Public outrage over the exorbitant prices of HIV/AIDS drugs in Africa is focussing public attention on the harmful role of global patent rules in blocking poor people's access to vital medicines. In response to mounting public pressure, World Trade Organisation (WTO) members have taken an unprecedented step in agreeing to hold a special meeting to discuss the impact of global patent rules on access to medicines. They will meet on 20 June at the WTO in Geneva.

The WTO has the power to change patent rules. As a result, this meeting, and the forthcoming WTO Ministerial in Qatar, offers the best opportunity yet to shift the balance of global patent rights in the interests of public health. The outcome of the meeting will have a critical effect on poor people's access to medicines.

Inventors need some protection but under the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) they are getting far too much. Briefly stated, the Agreement, which is the product of one of the most successful corporate lobbying campaigns in history, creates effective legal monopolies for patent holders across the world, enforceable by trade sanctions. This will drive up the price of vital medicines in poor countries, benefiting narrow corporate interests at the expense of public health.

The winners will be the large northern-based companies where innovation is concentrated and which account for 90 per cent of pharmaceutical patents. The strengthened protection provided by the Agreement allows them to sell their new medicines at higher prices for longer periods in more countries. The losers are the millions of people in poor countries who will be further excluded from access to these vital medicines, and their cash-strapped government health services.

It is not suprising that the TRIPS Agreement is fast becoming the epicentre of a battle which pitches some of the world's most powerful pharmaceutical companies, backed by rich governments, against some of the world's most vulnerable people. More widely, there is a growing sense that the Agreement is fundamentally unfair and unbalanced - a fact which threatens to bring not only the patent system but also the whole multilateral rules-based system into disrepute, and which policy makers ignore at their peril.

What is certain is that TRIPS will need serious revision if it is to stem the growing public backlash against patent rules. The recent controversy over the attempts by 39 pharmaceutical companies to block a law which allowed the South African government to shop around for cheaper patented products in other countries, and which the companies claimed violated the TRIPS Agreement, gave the world a graphic illustration of why the rules need to change.

Oxfam is calling for TRIPS to be reformed so that developing-country governments have the unambiguous right to obtain the cheapest possible life-saving medicines without facing the threats of legal challenges or trade sanctions experienced by South Africa and Brazil. To this end, Oxfam is asking WTO members to agree to:

- an in-depth review of the health and development impacts of TRIPS, with a view to reducing the length and scope of pharmaceutical patent protection in developing countries, or exempting developing countries from pharmaceutical patenting
- a moratorium on trade disputes with developing countries over TRIPS compliance until a review of TRIPS is concluded, and the concerns of developing countries about its implementation are addressed
- a commitment by rich countries not to exert bilateral pressure on developing countries to implement unnecessarily strict and potentially harmful intellectual property standards (whether through bilateral or regional trade agreements, or by other means)
- outlaw the use, or threatened use, of bilateral trade sanctions for enforcing unnecessarily strict and potentially harmful levels of intellectual property protection in developing countries, such as the 'Special 301' provisions of the USA's trade act
- stronger public-health safeguards and exceptions to give developing countries the option of reducing the length and scope of pharmaceutical patenting on public health grounds. These should include:
- a strengthened and meaningful public-health safeguard in Article 8;
- the option to exempt vital medicines from patenting on public-health grounds under Article 30;
- an easing of the conditions for compulsory licensing, including restrictions on the production of medicines for export to another country where a compulsory licence has been issued, and the development of fast-track procedures for public-health purposes.
longer transition periods for developing countries before they have to implement TRIPS, based on their attainment of development milestones rather than arbitrary dates.
These are modest proposals. If agreed, they would merely mark a return to the situation for poor countries prior to TRIPS. This would not, as the pharmaceutical companies claim, significantly reduce R&D into the diseases of poverty, nor jeopardise patent protection in richer countries.

Of course, reforming TRIPS is not a panacea. A broad package of measures is needed to improve access to medicines and to ensure adequate R&D into treatments for poverty-related diseases. These include massive investment in public-health services, public funding of R&D, and comprehensive systems of tiered pricing.

Nor will reform of TRIPS provide any guarantee that all governments will take positive action to improve poor people's access to medicines. It will, however, remove a key legal obstacle that currently constrains poor governments from obtaining the cheapest possible medicines for their citizens, and allow market forces to reduce prices through generic competition.

However, attempts by developing countries to change TRIPS so that it better reflects broader social and developmental objectives have been blocked by some rich countries, particularly the US. These countries continue to repeat pharmaceutical industry scaremongering that any tampering with new global patent rules will reduce company profits and undermine R&D.

If the USA or other rich countries block proposals to reform patent rules aimed at protecting public health, developing countries should push the issue to a vote at the forthcoming 4th Ministerial. They have little to lose. It is true that if the USA believes its commercial interests are being prejudiced at the WTO, it's commitment to multilateralism may weaken. But it would be far more damaging for public health and the multilateral system if developing countries renounced their efforts to seek pro-health and development reforms of TRIPS on these grounds. Moreover, the USA is already using bilateral pressure, including the threat of trade sanctions to ratchet up intellectual property standards outside the WTO.

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