwanda. Yet Malawi simply does not have the scale of human capacity that is required to ensure a pro-poor business environment. It lacks the capacity to ensure businesses have affordable access to finance, business development services, inputs, information, markets, labour and technology. The core problem is that civil society, government and the development community have not adequately recognised the roles that development and trade play in their poverty reduction objectives, the author concludes.
At the BRIC Health Minister’s meeting, held on 11 July 2011 in Beijing, the theme was access to medicine, framed by the Beijing Declaration’s affirmation of the importance of technology transfer among the BRICS countries (Brazil, Russia, India, China, South Africa) and the critical role of generic medicines in expanding access to antiretroviral medicines for all. The Health Ministers agreed to establish and encourage a global health agenda to promote innovation and universal access to affordable medicines, vaccines and other health technologies with assured quality, in support of reaching the MDGs and meeting other public health challenges. A powerful alliance could be expected on increasing access to new and innovative antiretroviral therapies (ART) for HIV and AIDS, and developing additional diagnostic tools and treatment for tuberculosis (TB), malaria as well as the neglected diseases. While committed to supporting the TRIPs safeguards and the Doha declaration on TRIPs, the BRICS countries are also determined to ensure that international trade agreements do not undermine TRIPs flexibilities, so as to ensure the sustainable delivery of low-cost quality medicines to low- and middle-income countries.
Kenya is allegedly among the top ten developing countries in terms of revenue lost to the European Union and the United States. But what can be done? The author of this article makes a number of recommendations. At national level, he urges the Kenyan government to implement reforms to tax policy, trade policy, customs and laws and to promote inclusive growth. To make this work, he calls for both political will and active civil society participation. He calls on government to change the law to insist on maximum transparency for all international transactions, and for banks to give full disclosure to tax and relevant national authorities. The author argues for using the price filter model used by the United States Customs to monitor trade misinvoicing. The best solution, he notes, will be an international agreement for automatic exchange of tax information globally. In the meantime, he argues for Kenya to sign bilateral information exchange agreements with the major tax havens and secrecy jurisdictions, to be given information on accounts and companies registered in these jurisdictions that trade and do business with Kenya. He also argues for government to require all transnational companies to publish every year Kenya-specific accounts showing the profits or losses they make. Finally, he argues that Kenya follow the lead of Nigeria, which has sued major international companies for corruption and has been compensated through out-of-court settlements.
Universal access to medicines was a key topic of discussion at a meeting on 11 July 2011 of health ministers from Brazil, Russia, India, China and South Africa (BRICS) in Beijing, China. The meeting, hosted by the Government of China, aimed to identify opportunities for BRICS countries to promote wider access to affordable, quality-assured medicines, with a view to reaching the Millennium Development Goals and other public health challenges. A ‘Beijing Declaration,’ issued on 11 July and signed by ministers of health from the five BRICS countries, underscored the importance of technology transfer among the BRICS countries, as well as with other developing countries, to enhance their capacity to produce affordable medicines and commodities. The Declaration also emphasised the critical role of generic medicines in expanding access to antiretroviral medicines for all. By signing the Declaration, leaders committed to working together to preserve the provisions contained in the Doha Declaration on TRIPS and Public Health—provisions that allow for countries to overcome intellectual property rights restrictions on medicines in the interest of public health. The five BRICS countries face similar health challenges, including a double burden of communicable and non-communicable diseases, inequitable access to health services and growing health care costs. Through collective action and influence, the BRICS coalition promises to deliver cost-effective, equitable and sustainable solutions for global health.