Brook K. Baker, Health GAP
December 19, 2002

The U.S. and the international pharmaceutical industry have tried to endgame the post-Doha negotiations by complaining about coverage of diseases beyond HIV/AIDS, tuberculosis, malaria, and other infectious epidemic of comparable proportion. In defense of its highly restrictive proposal, the U.S. has offered the laughable argument that expanding protections for exported medical products beyond those treating these diseases would "deflect attention" from these major pandemic disasters. Maybe two questions will highlight the public health absurdities of the U.S./Pharma position.

What's wrong with treating diabetes, heart disease, asthma, and cancer in Africa? The U.S. has directly complained that extending coverage beyond the Big Three and comparable epidemics will permit generic producers in India to produce and export cheaper generic medicines for diabetes, obesity, and cancer to other developing countries with insufficient capacity or market size to efficiently produce medicines on their own. Well, o.k., what's wrong with that? Don't poor people in Africa die from diseases other than AIDS, TB, and malaria? If you die from cancer or diabetes or heart disease are you less dead than if you die from AIDS? Is dying from treatable cancer more dignified or less traumatic than dying from treatable tuberculosis?

Evidence shows that people in developing countries are increasingly at risk from the same kinds of non-infectious diseases as those in the Global North ? heart disease, cancer, diabetes, and yes, asthma, are all on the rise. These diseases, too cause unnecessary medical suffering and death for millions of people in developing countries. The U.S. is basically telling African leaders to look at two lines of people with treatable diseases, one with HIV/AIDS, TB, and malaria, and the other with diabetes, heart disease, asthma, and cancer. The U.S. is saying: "You may let one line have access to more affordable medicines, but the other line must buy medicines from Pfizer, Merck, and Bristol Myers Squibb at full monopoly prices." How exactly does this make sense?

What's wrong with saving money of lots of medicines for lots of public health problems so that you'll have even more money to treat HIV/AIDS, TB, and malaria? Although the U.S. has suggested that having access to cheaper medicines for other public health problems will somehow divert resources from HIV/AIDS, TB, and malaria, the opposite is true. "Gee, Mr. Zoellick, if I spend $.10 for a hypertension medicine from India instead of $10.00 from Pfizer, won't I have an extra $9.90 to spend?" Given that patented medicines must ordinarily be paid for with scarce foreign exchange reserves and given that currency devaluation in developing countries frequently results in dramatic price inflation, doesn't it make sense that saving even more money is a good idea so that more people, with a broad range of diseases, can be treated more cost effectively? The USTR must have gotten some unemployed Enron accountant to help it come up with this math formula ? "charge them more on more products, it will help focus their attention."

If the U.S. position weren't so deadly, it would be laughable. It makes no sense from a public health perspective and even less sense from an economic one. The misguided effort of WTO officials to save the U.S. from itself by proposing a slightly expanded list of treatable diseases is a sinister form of assistance in an already sinister plot. The Doha Declaration is clear that public health principles should prevail and that there should be access to medicines for all, including our neighbors in developing countries with diabetes, heart disease, asthma, and cancer.

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