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Access to Medicines, TRIPS and Human Rights Lisa Forman Lupina Assistant Professor, Dalla Lana School of Public Health, Munk School of Global Affairs Director,

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Presentation on theme: "Access to Medicines, TRIPS and Human Rights Lisa Forman Lupina Assistant Professor, Dalla Lana School of Public Health, Munk School of Global Affairs Director,"— Presentation transcript:

1 Access to Medicines, TRIPS and Human Rights Lisa Forman Lupina Assistant Professor, Dalla Lana School of Public Health, Munk School of Global Affairs Director, Comparative Program in Health and Society University of Toronto Undergraduate Medicine Pre-Clerkship, Global Health Longitudinal Elective, 9 February 2011

2 Structure 1. Access to medicines and TRIPS 2. Human rights and advocacy for AIDS medicines 3. Implications for global health equity

3 1. Access to Medicines Gap 2 billion people1/3 global population lack regular access 50 percent of populations in poorest Asia and Africa lack access

4 4 Factors Affecting Access Economic factors disproportionate in poor countries Common infectious and non-communicable diseases require costly drugs Source: WHO (2004)

5 20 year exclusive patents for pharmaceuticals TRIPS flexibilities allow generic manufacture and import (compulsory licensing, parallel imports) But obstacles to their use Unilateral trade sanctions Corporate litigation TRIPS-plus free trade agreements WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)

6 Impacts on health and development Pressures persist despite Doha Declaration on Public Health (2001) TRIPS/TRIPS-plus rules raise drug prices, reduce access to generics, exacerbate drug gap Threaten realization of rights to health and development

7 2. International human right to health Universal Declaration of Human Rights 25.1 Everyone has the right to a standard of living adequate for health and well-being including food, clothing, housing and medical care and necessary social services International Covenant on Economic, Social and Cultural Rights 12.1 State parties recognize everyones right to the enjoyment of the highest attainable standard of physical and mental health

8 Corporate Views Circa 2001 In the middle of the global AIDS epidemic, it is easy although misguidedto assume that the cost of drugs used to treat HIV and AIDS is the primary barrier to people in poor countries having greater access to such drugs …The main barrier to access is the lack of adequately resourced healthcare systems Richard Sykes, Chairman of Glaxo Smith Kline (2002) We are not the Red Cross. We are a for-profit company Clementine L. Clemente, Executive VP, Pfizer (2001)


10 10 Global compliance with status quo UN suggested treatment was unwise use of resources No international funding Limited price concessions Medicines largely inaccessible in low and middle income countries

11 11 Issue reframed by activists Global activists resist status quo Norm entrepeneurs reframe as issue of rights and morality Battles using rights-based argument, research and mass action

12 12 Opportunistic advocacy in South Africa 40 companies sue government to block drug legislation Companies argue breach of TRIPS Social actors join case bringing human rights arguments

13 13 Global Public Action Global demonstrations in thirty cities International petition with signatures EU, Dutch, German and French resolutions call for withdrawal of case Mandela criticizes companies Source: Gideon Mendel

14 14 Growing Negative Opinion Sydney Morning Herald March 6, 2001 Drug giants fight against cheap relief for AIDS Los Angeles Times 18 March 2001 South Africa Again Gives the World a Conscience The Washington Post Patent Wrongs Editorial, 25 February 2001 TIME AIDS Drugs Case Puts Our Ideas about Medicine on Trial Tony Karon, 5 March 2001

15 15 Norm Cascades at UN April 2001: Commission on Human Rights, Access to Medication in the Context of Pandemics such as HIV/AIDS June 2001: Intellectual Property Rights and Human Rights: Report of the Secretary-General The Impact of TRIPS on Human Rights–Report of High Commissioner Aug 2001: Intellectual Property Rights and Human Rights Dec 2001:Committee on Economic, Social and Rights, Human Rights and Intellectual Property July 2002: OHCHR and UNAIDS, Revised Guideline 6 on Access to Prevention, Treatment, Care and Support

16 16 Norm emerges at WTO Doha Ministerial Declaration on TRIPS and Public Health (November 2001): TRIPS 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 affirm the right of WTO Members to use, to the full, the provisions in the TRIPS Agreement, which provide flexibility for this purpose

17 17 Major policy shifts International funding materializes in GFATM and PEPFAR From 3x5 to goal of universal access adopted by WHO, UNAIDS, UN General Assembly, G8 in 2005

18 Major price drops

19 19 ARV Access Shoots Up

20 20 Declines in [mortality in] the past two years are partly attributable to the scaling up of antiretroviral treatment services AIDS Deaths Reduce Source: WHO and UNAIDS, 2007, annotation added

21 New GSK head, Andrew Witty, will slash prices on all medicines in the poorest countries, give back profits to be spent on hospitals and clinics and share knowledge about potential drugs currently protected by patents Drug Giant GlaxoSmithKline pledges cheap medicines for worlds poor Head of GSK shocks industry with challenge to other big pharma companies Sarah Boseley, 13 February 2009 Witty says he believes drug companies have an obligation to help the poor get treatment. He challenges other pharmaceutical giants to follow his lead.

22 Efficacy of human rights Rights-based action ensured coercive reputational damage key to withdrawal PMA initiated broader acceptance of human rights claim for AIDS medicines in Africa Global support for AIDS treatment in Africa followed

23 Implications for global health equity Activists established causality between trade rules, corporations and inaccessibility Causality between actors, rules and outcomes created consensus on violation Apparent moral violation makes human rights frame resonate

24 24 Conclusion Rights offer ideational tools to reconstruct identities, preferences and behaviour Rights offer a normative and legal power to shift actors towards more just outcomes

25 25 Acknowledgements Research funded by Comparative Program on Health and Society, University of Toronto Canadian Institutes of Health Research For further information

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