At a formal meeting of the regular session of the TRIPS Council on 24-25 October 2011, Member States conducted their annual review of the implementation of the ‘Paragraph 6’ solution in respect of the TRIPS Agreement and public health. The solution aims to help developing countries with insufficient or no pharmaceutical manufacturing capacities to import cheaper generic medicines produced under compulsory licensing. Ecuador and Venezuela continued to argue that, since the system has only been used once, it is too complicated to be effective, while other Member States questioned whether it is working and said they need more information. Members also agreed to extend the period for acceptance of the protocol amending the TRIPS Agreement (of 2005) for a further two years – till 31 December 2013 – until two thirds of World Trade Organisation (WTO) Members accept the amendment, which is required for it to take effect. Discussions were also held on the Anti-Counterfeiting Trade Agreement (ACTA), during which India, the world’s largest generic manufacturer, stressed that ACTA border measures constituted a grave threat to trade in generics. India argued that ACTA is not legitimate, as it bypasses the multilateral processes of WTO or the World Intellectual Property Organisation and goes far beyond the enforcement levels laid down in the TRIPS Agreement. It noted that ACTA proposals that are underway could undermine the provisions and flexibilities in the TRIPS Agreement by requiring patentability of new uses and minor variations of older known drugs, resulting in indefinite lengthening of the patent life and undermine the generics industry.
Health equity in economic and trade policies
According to this press release by the Treatment Action Campaign (TAC), a South African coalition of HIV and AIDS treatment activists, South Africa currently provides patent protection beyond what is required by the international TRIPS agreement, which regulates patents, including those governing production of medicines. Flexibilities in TRIPS allow developing countries to produce or procure affordable generics and countries like India, Brazil and Thailand have used these flexibilities to curb excessive patenting of pharmaceuticals and promote public health. Yet South Africa has not followed their example, argues TAC, having granted 2,442 pharmaceutical patents in 2008 alone, while Brazil only granted 278 pharmaceutical patents between 2003 and 2008. Although President Jacob Zuma has signed on to a joint declaration with India and Brazil recognising the urgent need to scale up production of generic medicines by using TRIPS flexibilities, TAC argues that government has not yet taken the concrete steps needed to fulfill this commitment.
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.
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.