It has been frequently claimed that cholera epidemics, both in the 19th century and today, were and can be the key stimulus for procurement of safe water and sanitation, an idea that the author calls ‘cholera forcing’. ‘Technology forcing’ refers to imposition of exogenous factors that suddenly make possible achievements that had not seemed so; cholera has been seen in this light. He argues that this view oversimplifies and under-represents the importance of industrialisation in securing water supplies. Careful study of the financial, political, and administrative foundations of such changes will be more fruitful.
Health equity in economic and trade policies
Cholera forcing: The myth of the good epidemic and the coming of good water
Hamlin C: American Journal of Public Health 99(11): 1946–1954, November 2009
Counterfeit, substandard and generic drugs: Distinct definitions for distinctly different problems
Medicin Sans Frontiers: April 2009
Today there is a real attempt by certain actors to confuse the debate about substandard, counterfeit and generic drugs. Articles in the media often discuss counterfeit, substandard and generic medicines as if they are all one problem and the same solution can be used for all of them. This confusion can have a negative impact – because if the public believes that generic medicines are the same as counterfeit medicines, they will lose confidence in generic medicine. Another negative consequence of confusing counterfeit and generic drugs, is that this often leads to calls for stronger intellectual property enforcemement, which then creates access to medicines problems. Even at the level of policy makers, these confused messages can have a very negative effect. The World Health Organization (WHO) has a role to play in supporting national regulators to take measures against both counterfeit and substandard medicines. But, perhaps most importantly, WHO should shift its attention to substandard medicines, a much bigger problem.
Draft decision emerges from World Intellectual Property Organization General Assemblies
World Intellectual Property Organization General Assemblies: 1 October 2009
After a year of stalled deliberations on the issue of protecting traditional knowledge, genetic resources and traditional cultural expressions, delegates at the World Intellectual Property Organization General Assemblies on 1 October found a compromise text that gives the committee its strongest mandate yet. The new Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional Knowledge and Folklore (IGC) agreement is to undertake text-based negotiations that will eventually become an ‘international legal instrument (or instruments)’ to ‘ensure the effective protection of’ traditional knowledge, genetic resources and traditional cultural expressions (folklore). It also lists three texts – containing language in the format of a possible draft instrument – that will form the basis of those negotiations, though it does not limit negotiations to just those texts. It also says there will be three inter-sessional working groups during the next biennium to accelerate the work.
G20: One voice for all?
Collodi J: 30 September 2009
It caught observers and analysts by surprise. The Pittsburgh G20 summit witnessed the death-knell of the G8 as the sole arbiter of global economic policy and the transference of power to the G20 grouping. Officially this will take place at the G20 summit at the end of 2010 in South Korea, as Canada – in perhaps an unwelcome reminder of parochial G8 decision-making –is keen to keep ‘its’ G8 event as relevant as possible. The author argues that the G8, after much debate over its futility as a global decision-making body, is consigned as a forum to consider security matters. But the G20 counts just one African nation as a member. Although developing countries such as India, Brazil and South Africa have more authority to speak on behalf of poorer nations, the voices of low-income countries themselves were not included or seemingly solicited. ‘One of the most important successes of Pittsburgh is that that the G20 is the most qualified forum to deal with global issues,’ African Development Bank president Donald Kaberuka said, speaking on the periphery of a conference. ‘(However) (t)he way it is now structured...the low-income countries' priorities are still an appendix, a footnote.’
Kenyan court case holds up national ARV supply
Plus News: 12 October 2009
Kenya is facing a nationwide shortage of anti-retroviral (ARV) drugs after a court case held up the purchase of the life-prolonging medication. The High Court in the capital, Nairobi, barred the Ministry of Health from procuring ARVs after a consortium of drug suppliers challenged the tender process earlier this month. According to James Ole Kiyapi, permanent secretary in the Ministry of Public Health, unless the court allows the government to purchase ARVs, there is a real risk that people who depend on government hospitals for their medication could go without. ‘We have very little medicine left and there is nothing we can do to get the drugs because we have to abide by the court order; we can do very little at the moment unless the court reverses the order,’ he said. Earlier this year, the Public Procurement Review Board (PPRB) – responsible for monitoring the government's purchases – issued an order forcing the Kenya Medical Supply Agency (KEMSA) to accept tender documents by an Indian company, Hetero Drugs Limited, and start the tender process afresh. KEMSA had rejected the company's tender documents because they allegedly did not comply with procurement rules. The consortium that originally won the controversial tenders has now gone to court to reverse the order of the PPRB.
