US Government efforts to limit the scope of diseases in the implementation of the Doha Declaration on TRIPS and Public Health have outraged the public health community, and have been presented in a highly dishonest way by the White House and USTR, damaging US reputation abroad

March 5, 2003

In November 2001, the United States and the other Members of the World Trade Organization signed the Doha Declaration on the TRIPS Agreement and Public Health, which states that the TRIPS Agreement "can and should be interpreted and implemented in a manner supportive of WTO members' right to protect public health and, in particular, to promote access to medicines for all." The Doha Declaration specifically reaffirms the right of WTO Members to issue compulsory licenses and to determine the grounds on which they may be issued. One issue that delegates left unfinished was spelled out in paragraph six:

6. We recognize that WTO members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement. We instruct the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002.
Only a handful of countries have a large enough domestic market to support efficient domestic only production of generic drugs. Ironically, the "free trade" WTO rules impose a highly inefficient country-by-country rule for generic production under compulsory licenses. Poor countries were promised in Doha that this would be fixed, as a condition for a new round of trade negotiations.

The White House, including Karl Rove, was asked by CEO's of Pfizer, Merck, BMS, GSK and other large firms, to renege on the promises made in Doha, and they have done this by seeking to limit the solution to only the smallest market countries, so generic suppliers will not have sufficient economies of scale, and to limit the solution to a handful of diseases. This has been justified in the US press by a series of offensive if not racist statements about compulsory licensing for viagra (a product already off patent in many countries), combined with bald assertions that the poor in developing countries should not have access to affordable treatments for cancer, diabetes, heard disease or asthma -- in the face of mountains of evidence that these diseases are huge public health problems in the developing world.

Cardiovascular disease is the world's leading cause of death, killing 17 million people a year, 78% of which live in developing countries. 177 million people in the world are diabetic, and this number will be 300 million in 2025, most of which are in developing countries. The World Health Organization estimates that 150 million people have asthma, once again - mostly in developing countries. An estimated 80 million persons in developing countries suffer from cancer without treatment.

"In the context of the Doha Declaration on the TRIPS Agreement and Public Health, we have supported the public health principle that the people of a country which does not have the capacity for domestic production of a needed product shall be no less protected by compulsory licensing provisions (or other TRIPS provisions) than people living in countries capable of producing the product. We are taking the line that the need of poor countries for lower prices should have a broad basis." -- Dr Gro Harlem Brundtland, Director-General World Health Organization

"Developing countries see [limits on scope] as a retreat from the rich countries' promises that trade talks would address their needs. After all, half of the premature deaths in poor countries are from noninfectious causes like heart attacks and cancer. Does a child dying of leukemia have less right to low-cost medicine than a child with AIDS?" -- Nicholas Stern, Chief Economist of the World Bank

"The solution must not be restricted to medicines and medical technologies for the treatment of HIV/AIDS, tuberculosis and malaria. While there is no doubt that these epidemics are ravaging developing countries, they cannot be considered the sole public health threats in poor regions--either now or in the future. Furthermore, the WTO is not the appropriate forum for determining sovereign countries' national public health priorities and needs." -- Allan Rosenfield, MD, Dean, Mailman School of Public Health, Columbia University, Michael H. Merson, MD, Dean of Public Health, Yale University, Laurence G. Branch, Ph.D, Dean, College of Public Health, University of Southern Florida, Stephen M. Shortell, Ph.D, Dean, School of Public Health, University of California, Berkeley

For more information:
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