In this article, the author states that affordability through reduced pricing is only one part of enhancing access to treatment in public health emergencies: supply security and the guarantee of supply consistency is the other. To the extent that patent pooling is able to create regional African manufacturing capability, Africans will support the concept. However, if it further decentralises manufacture away from the continent and increases Africa’s dependence on imports, it can potentially weaken supply security and will continue to relegate Africa a continent of dependency, rather than one that invests in its own capability. The author cautions that patent pooling should be viewed guardedly on the African continent and only be embraced if it is consistent with the AU Heads of State’s call for an African manufacturing plan. Africa must aspire to move from ‘converting charity dollars into sustainable, long term investment dollars’.
Health equity in economic and trade policies
German Marshall Fund of the United States: 19 November 2009
This document is a collection of seventeen essays on economic partnership agreements (EPAs) authored by recognised trade experts and senior policy-makers. Their responses constitute a mix of positive and negative elements, reflecting the complexity of the EPA processes. The negative message here is that EPAs are not useful or, at least, that these agreements are not necessarily relevant in light of the challenges faced by poor and vulnerable states, such as the African, Caribbean and Pacific (ACP) countries. The positive message is that all stakeholders continue to strongly believe that the EPAs should and can make a positive difference and that it is therefore possible to shape them for a truly positive outcome. The views expressed here reflect great convergence over the fact that there continues to be a huge trust gap in the negotiations. Whether perceived or observed, there is a persistent impression among ACP negotiators that EPAs are about European interests. Without trust among negotiating parties, chances are scant that negotiations will actually lead to genuine partnerships, as implied by the term ‘economic partnership agreement’.
A waiver to World Trade Organization (WTO) rules intended to aid people in poor countries in gaining access to medicines is reported to have remained essentially unused in the over six-and-a-half years since it was put in place. Member states of the WTO will be holding an informal meeting to discuss this situation and see what, if anything, needs be done. The 2003 waiver was made an amendment in 2005 within the WTO Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement to allow for increased export of medicines made under compulsory licences. This was intended to give a helping hand to nations without a domestic pharmaceutical industry, who might have public health needs for a patented and unaffordable medicine they are unable to produce themselves.
Under TRIPS, compulsory licences are meant to primarily serve a national market, but the TRIPS public health amendment (often referred to as the ‘paragraph 6’ solution referring to the Doha Declaration on TRIPS and Public Health) allows countries with pharmaceutical industries to manufacture and export more medicines under a compulsory licence to countries without them, provided certain conditions are met.
Kenya and Tanzania have recently passed anti-counterfeit laws and regulations that risk blocking legitimate generic medicines instead of fake products, which is the purported purpose of these laws. Uganda is now considering a similar bill. Like the other East African legal provisions, Uganda's draft bill defines counterfeiting in such a way as to criminalise manufacturers and importers of safe, high-quality generic medication. Critics say Uganda already has adequate legislation against fake products. To explain what is spurring the adoption of these new laws on intellectual property rights, intellectual property rights expert, Sisule Musungu, points to the politics of global trade. In this interview, he notes: '…Intellectual property rights don't guarantee quality or certification of quality. And that is why talking about quality and intellectual property does not add up because they are two different things: the latter confers rights to intellectual property owners and has nothing to do with the quality of products.'
Access to medicines in developing countries continues to be a significant problem due to lack of insurance and lack of affordability. Chronic myeloid leukemia (CML), a rare disease, can be treated effectively, but the pharmaceutical treatment available (imatinib) is costly and unaffordable for most patients. GIPAP is a programme set up between a manufacturer and a non-governmental organisation to provide free treatment to eligible CML patients in 80 countries worldwide. In this study, data for 13,568 patients across 15 countries, available quarterly, were analysed over the 2005-2007 period. Four waves of patients entering quarterly in 2005 were used to evaluate patient survival over the sample period. Having controlled for age, location and occupation, the analysis showed that patients were significantly more likely to move towards a better health state after receiving treatment irrespective of their disease stage at the point of entry to the programme.
