Ambassador Robert B. Zoellick
United States Trade Representative
600 17th Street, N.W.
Washington, DC 20508

Sent Via Facsimile Transmission

December 19, 2002

Dear Ambassador Zoellick,

We are writing as deans of the leading schools of public health in the
United States to share our views with you on the status of negotiations
at the World Trade Organization (WTO) on public health, access to
medicines, and intellectual property rights.  At the 4th Ministerial
Conference of the WTO in Doha last year, the imperative of public health
was affirmed by all WTO member states through the adoption of the
Ministerial Declaration on the TRIPS Agreement and Public Health.  Just
one year after this historic agreement was reached, this advance is at
risk of being compromised, to the detriment of millions of people
suffering from diseases throughout the world.

The WTO was charged with producing a solution to the problem expressed
in paragraph 6 of the Doha Declaration, which states that:

"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

Negotiations on the solution to this problem should be guided by the
needs and interests of poor people who are suffering without access to
medicines, and by the Doha Declaration itself, 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."

We urge you to consider the following:

1.    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
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.

2.    The solution must not be limited to medicines only. Vaccines,
diagnostics, and monitoring tests, for example, are important medical
technologies for developing countries. They should not be excluded from
any solution.

3.    The solution must not include overly burdensome "safeguards."
Low-cost medicines intended for consumption in poor countries should not
be diverted to wealthy country markets. However, any system of
safeguarding against such diversion should not put too heavy a burden on
developing countries, and should not be so burdensome as to counter to
the goal of the system itself to broaden access to affordable medicines.

4.    The solution must be workable and must not include overly
burdensome procedural requirements.  Complex, restrictive conditions for
making use of the solution will only serve to undermine the overall
objective of protecting public health.

Increasing the pace of innovation in pharmaceuticals is necessary if the
medical and public health community is to have any hope of success in
battling major public health problems. But rewarding innovation must not
come at the expense of equitable and sustainable access to these
essential inventions.

As health professionals and concerned citizens, we urge you in the
strongest possible terms to reject any solution that includes any of
these restrictions.


Allan Rosenfield, MD
DeLamar Professor and Dean
Mailman School of Public Health
Columbia University*

Michael H. Merson, MD
Anna M.R. Lauder Professor and Dean of Public Health
Chairman, Department of Epidemiology & Public Health
Yale University*

Laurence G. Branch, Ph.D
College of Public Health
Dean, University of Southern Florida*

Stephen M. Shortell, Ph.D.
Dean, School of Public Health
University of California, Berkeley*

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