This study aims to contribute to the implementation of South Africa’s National Strategic Plan (NSP) on HIV, STIs and TB 2012–2016 by making specific recommendations on law and policy reforms to achieve an enabling and accessible legal framework in three key areas: patent, competition, and medicines law. The South African Patents Act, as it currently stands, does not take full advantage of the flexibilities available in respect of limitations to patent rights. The study recommends that the Patents Act make use of the full range of express exclusions from patentability available under TRIPS, and proposes that the process for issuing compulsory licenses be significantly streamlined, with clear legislative guidelines for determining the grounds upon which compulsory licenses can be granted, as well as their terms and conditions to prevent unnecessary delays. The study concludes by emphasising that its recommendations are aimed at achieving mutually reinforcing goals: promoting access to essential medicines and developing and supporting policies conducive to the growth and development of the domestic generic pharmaceutical industry. The process of reforming South Africa’s laws could benefit from a policymaking approach that is consultative, coherent and developed with the input of all relevant actors, governmental and non-governmental alike.
Health equity in economic and trade policies
The ministers of health of the People’s Republic of China and African countries as well as representatives of the African Union, the World Health Organization, UNAIDS, UNFPA, UNICEF, the World Bank, the Global Fund to fight against HIV / AIDS Fund, Tuberculosis and Malaria and GAVI, met in Beijing in August 2013 to implement the Beijing Action Plan 2013-2015, adopted by the 5th China-Africa Cooperation Forum Ministerial in 2012. Under the theme of “Priorities of China-Africa Cooperation Health in the New Era”, the meeting reviewed previous health cooperation between China and Africa and reached consensus on the priorities for and ways of health cooperation. The meeting agreed on various areas of future links including on health worker training; cooperation between research institutions in China and Africa, strengthening of health information systems; prevention and control of communicable and non-communicable diseases; support for health infrastructure development donating modulated clinics to Africa, adapted to local conditions; cooperation in standard setting and inspection of medical products through capacity building and use of appropriate technology and promotion of health technology transfer to reduce the price of health commodities including pharmaceuticals, diagnostics, vaccines and equipment, and to increase their affordability.
Since 2000, China has hosted six ministerial Fora on China-Africa Cooperation (FOCAC), held every three years, in which health is but one of many areas of attention. In the last FOCAC, the accompanying Beijing Action Plan for 2013-15 listed cooperation in many areas – 6 in political, 9 in economic, 6 in cultural, and 6 in development – of which ‘medical aid and public health’ is one. This opinion piece discusses the strengths and challenges of the inaugural forum on health held in August 2013 and the Beijing declaration after the Forum, seen by the author to mark a turning point in the history of Chinese development and health cooperation to Africa. The author notes that China’s top-level leadership clearly sees the political, economic, and perhaps health importance of global engagement especially in Africa.
How to foster agricultural development and food security in East Africa as the effects of climate change become more serious is the subject of the study East African Agriculture and Climate Change: A Comprehensive Analysis. The authors develop several weather-based scenarios for how climate change might affect countries in the region between now and 2050. National contributors from Burundi, the Democratic Republic of Congo (DRC), Eritrea, Ethiopia, Kenya, Madagascar, Rwanda, Sudan, Tanzania, and Uganda review the scenario results for their countries and propose a variety of policies to counter the effects of climate change on agriculture and food security. These policies include greater investment in agricultural research and extension, equitable access to land and inputs such as seeds and fertilizer, expanded irrigation, and improved infrastructure.
In 2012, the World Health Organisation’s Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) proposed a binding convention that would mandate every signatory country to invest a minimum of 0.01% of its gross domestic product (GDP) in research and development (R&D) falling within the established scope. In this article, the author explores the proposed convention’s possible ramifications. In its narrowest interpretation, the convention would only address R&D gaps in areas where no suitable products exist. This would involve funding a publicly-driven pharmaceutical effort since, by definition, no commercial incentive exists in these areas. But even this approach leaves room for interpretation, the author argues. If narrowly interpreted, coverage would be limited to R&D gaps for Type II and III diseases; if more broadly interpreted, coverage would also extend to R&D gaps in Type I products suitable for developing countries. The author argues that, despite advances in global health, developing countries continue to have a shortage of appropriate tools to prevent, diagnose and treat many diseases. The proposed convention is intended to address this problem, but lack of clarity in the convention’s remit has left its scope open to interpretation. He calls for this uncertainty to be resolved in order for discussions to move forward.
