[Ip-health] Governance Now - In search of affordable medicines for the poor: Russia, China urge BRICS bloc to have coherent policy for affordable medicines

Thiru Balasubramaniam thiru at keionline.org
Wed May 25 22:05:50 PDT 2016


In search of affordable medicines for the poor

Russia, China urge BRICS bloc to have coherent policy for affordable

Shreerupa Mitra-Jha | May 25, 2016 | Geneva

A high-level panel hosted by India as part of the BRICS group of countries
discussed the issues of trade deals that inhibit access to medicines and
also limit policy space for governments to legislate in public interest.

Minister of state for health and family welfare Shripad Naik called the
proliferation of regional trade agreements “a reality” but added that these
processes should move “within the ambit” of the World Trade Organisation

“We believe that the regional processes must move in tandem with the rules,
standards and multilateral trade liberalisation, within the ambit of the
WTO, to maximise overall gains, for all countries,” Naik said at the event
that was organised on the sidelines of the 69th World Health Assembly that
kicked off in Geneva on May 23.

“This will also pave the way for an expanded access to affordable medicines
across the globe,” he added.

This is the first time that India hosted an event on health as the
president of the BRICS bloc for this year. The panel that was co-sponsored
by the BRICS countries saw a full house with attendance from the health
ministers and deputy health ministers from across the BRICS bloc and also
from Chile, apart from the presence of World Health Organisation (WHO)
director-general Margaret Chan and UNAIDS executive director Michel Sidibé.

“The regional trade agreements should give priority to public health
services, in particular remove barriers to all stakeholders that may
endanger medicine accessibility and promote policy coordination,” said Li
Bin, chair of the National Health and Family Planning Commission in China.

Li and the Russian deputy minister of health Sergei Kraevoi called for a
better coordination among the BRICS countries that have robust generics
industries to both counter spiraling drug prices and ensure better access
for its population.

Citing a report of the Global Commission on HIV and the Law published in
2012 by the UN, South African minister of health Aaron Motsoaledi said that
the current laws are failing to promote access innovation that serve the
medical needs of the poor.

“Human well-being is the only reason we are ever given when any company
innovates any new pharmaceutical (product). No other reason has ever been
offered, at least not in public. We are not insensitive to the financial
well-being of pharmaceutical companies, we are just but more sensitive to
human well-being,” Motsoaledi said.

Increasing patents for non-communicable diseases (NCDs) – the incidence of
which has steeply risen in India in the past few years – and also for
biologics, is a glaring reality that poses emerging challenges to
governments. The flexibilities ensured under the WTO’s Trade-Related
Aspects of Intellectual Property Rights (TRIPS) agreement “are less likely
to solve the problem of affordability and accessibility for this”. The
developing states will have to find alternate methods to access these
medicines “so people in developing countries may live”, the South African
minister added.

Plurilateral trade deals

The issues around access to medicine, vaccines, and diagnostics are
multi-dimensional –including possibilities of delinking the current
patent-based funding system from research and development (R&D) costs of
pharmaceutical products, incentivising companies to work on
“non-profitable” diseases like tuberculosis (TB), ensuring that innovative
products reach the general population and particularly, the poorer
sections, and debates around how much leeway a government has to set its
own national patent laws.

Ironically, however, access for the poor aside, drugs are getting too
expensive even for developed countries. In the US medicine prices have
doubled in the last five years. However, governments, particularly of the
US, EU, Switzerland and Japan – all major host countries for the big
pharma, demand stronger protection that will worsen the situation, Médecins
Sans Frontières (MSF) said.

“The way we are going many countries are going to go bankrupt. How many
countries can treat their way out of cancer, diabetes [etc.]? These are
very expensive diseases,” Chan told the gathering.

The UN secretary-general Ban Ki-moon has set up a High-Level Panel on
Access to Medicines to whip up solutions balancing the rights of inventors,
international human rights law, trade rules and public health in the
context of health technologies.

There has been a renewed emphasis in recent decades on regional trade deals
that bypass multilateral rules agreed-upon by countries, particularly
through private arbitration mechanisms that could potentially be used to
sue governments legislating laws that work against company interests.

The so-called Investor-State Dispute Settlement (ISDS) mechanisms have seen
a runaway proliferation in recent times with many governments being sued
for legislating in public interest. For instance, tobacco giant Philip
Morris sued Australia and Uruguay for anti-smoking measures that the
governments had adopted and pharmaceutical giant Eli Lilly sued Canada
under the North America Free Trade Agreement after it was stripped-off its
patent rights to two new drugs.

A European report called ‘Profiting from Injustice’ says that there were
450 such known investor-state cases by the end of 2011.

“Health ministers certainly have to be sensitive to making sure that ISDS
provisions are controlled under new agreements,” said Frederick M Abbot, an
American academic, calling such mechanisms “a major threat”.

The challenge is also that health ministers don’t find space on the
negotiating table when these trade deals are brokered.

“If you are not around the table, I was told, you are on the menu,” Dr.
Chan said on a lighter vein though effectively putting her point across.

The ongoing trip of the US president Barack Obama to Asia to push, among
other things, the Trans Pacific Partnership (TPP) – 12-nation Pacific Rim
trade deal – has made human rights experts, policy makers and academics

Prof. Abbot also pointed out the “problematic” aspects of compulsory
licensing exemptions in the TPP and the lack of clarity on how the
agreement would sit with commitments made under Doha Declaration.

“The TPP is the worst-ever trade agreement with respect to access to
medicines,” Rohit Malpani of MSF said.

Pharmacy for the poor

India is known as the pharmacy of the developing countries for its robust
generic industry that supplies drugs to parts of the world that would be
unable to afford such treatments otherwise – more than 50 percent of its
$10 billion annual generic medicine production is exported.

For instance, in Africa, it currently costs $2 billion per year for putting
15 million people on HIV treatment that works out to $80 per person per
year which otherwise would have spiked up to $150 billion per year. “If we
didn’t have India, thanks to you, we didn’t have generics, no way we could
have accessed those 15 million people at those costs of $2 billion,” Sidibé

Even after the innovation of HIV medicines, it took governments eight years
to get them to the African people due to strict patent laws. “We were just
seeing people die in hospitals – no access, no hope,” till the Indian
generics burst into African hospitals, he said.

Referring to the Indian Patent Act, Naik cited the example of the expensive
anti-cancer drug, Sorafenib, for which India issued a compulsory licence
because the patented invention was not available at a reasonable price.

“The Indian courts, including the highest court, upheld the decision of the
Indian Patents Office,” he added.

MSF urged India to “reject” the pressures exerted by through trade
negotiations by US drugs’ companies “that seek to undermine its role as the
pharmacy to the developing world”. The Regional Economic Comprehensive
Partnership agreement could also potentially negatively impact the
accessibility of affordable medicines in all the 16 negotiating countries,
including India and China, the humanitarian organisation said.

“BRICS countries can resist trade agreements that block use of TRIPS
flexibilities. They can do that,” Sidibé said.

States have a core obligation to protect the fundamental human rights of
their citizens and “nothing that is negotiated under a free trade agreement
can prevent a government from taking the necessary measures to invoke and
defend that core obligation,” Abbot said.

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