Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. This article reviewed academic articles, grey literature, and media sources extracted from 18 databases to examine what is known about the effects of medical tourism in destination and departure countries. It found that most of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North only, focusing on the flow of patients from high-income nations to lower- and middle-income countries, biasing the findings. Five interrelated themes emerged: medical tourism was promoted as a solution to health system problems and a revenue-generating industry offering patients higher standard of care, but some studies criticised it for using scarce public resources and causing health inequity. The study concluded that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.
Health equity in economic and trade policies
European governments have promised to fix laws that caused generic medicine seizures in the Netherlands, the Indian Minister of Commerce and Industry announced. He added that seizures were illegal under the Trade-Related Aspects of Intellectual Property Rights agreement. Minister Anand Sharma pointed to significant savings in buying Indian-made generics for developing countries, for example by reducing the price of treatment for one patient for one year of antiretroviral medicines from US$12,000 to $400. He cautioned against confusing generic medicines with counterfeits, arguing that India was fully TRIPS compliant. India has had meetings with the Directorate-General for Trade at the European Commission, and European Union (EU) Trade Commissioner Karel De Gucht and his predecessor Catherine Ashton in this regard. Some were expecting India to call for formation of a panel in the dispute case after several months of consultations, but the Minister said that he has received ‘clear assurance [from] the EU trade commissioner that the notification under which actions were taken was misinterpreted and will be amended to plug all loopholes’.
According to the authors of this article, the exchange of South-South knowledge and experience has an enormous potential role in the emerging global development architecture. Many current answers to development challenges come from developing countries. For example, developing countries have designed and implemented solutions that have no precedent in the developed world, such as microfinance models in countries like Bangladesh and Indonesia, or the use of mobile technologies for all kinds of services in Africa and elsewhere, including health. Those same developing countries are building strong and reputable academic institutions and development think tanks, with implications for the diversity, sources, and availability of development knowledge and experience. The article proposes greater investment in a more demand-driven model of co-operation that promotes horizontal relationships, invests in local capacity and moves away from a one-size-fits-all solution. For this new approach to work, regional and global multilaterals should mainstream South-South approaches in their business lines and develop funding and brokering mechanisms for low-and middle-income countries, as well as for short-term and long-term projects. Traditional external funders need to be made aware of the win-win opportunity that lies in developing capacity in one country to promote sustainable change in another, and they need to adapt their co-operation strategies accordingly. Parliamentarians and civil society organisations can ensure that governmental peer learning fosters democratic ownership and human rights. Academia and the private sector can help enrich the agenda and engage more with governments and other stakeholders.
This report summarises the main themes, ideas and discussion points from the G20 Conference, held on 30 June 2010. The purpose of this conference was to explore options for the future for the G20 in advancing key issues in global health and development, set against a background of a G8 legacy of contributions to global health aid and the G20’s current focus on the economic crisis. Several themes emerged. First, the Global Fund noted it cannot meet its funding promises and is looking for contributors for the next three years. The Fund needs US$10 billion to sustain current levels, and $17 billion to continue to make gains in fighting HIV and AIDS, tuberculosis and malaria. The conference heard that there is a real possibility of eradicating polio in the next ten years, as just four countries still suffer from the disease, but this requires a concerted effort and political will. While it could be expensive, the long-term savings may be huge as people will no longer need to be immunised against the disease.
Substantive progress eluded the United Nations Convention on Biodiversity (CBD) Interregional Negotiating Group on Access and Benefit Sharing (ABS), which met from 18-21 September in Montreal, Canada. This third attempt at finding consensus on key aspects of the text was unsuccessful and negotiations were postponed to October 2010. At stake is a binding instrument aimed at protecting against extraction of biological resources without proper access to or benefits from products arising from them. Outstanding issues include what genetic resources may be excluded from the text, such as human genetic resources, or human pathogens, and the benefits to indigenous peoples and local communities who are often the most affected by biopiracy.
The United States National Institutes of Health has become the first patent holder to join the newly created Medicines Patent Pool, a project of the drug-purchasing mechanism, UNITAID. Public health organisations, such as Medicins sans Frontiers, hailed the move as key step in the right direction but said there is still much work to do. The pool is intended to be a ‘one-stop shop’ for licensing on generic versions of patented HIV medicines. The hope is that by cutting down on the complexity and cost that often surrounds the licensing process – particularly when one drug can carry several patents from several different places –the pool will reduce the cost and increase the speed at which generic medicines can be made available. It is also hoped that the ease of licensing will help ease also the development of affordable formulations specific to children and to conditions in poorer countries where they are often needed. According to Guy Willis of the International Federation of Pharmaceutical Manufacturers and Authorities (IFPMA), the UNITAID Patent Pool is part of an increasing trend towards open innovation in research and development to create new medicines.
