At the heart of almost every dispute about access to medicines lies this question: how do countries balance the need to protect public health against patent rights that lead to high medicine prices and limited access for people in need?
Ten years ago this month in Doha, Qatar, all of the governments in the World Trade Organization (WTO) seemed to provide an answer when they declared in no uncertain terms that trade rules "...should be interpreted and implemented in a manner supportive of (countries') right to protect public health and, in particular, to promote access to medicines for all."
A decade later, where do we stand with regard to access to medicines?
The Doha Declaration was signed against the backdrop of a full-blown AIDS epidemic in the developing world, with unconscionable disparities in access to life-saving medicines between rich and poor countries. Then-UN Secretary General Kofi Annan welcomed the declaration by saying there was now little to stop developing countries from taking measures to protect public health.
It was a landmark declaration. It was recognition in the most important multilateral trade arena that public health should not be subverted by intellectual property rules. It reaffirmed that countries could look after their citizens' interests and take measures -- like issuing a compulsory license to allow generic production, or designing patent laws privileging people's health over profit -- without the threat of censure. It has spurred continuing debate at the WTO and the World Health Organization on how to integrate innovation and access to medicines. Thailand, Brazil and many African countries benefitted from this reaffirmation of rights within the WTO's trade rules by issuing compulsory licenses or not enforcing product patents to allow them to import generic medicines.
Doha also gave many countries the space to implement pro-public health laws. Until recently, India did not grant patents on medicines, allowing the country to become one of the world's biggest producers of affordable generic versions of medicines. India is now known as the 'pharmacy of the developing world.' When India joined the WTO in 2005, it was obliged to start granting patents on medicines, and in the interest of public health and access to affordable medicines, the country designed a common sense law that is strict about what does and does not deserve a patent.
The promise of Doha, though, has not always been put into practice. Often it's been a case of double standards.
When developing countries have tried to use these public health flexibilities to protect their citizens, developed countries have exerted massive pressure on them.
So when Thailand issued a compulsory license in 2007 for a drug to treat its growing number of citizens living with HIV, the U.S. placed Thailand on their '301 Priority Watch List', reserved for states seen not to be keeping their end of the intellectual property bargain. The US-based pharmaceutical company Abbott even retaliated by withdrawing all new medicines applications from the Thai market.
India's use of the public health flexibilities in designing its patent law is also under attack. Not only is the U.S. advising other countries not to adopt such measures, but the pharmaceutical company Novartis has gone so far as to sue the Indian government. Even under its common sense patent law, some drugs in India will still be patented, and because price-busting competition among generic manufacturers will be blocked, many of the latest, most effective treatments for HIV and other diseases will likely be priced out of reach for people in developing countries. In the absence of generic competition, the poorest countries are relying on voluntary discounts from companies that go nowhere near far enough and leave millions without access to vital, lifesaving drugs.
Today, the U.S. government is using negotiations over the Trans-Pacific Partnership (TPP) trade agreement to demand aggressive intellectual property provisions that undermine the Doha Declaration and the safeguarding of public health. These harmful provisions must be removed.
And time is running out for the world's least developed countries (LDCs) like Burundi and Cambodia: by 2016, they will be required to start issuing product patents. Once this deadline passes, the world's poorest countries will have to keep up with the policies of wealthy nations, which is simply unsustainable. There are calls from WTO members to issue another extension, but others, like the U.S., are even holding out the threat of sanctions for those countries that fail to comply.
So this is where we stand ten years after the Doha Declaration: Even though it continues to have an important impact, the playing field is still tilted in favor of rich countries and bullying tactics employed by wealthy countries threaten to tilt the field even further.
So what more can be done to live up to the promise of Doha and ensure that public health needs are addressed without censure or punishment? This past August, Doctors Without Borders launched an ideas contest on the theme of 'Revising TRIPS for Public Health.' Next week sees the climax of that, with the winners presenting their ideas at a conference in Geneva. We'll be broadcasting the event and posting the winning entries on our website, www.msfaccess.org.
I hope the winning ideas can generate some discussion and look towards effecting change, so that the next decade sees us moving towards more access to medicines for those who need them most.