[Ip-health] Health: Joint Symposium to focus on innovation and access challenges in MIC

K.M. Gopakumar kumargopakm at gmail.com
Wed Nov 5 03:54:38 PST 2014

*TWN Info Service on Intellectual Property Issues (Nov14/2)*
5 November 2014
Third World Network

*Health:  Joint Symposium to focus on innovation and access challenges in

Geneva, 5 November (TWN) – The fourth joint symposium of WHO, WTO and WIPO
will focus on innovation and access challenges in the middle-income

The one-day symposium titled “Innovation and Access to Medical
Technologies: Challenges and Opportunities for Middle-Income Countries” is
taking place today at the WIPO headquarters.

According to the background note the symposium is to “shed light on the
concept of rating countries according to their gross national income, in
particular, why such a benchmark alone is not adequately reflecting the
public health situation and what public policies are needed to ensure that
economic growth contributes to achieving Universal Health Coverage”.

Further, the symposium is also to address “the twin challenges of promoting
biomedical innovation within middle-income countries while ensuring access
to that innovation”.

The symposium has three technical panels:

The first panel will discuss the concept of middle-income countries (MIC):
What does it mean? How do we measure capacity for innovation? What are the
factors of success? The second is on trends in medical technologies
innovation in MIC. The third is on the challenge of ensuring access to
medical technologies in MIC.

The symposium also has a 30-minute session on ebola titled “Ebola:
Innovation and Access to New Treatments.”

The opening session will be addressed by Xiaozhun Yi, Deputy
Director-General of WTO, Marie-Paule Kieny, Assistant Director–General,
Health Systems and Innovation, WHO, Johannes Christian Wichard, Deputy
Director-General, Global Issues Sector, WIPO.

The background note clearly brings out the fallacy of MIC. The World Bank
Classification classifies countries as MIC if their gross national income
is within the range of US$ 1,045 -12,615.  Currently 105 countries are
classified as MIC. This group is further divided into lower middle income
countries (LMIC) and upper middle income countries (UMIC).  Currently 50
countries are classified as LMIC and 55 countries are UMIC.

According to the background note, “The current 105 middle-income countries
include 17 countries that, in the UN system, are considered least developed
countries, due to the different selection criteria for the two groups”.  It
further states: “While the World Bank’s main criterion for classifying
economies is gross national income, the United Nations Committee for
Development Policy uses two additional criteria, the human asset index and
the economic vulnerability index”.

The background note also clearly states: “ Given that the gross national
income in many of these countries is unequally distributed, the rating as a
middle-income country does not mean that the majority of people in these
countries are well off. Today, more than three-quarters of poor people in
the world who live on less than US$ 2 per day are in middle-income
countries rather than in low-income countries”.

The notes states that in the absence of widespread health insurance
coverage and the lack of international aid and assistance, access to health
services and especially medicines is a huge problem and put poor people in
MIC at risk.

The situation is getting worse due to the recent development of excluding
MIC especially those in the UMIC from the voluntary licences (VL) granted
by patent holding pharmaceutical giants to selected generic medicines
manufacturers. These VLs not only exclude the MIC from the scope of the
licences but also cut the supply line by giving VLs to limited selected
companies and preventing them from supplying to the excluded MIC.  In the
absence of manufacturing capability many MIC depend on generic companies
from India and the VLs issued to Indian pharmaceutical companies prevent
them to supply to excluded MIC.  As a result, MIC that do not have the
manufacturing capability cannot even use the TRIPS flexibilities like
compulsory license to import.

A stark case is the recent Gilead Sciences VL on sobosfovir given to
several Indian companies that exclude MIC from the scope of its VL even
when there are no valid patents in force in the excluded MIC. The
restrictions in the Gilead licence make it difficult to supply to the
excluded MIC under a compulsory license.

According to Health Global Access Project (Health Gap), the Gilead licence
excludes nearly 49 million people in MIC from accessing sobosfovir, a
crucial hepatitis C medicine, at an affordable price. The background note
acknowledges this problem and states: “Middle-income countries have often
been at the heart of the debate on the impact of intellectual property (IP)
on access to medicines in the past years: one of the most controversial
aspects of the increasing number of voluntary license agreements in the
area of antiretroviral treatment for HIV is the inclusion or exclusion of
middle-income countries. With the upcoming new treatments for hepatitis C,
there is even greater focus on middle-income countries that bear a very
high disease burden. To achieve their public health objectives,
middle-income countries appear to be adopting different IP strategies.’

VLs issued to Indian pharmaceutical companies through the Medicines Patent
Pool also exclude MIC.

The interesting thing to watch out for at the WHO/WTO/WIPO symposium is
whether there will be a clear articulation on the use of TRIPS
flexibilities such as the use of compulsory licence/government use order to
address the challenges of access to medical technologies including new

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