The Medicines Patent Pool and Roche have announced an agreement to increase access in developing countries to valganciclovir, a key easy-to-take oral medicine to treat cytomegalovirus (CMV), a viral infection that can cause blindness in people living with HIV. The agreement will significantly improve access to Roche's valganciclovir for people living with HIV in 138 developing countries by making it up to 90% cheaper than current prices. As a second step, the Medicines Patent Pool and Roche will also enter into licensing and technology transfer negotiations to encourage the development of internationally approved quality generic versions of valganciclovir. The most widely used treatment for CMV in developing countries requires injections directly to the eye, which can be painful and also difficult to administer on a large scale. The Medicines Patent Pool will also work with other key stakeholders to develop long-term treatment strategies for scaling up the use of valganciclovir for treatment of HIV-related CMV in developing countries.
This study reviewed evidence on the impact of reproductive, maternal, newborn, and child health (RMNCH) on economic growth and development. The authors performed a systematic search of the published literature in electronic databases and consulted grey literature such as working papers and reference lists of selected articles. They found that GDP loss attributable to maternal mortality varies from US$0 per year in Botswana to US$504 per year in Ethiopia. If maternal mortality increases by one death, GDP per capita decreases by US$0.36 per year on average in 45 sub-Saharan countries. AIDS was found to have a negative effect on economic growth, especially in sub-Saharan Africa, although the magnitude varies among studies from 0.05% to 1% decline in GDP per capita. The intergenerational effect of HIV and AIDS is much higher, at 30-50% reduction of GDP per capita over four generations at a 15-20% HIV prevalence rate. The review revealed inadequate evidence on the impact of RMNCH on economic growth and development, which may, in part, be due to difficulties in measuring economic impact over extended time periods, and may also be due to the breadth of health states that fall within the RMNCH continuum. The authors argue that future research should focus on identifying the most cost-effective policy, programmes and interventions to prevent, reduce, delay or eliminate the complications of RMNCH.
The authors of this paper argue that there is scope to balance current fiscal consolidation efforts in favour of more equity with only limited adverse impact on potential growth. In particular, relatively little weight has been given to reducing tax expenditures and raising taxes on immovable property. A number of consolidation instruments are consistent with equity goals while doing little or no harm to potential growth: increases in the effective retirement age, raising efficiency in the education and health care systems, cutting certain tax expenditures, hiking taxes on immovable property and broadly-based consumption taxes. Increases in capital income taxes would also be equitable but need to be well designed to avoid being distortive. Calculations based on simplifying assumptions indicate that increasing household direct taxes would reduce income inequality, while cutting transfers by the same amount would have a larger and opposite effect on inequality. However, raising progressive labour income taxes could have adverse effects on long-run growth. Cuts in government wages and employment can yield fast consolidation gains but the authors warn that this needs to be accompanied by increases in efficiency of service delivery to avoid that reductions in public services mainly hit poor people.
In this article, the authors discuss the issue of how medicines may be eligible for patents and how this affects evergreening practices, whereby pharmaceutical companies extend the patent on their medicines by making slight modifications. However, evergreening of pharmaceutical patent protection, also includes patent monopolies over manufacturing processes, formulations, dosages, uses and methods of treatment. The authors present data that shows that evergreening patents have extended patent protection to nearly 50 years in some cases, well beyond the 20 year period provided in TRIPS. They argue that the net cost for society of evergreening patents is substantial and they have been proven to interfere and hinder fair competition in the pharmaceutical market, with the result that pharmaceutical companies can charge high monopoly prices for far longer than is justified. Because of its critical implications for competition and public health, India’s s.3(d) is becoming a model criteria for patent eligible subject matter in other countries. For instance, Brazil’s patent reform proposes to adopt such a provision. The invention threshold plays a critical role in the patent system. Setting the bar too low makes it easier for the patent system to be improperly exploited by those that use extended patent monopolies to extract economic rents. This behaviour should not be facilitated, the authors argue, as it unreasonably restricts society’s ability to benefit from the technology transfer trade-off.
According to this book, governments across the globe are being persuaded by economists that government spending on services like education and health is unnecessary and can only worsen the global economic crisis. To this effect they have advanced a policy of draconian budget cuts – austerity - to solve the financial crisis. However, the author of this book argues that the source of the financial crisis is not in government spending but the direct result of bailing out, recapitalising and adding liquidity to the broken banking system. Through these actions private debt was reclassified as government debt, which now is the responsibility of taxpayers to pay off, hence the proposed cuts in government spending. Blyth argues that historical evidence shows that austerity doesn't work when all states try it simultaneously: all they do is shrink the economy. He shows how austerity policies aggravated the Great Depression of the 1930s and created the conditions for seizures of power by the forces responsible for the Second World War: the Nazis and the Japanese military establishment. He concludes that the arguments for austerity are tenuous and the evidence thin. Rather than expanding growth and opportunity, the repeated revival of this dead economic idea has almost always led to low growth along with increases in wealth and income inequality.