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.
Health equity in economic and trade policies
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.
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.
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.
On 25 September 2009, hundreds of farmers, traders, students, women groups and civil society from across Kenya congregated at Uhuru Park to proclaim their concerns about the economic partnership agreements (EPAs) currently under negotiation between the European Union (EU) and African countries. The protesters delivered a petition to the Ministry of Trade as well as Trade committee of the Kenyan parliament. Through a collective mass fax and e-mail action, more than 80 organisations in 30 countries across Europe, Africa and the Pacific have called on decision-makers to fundamentally change the course of the ongoing negotiations. The multiple messages are aimed at stressing the importance of bold committed African leadership displayed by only supporting trade and economic policies that lead to the development of their people.
On 14 September, the governing Trade and Development Board (TDB) of the United Nations Conference on Trade and Development (UNCTAD) began its fifty-sixth session with UNCTAD Secretary-General Dr Supachai Panitchpakdi stressing that the global financial and economic crisis presents an opportunity to find long-term, multilateral solutions to the cycle of financial crisis and unsustainable global imbalances. Amongst others, this year's TDB session will also be holding a high-level discussion on the global economic crisis and the necessary policy response. The mega-stimulus packages introduced by many governments appear to have had a decisive impact in slowing the global economy's descent, but Dr Panitchpakdi nevertheless ‘believes we must still continue to be cautious about the evidence for recovery, and in particular what this means for developing countries.’ He also referred to the so-called 'shadow banking system', which at its peak, held assets in the US of approximately $16 trillion, the collapse of which kick-started the global economic crisis.
Following the signing of the Southern African Development Community (SADC) countries to negotiate an economic partnership agreement (EPA) with the European Union, the Botswana government has been warned to exercise its rights in making sure that threats facing the private sector are taken into consideration. Dr Howard Sigwele, executive director of Delta Diaries, Botswana's first jointly owned citizen milk producing company, indicated that although there were benefits in the agreement in trying to enhance private sector participation in foreign markets, there were possible threats such as unregulated entry of goods and subsidised European Union imports into Botswana, undermining the performance of local business and lead to company closure. He warned about the possible entry of goods of inferior standard and possible importation of diseases and pests unless measures are taken to prevent this.
Authorities in India, the leading producer of generics in the world, have rejected applications for patents on two AIDS drugs, opening the way for cheaper generic versions to be developed and marketed. In the Gleevec case, the Swiss drug company filed a special petition, seeking leave to appeal to the Supreme Court. The petition was to be heard on 31 August but the matter was adjourned after the presiding judge recused himself. India’s patent office has rejected the patents for tenofovir and darunavir, which are expensive but needed for AIDS patients failing on their existing treatments. Brand-name producer Gilead also previously failed to win a patent for tenofovir in Brazil, according to Medicin Sans Frontieres (MSF). The rejection of the patents has yet to be confirmed by official sources. MSF credited Indian Law Section 3(d) with preventing the evergreening of drug patents and opening the way for generics competitors to enter the market.
The legitimacy of the intellectual property (IP) system depends on the correct balance between the public interest and the private privilege given to the IP holders. This balance has been disrupted by a one-size-fits-all global regime in the TRIPS agreement. Yet TRIPS has some flexibilities that can be used. Recently, developed countries have been promoting a TRIPS-Plus agenda that reduces or removes TRIPS flexibilities. Their IP enforcement programme has resulted in legitimate generic drugs of developing countries being seized in European ports while in transit to other developing countries. At the World Intellectual Property Organization (WIPO), developing countries have not accepted the TRIPS-Plus proposals and are protesting against the actions on generic medicines. Issues covered here include the row over generic drug seizures, the recent controversies at the WIPO meeting on Patent Cooperation Treaty, the TRIPS-Plus enforcement agenda, and the move towards a ‘global IP infrastructure’.
The two-day Mini-Ministerial meeting of 36 trade ministers hosted by India on 3–4 September appears to have concluded with a few proposals on a process to ‘re-energise’ the World Trade Organization Doha Round of multilateral trade negotiations, but with no movement on substance. Virtually all developing country groupings endorsed the multilateral approach of negotiations and cautioned against the attempt to subvert the process through bilateral or plurilateral negotiations. They also endorsed the December texts as the basis of negotiations rather than unravelling the texts. This is presumably because the US is demanding even more concessions than what is outlined in the December text. In the corridors on the last day of the meeting on 4 September, one negotiator from an invited country said: ‘Not much has happened here but a discussion on process and reiteration of positions.’ A delegate from a G20 country stated: ‘The US came here, but is in no position to offer anything. They are demanding that we open the text and give more market access, but are not willing to offer anything in return.'