According to this book, the first certain trade between Africa and China may be dated from the fourteenth century, but east African city-states may have been trading with southern China even earlier. In the mid-twentieth century, Maoist China funded and educated sub-Saharan African anticolonial liberation movements and leaders, and China then assisted new sub-Saharan nations. Africa and China are now immersed in their third and most transformative era of heavy engagement, one that this book believes will promise to do more for economic growth and poverty alleviation than anything attempted by Western colonialism or international aid programs. Robert Rotberg and his Chinese, African and other colleagues discuss this important trend and specify its likely implications. Among the specific topics tackled here are China’s interest in African oil; military and security relations; the influx and goals of Chinese aid to sub-Saharan Africa; human rights issues; and China’s overall strategy in the region. China’s insatiable demand for energy and raw materials responds to sub-Saharan Africa’s relatively abundant supplies of unprocessed metals, diamonds, and gold, while offering a growing market for Africa’s agriculture and light manufactures. As the book illustrates, this evolving symbiosis could be the making of Africa, the poorest and most troubled continent, while it further powers China’s expansive economic machine.
According to this paper, environmental risks arise largely from unsustainable development policies related to the use of water and land resources, transportation and energy. The health impacts of environmental pollution and ecosystem degradation disproportionately affect the disadvantaged and vulnerable socioeconomic groups, such as children, the rural and urban poor, and informal-sector workers. Economic, institutional, political and social factors present barriers to more sustainable environment and health policies, while macroeconomic considerations tend to be the major drivers of policy-making on the continent. Health ministry policies are generally focused on health care services and may not systematically address the related broader environment and development agendas. Environment ministries are often newer entities, and lack the power or resources to steer government investments towards sustainable development. African countries need to be able to monitor, prevent or mitigate risks that might develop into full-scale environmental and health crises.
At an informal meeting between the World Health Organization and a number of countries, held on 20 January 2010, the importance of having a fully realised framework for handling pandemic influenza was discussed. The meeting made progress on virus and benefit sharing, but it needed to cover pandemic risk response as well as pandemic risk assessment, said the Indonesian delegate. There was also some discussion on the way to handle virus and benefit sharing. India wanted assurance that the WHO does not commit to terms and conditions that might get set as precedents and upset the balance between virus and benefit sharing. Japan said that the agreement should focus on voluntary, not mandatory, benefit sharing but that states should do more to contribute as much as they can in terms of financial and technical resources to countries that need them. Sangeeta Shashikant of the Third World Network said, 'the inequity of a system that delivers vaccines to developed countries but requires developing countries to rely on ad hoc measures such as donations is apparent.'
The author notes that, given the magnitude of Western debt and the need to reduce it at a rate that does not disrupt any signs of growth, 2010 may well be the most benign year for development between now and 2015. He believes that the big cuts will come in 2011 onwards and makes ten predictions that may help inform development decisions during 2010. 1. China's view will become the bellwether of all development agreements. 2. ‘Minilateralism' is the wave of the future. 3. Copenhagen will energise, not demoralise, those fighting for climate issues to be higher up the agenda. 4. The Commonwealth will become more important in development. 5. USAID will become more relevant to international development. 6. Food and nutrition will slowly slip from the top table of the development agenda. 7. Africa will get back onto the international agenda, albeit briefly. 8. Economics will change, but only at the margins. 9. The UK Department for International Development (DFID) will undergo evolution not revolution. 10. People power in development will move into a new age.
Finding financing to develop medicines for under-researched diseases, regulatory harmonisation and pandemic influenza preparedness topped the agenda at the World Health Organization's (WHO) Executive Board meeting, held from 18–23 January 2010. Its recommendations will be sent to the annual WHO member decision-making World Health Assembly, which meets in May 2010. Regulatory harmonisation, such as streamlining processes for ensuring drug safety, is one of the major recommendations of the Expert Working Group to increase efficiency in the research and development system. Strengthening regulation is also one of the activities the WHO secretariat has said it is undertaking as part of the implementation of its global strategy, which requires a 'strengthening of the WHO prequalification programme'. Drug regulation may become a key discussion point on public health and intellectual property this year, according to sources. And there is recent concern from several members of the Parliamentary Assembly of the Council of Europe that the threat of pandemics, specifically the flu epidemics, may have been exaggerated 'in order to promote … patented drugs and vaccines'.