This article argues that Africa today is trailing the rest of the world because, in part, the African leadership has failed to mobilise its people along the lines of a Pan-African agenda that informed the earlier phases of our political development. This is due to its weak ideological base, which, instead of drawing from such a heritage, is wedded to Western ways of knowing and doing things which we have derived from their educational institutions without questioning, including Christian and Muslim religious influences. While these external interventions have added to Africa’s modern culture, the article argues, they have also left a negative impact on African intellectual capacity to think independently unlike, say, the Asian intellectuals and political leaders who have links to their religions and cultures. This is due to the fact that Asia, unlike Africa, was less destabilised by way of religious intrusions, resulting in its intellectual and political leadership remaining more anchored to their religions, languages and cultures.
This paper points to the failure of the ‘post-Washington Consensus’ in the 1990s to reduce poverty, due to macroeconomic policies that promoted fixed investment, neglect of productivity growth and employment creation, a focus on price stabilisation, the absence of accelerated structural change and insufficient capital accumulation. Consequently, the development gap has widened over the past 20 years in South America and Africa. In most developing countries there is a pressing need to increase public sector provision of essential social services, especially those concerned with nutrition, sanitation, health and education. This is important not only for the obvious direct effects in terms of improved material and social conditions, the paper notes, but also for macroeconomic reasons. The public provision of such services tends to be labour intensive, and therefore also has considerable direct effects on employment. Government revenues from the extractive industries could be used not only for public investments in infrastructure, health and education, but also for the provision of fiscal incentives and improved public services under industrial policies aimed at diversification of economic activities. This would reduce countries’ dependence on natural resources. Growth in the modern sector is associated with higher private and public investment in fixed capital as well as greater government spending for the provision of education and health services and social protection.
This study set out to produce quantitative estimates of the Indian role in generic global anti-retroviral (ARV) supply to help understand potential impacts of such measures on HIV and AIDS treatment in developing countries. It utilised transactional data containing 17,646 donor-funded purchases of ARV tablets made by 115 low- and middle-income countries from 2003 to 2008 to measure market share, purchase trends and prices of Indian-produced generic ARVs compared with those of non-Indian generic and brand ARVs. The study found that Indian generic manufacturers dominate the ARV market, accounting for more than 80% of annual purchase volumes. From 2003 to 2008, the number of Indian generic manufactures supplying ARVs increased from four to 10 while the number of Indian-manufactured generic products increased from 14 to 53. Indian-produced generic ARVs used in first-line regimens were consistently and considerably less expensive than non-Indian generic and innovator ARVs. The study warns that future scale up using newly recommended ARVs will likely be hampered until Indian generic producers can provide the dramatic price reductions and improved formulations observed in the past. Rather than agreeing to inappropriate intellectual property obligations through free trade agreements, India and its trade partners - plus international organisations, donors, civil society and pharmaceutical manufacturers - should ensure that there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying developing countries with low-priced, quality-assured generic medicines.
At the African Regional Intellectual Property Organization (ARIPO) diplomatic conference on 9-10 August in Swakopmund, Namibia, the protocol on the Protection of Traditional Knowledge and Expressions of Folklore was signed by African nine states. ARIPO currently has 17 member states. Nine states signed the protocol and the remaining eight states will have to accede to the protocol. Some states have already initiated the process for the ratification and accession, according to a spokesperson for ARIPO, Emmanuel Sackey. The protocol will enter into force after six contracting states have ratified or acceded to it, Sackey said. The organisation is expected to take initiatives on traditional knowledge and link its initiatives with those undertaken by the World Intellectual Property Organization (WIPO) through its active involvement in the WIPO activities in this field. The protocol is meant to ‘protect creations derived from the exploitation of traditional knowledge in ARIPO member states against misappropriation and illicit use through bio-piracy,’ according to ARIPO. The protocol should also prevent the ‘grant of patents in respect of inventions based on pirated traditional knowledge (…) and to promote wider commercial use and recognition of that knowledge by the holders, while ensuring that collective custodianship and ownership are not undermined by the introduction of new regimes of private intellectual property rights.’ The United Nations has warned against the application of western legal and economic principles to collectively owned knowledge in traditional communities.