The global politics of pharmaceutical monopoly power
Hoen EFM, Medecins Sans Frontieres : 2009
Many countries have been able to use the TRIPS flexibilities to access lower-priced generic drugs. However, as pharmaceutical product patents start to be granted in producing countries, this situation will change. To resolve the problem of high drug prices caused by patent monopolies, this book recommends that developing countries should make full use of the provisions in the Doha Declaration. It introduces a re-conceptualised definition of innovation as encompassing discovery, development and delivery, thereby including access as an integral part of innovation. Equally important, the international community should consider supporting patent pools as a tool for improving the management of intellectual property for access and innovation. In this sense, the book suggests a new agreement on sharing the costs and benefits of medical research and development (R&D) for the sake of humankind. In like manner, the book underlines a proposition to change the way R&D is financed. At the core of this proposal is the elimination of the linkage between drug prices and drug discovery. It also highlights the importance of establishing a trade framework for R&D that focuses on equitable contribution to the cost of R&D through multiple means – not exclusively through the granting of patent monopoly rights.
The International Monetary Fund’s effects on global health: Before and after the 2008 financial crisis
Stuckler D and Basu S: International Journal of Health Services 39(4): 771–781, October 2009
In April 2009, the G20 countries committed US$750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF loans to financially ailing countries come with loan conditions that have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund’s effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programmes have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to ensure progress towards meeting the health Millennium Development Goals.
Tobacco companies’ use of developing countries’ economic reliance on tobacco to lobby against global tobacco control: The case of Malawi
Otañez MG, Mamudu HM and Glantz SA: American Journal of Public Health 99(10): 1759–1771, October 2009
Transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it. This study analyses tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organisations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC.
WIPO members step up to implement development agenda
Mara K and New W: Intellectual Property Watch, 15 October 2009
World Intellectual Property Organisation (WIPO) members are preparing to take the reins of the Development Agenda as it becomes clear that implementation success will depend on their actions. And their actions must not only be focused on specific projects such as patent databases but also on the broader spirit of the agenda for change at WIPO, key developing countries said. A range of stakeholders met at WIPO on 13–14 October at an ‘open-ended forum on proposed Development Agenda projects’. A number of officials said they were pleased with the secretariat’s efforts on implementation and with it holding the event. But there are many problems with that assumption: patents leave out necessary information, some technologies require material transfer in order to be used, and availability of patent information does not equate to permission to use it, she said. In order to be relevant to developing country interests, said Shashikant, WIPO should undertake programmes to help developing countries use compulsory licences as needed to improve access to technology, to document and train in the use of patent oppositions, and to study the degree to which technology transfer is happening under World Trade Organization mechanisms so that WIPO programmes can learn from and improve on problems.
WTO Forum: Bypassing international agreements may hamper medicines access
Saez C: Intellectual Property Watch, 11 October 2009
Access to medicines in developing countries may be put at risk by European customs regulations and more broadly by trade provisions in most free trade agreements between developed and developing countries, said speakers at the recent World Trade Organization (WTO) Public Forum, held from 28–30 September. European Union (EU) regulation 1383/2003 concerning customs action against goods suspected of IP infringement is open to interpretation, said Sunjay Sudhir, counsellor at the Permanent Mission of India. There are fears that decisions taken under regulation 1383/2003 reflects a larger design for tougher enforcement of IP rights, part of which is a campaign of deliberately confusing quality concerns with IP rights in international organisations. The issue has arisen in the World Health Organization, and can be noticed in TRIPS-plus elements in bilateral free trade agreements, and the Anti-Counterfeiting Trade Agreement (ACTA) under negotiation to the exclusion of many countries, including developing and least-developed countries, according to Sudhir. ‘Regulation 1383/2003 should be reviewed and brought into line with TRIPS, GATT, and the Doha Declaration on the TRIPS agreement and public health,’ he recommended.