[Ip-health] HuffPo Impact Blog: TPP: Still a Terrible Deal for Poor People's Health

Jennifer Reid Jennifer.Reid at newyork.msf.org
Tue Jul 15 14:31:36 PDT 2014

TPP: Still a Terrible Deal for Poor People's Health 

Dr. Manica Balasegaram
Executive director of MSF’s Access Campaign
Posted: 07/14/2014 6:16 pm EDT Updated: 07/14/2014 6:59 pm EDT
When the intellectual property (IP) chapter of the U.S.-led Trans Pacific 
Partnership (TPP) trade agreement was leaked late last year, it confirmed 
everything public health watchers had warned about for years. The 
far-reaching 12-country trade agreement would deny access to affordable 
medicines for patients across all TPP countries by strengthening and 
lengthening drug patent and regulatory monopolies and delaying generic 
competition. Several negotiating countries balked at the blatantly 
anti-public health provisions, so the U.S. proposed giving the poorest 
countries more time to comply with a few provisions.
According to the new U.S. proposal, TPP countries would be divided into 
two groups using the World Bank's income classification system. Countries 
that currently fall below the high-income line (e.g. Malaysia, Mexico, 
Peru and Vietnam) would be temporarily exempt from three of the most 
harmful provisions, each of which would serve to block or delay the 
availability of more affordable versions of medicines."
Other provisions similarly harmful to public health would still be 
immediately required of all countries. The limited exemption would remain 
in effect for a specific period of time, which would either be determined 
by when the country graduates to "high income" status according to the 
World Bank income classification, or be arbitrarily set through a TPP 
"transition" period.
U.S. negotiators have described this proposal as an important concession 
in the interest of public health. But further analysis by Oxfam and 
Doctors Without Borders/Médecins Sans Frontières (MSF), reveals that the 
U.S. plan would not only leave the worst aspects of the TPP intact, it 
would be devastating to hundreds of millions of poor people living in all 
TPP countries. It would also further exacerbate income and health 
inequalities in these countries.
The U.S. proposal draws an arbitrary and unfair line to determine which 
countries would have to comply with all TPP provisions right away. World 
Bank income classification is an inappropriate measure of a country's or a 
population's capacity to afford high-priced medicines. The classification 
dates back to the 1980s and only measures a country's per-capita average 
of total income. Looking at average income doesn't account for uneven 
distribution of income within a country, or its public health needs.
The map of poverty has changed since the 1980s. Today, the majority of the 
world's poor no longer live in poor countries, but rather in places where 
there is greater wealth along with higher inequality.
The fact that MSF is increasingly responding to the unmet medical needs of 
patients living in countries considered middle or high income is a clear 
representation of this shift. MSF now operates in more than 30 countries 
classified by the World Bank as middle or high income. Activities range 
from short-term emergency response and HIV and TB programs, to programs 
for refugees and migrants and emergency obstetrics and trauma surgery.
To assess the impact of the TPP, MSF and Oxfam used the U.S. 
Medicaid-defined poverty line ($21.50/person per day) to estimate how many 
millions will live below it once countries cross the high-income 
threshold. In eight of the 12 TPP countries for which there is data, more 
than a quarter of a billion people will live below the U.S. Medicaid line 
when their country is classified as high income. By the time Malaysia and 
Mexico reach high income designation, more than 80 percent of their 
populations will still fall below this poverty line. Among current 
high-income TPP countries, which will be forced to immediately adopt all 
TPP provisions, the percentage of the population under this poverty line 
ranges widely, going as high as 69 percent in Chile.
As countries become richer by World Bank standards and are expected to 
invest more funds towards health care and medicines, continued access to 
affordable medicines and generic competition will become even more 
The ability to manufacture and/or purchase low-cost generic medicines 
requires maintaining a balance in a country's patent system between 
monopoly protection and public health. Yet, the TPP will reduce or 
eliminate that balance by curtailing existing legal flexibilities, and 
limiting government discretion to negotiate medicine prices.
Under existing international trade rules negotiated less than 20 years 
ago, which implemented the strictest IP global norms in history, countries 
were assured of the right to use basic legal safeguards to facilitate 
generic competition to protect public health. With the TPP, the U.S. 
government is attempting to re-write the rules.
No matter how long some of the most onerous provisions are delayed, the 
TPP in its current form will be a terrible deal for all countries 
involved. Negotiating countries must not be fooled by this so-called 
compromise from U.S. negotiators. The TPP is as damaging today as it has 
ever been. For the health and well-being of at least 800 million people, 
countries must reject these terms.

Jennifer Reid
Researcher, MSF Access Campaign
Doctors Without Borders/Médecins Sans Frontières (MSF)
333 Seventh Avenue, 2nd Floor, New York, NY 10001
Phone:  +1-212-763-5714
Email: jennifer.reid at newyork.msf.org

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