1. Econometica Milano Global Justice and Health: Intellectual Property Rights versus Access to Essential Medicines Thomas Pogge Professor of Political Science, Columbia University Centre for Applied Philosophy and Public Ethics, Australian National University Centre for the Study of Mind in Nature, University of Oslo

2. 1 Our Shared Commitment “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control” [Article 25(1)]. Universal Declaration of Human Rights

3. 2 Human Cost of Poverty Today Among 6450 million human beings (2004), about 830 million are undernourished (UNDP 2006, p. 174), 2000 million lack access to essential drugs (www.fic.nih.gov/about/summary.html), 1100 million lack access to safe drinking water (UNDP 2006, p. 33), 1000 million lack adequate shelter (UNDP 1998, p. 49), 2000 million have no electricity (UNDP 1998, p. 49), 2600 million lack adequate sanitation (UNDP 2006, p. 33), 799 million adults are illiterate (www.uis.unesco.org), 211 million children (aged 5 to 14) do wage work outside their family — 8.4 million of them in the “unconditionally worst” forms of child labor, which involve slavery, forced or bonded labor, forced recruitment for use in armed conflict, forced prostitution or pornography, or the production or trafficking of illegal drugs (ILO: A Future Without Child Labour, 2002, pp. 9, 11, 17-18).

4. 3 One Third of all Human Deaths — some 18 million per year or 50 000 daily — are due to poverty-related causes, cheaply preventable through food, safe drinking water, rehydration packs, vaccines or other medicines. In thousands: diarrhea (1798), malnutrition (485), perinatal (2462) and maternal conditions (510), childhood diseases (1124 — mainly measles), tuberculosis (1566), meningitis (173), hepatitis (157), malaria (1272), tropical diseases (129), respiratory infections (3963 — mainly pneumonia), HIV/AIDS (2777), sexually transmitted diseases (180) (World Health Organization: World Health Report 2004, 120-5).

5. 4 Distribution of Deprivations Nearly all the deprived are persons of color. Children under age five account for 10.6 million or 59% of avoidable deaths each year from hunger and diseases (UNICEF: The State of the World’s Children 2005). Women and girls are substantially overrepresented among the deprived (UNDP: Human Development Report 2003, pp. 310-330; UNIFEM; UNRISD 2005; Social Watch: Unkept Promises, 2005).

6. 5 Death Toll of Century's Atrocities http://users.erols.com/mwhite28/war-1900.htm

7. 6 Millions of Deaths

8. 7 Income Poverty Relative to the World Bank’s “$1/day” and “$2/day” Poverty Lines “$1/day” ($1.075/day PPP 1993) Amounts Per Year “$2/day” ($2.15/day PPP 1993) Poverty Line Poverty Gap Consumption Poverty Line Poverty Gap Consumption $393 PPP 1993 or today ca. $560 in USA 28.4 percent $112PPP1993 or today ca. $159 in USA 71.6 percent $281PPP1993 or today ca. $401 in USA In US$ PPP, per Person $786 PPP 1993 or today ca. $1120 in USA 42 percent $330PPP1993 or today ca. $470 in USA 58 percent $456PPP1993 or today ca. $650 in USA $70 to $280, depending on purchasing power of poor country’s currency $20 to $80, depending on purchasing power of poor country’s currency; typically ca. $40 $50 to $200, depending on purchasing power of poor country’s currency; typically ca. $100 At market exchange rates, per Person $140 to $560, depending on purchasing power of poor country’s currency $60 to $240, depending on purchasing power of poor country’s currency; typically ca. $120 $80 to $320, depending on purchasing power of poor country’s currency; typically ca. $160 ca. 1089 million extremely poor people; (17% of humankind) ca. $44billion (versus $35142 billion social product of the rich countries containing 16% of humankind) ca. $109 billion (ca. 0.25 percent of the $45,000 billion global product) Aggregates (1 billion = 1000 million) ca. 2735 million very poor people; (43% of humankind) ca. $330 billion (versus $35142 billion social product of the rich countries containing 16% of humankind) ca. $440 billion (ca. 1 percent of the $45,000 billion global product)

9. 8

10. 9 Shares of World Population: Income: Poorest Households versus Richest Countries

11. 10 Shares of Global Income: Income: Poorest Households versus Richest Countries Calculated in terms of market exchange rates so as to reflect the avoidability of poverty. Rich-Poor Ratio over 200:1. Decile Inequality Ratio 320:1 (Milanovic 2005, pp. 111-12).

12. 11 Reported Changes in Population Below $1/Day: China and the Rest of the World (Chen and Ravallion 2004)

13. 12 Reported Changes in Population Below $2/Day: China and the Rest of the World (Chen and Ravallion 2004)

14. 13

15. 14 Shares of Global Wealth: Poorest versus Richest Households Calculated in terms of market exchange rates so as to reflect the avoidability of poverty. Decile Ineq’ty 2837:1. Quintile Ineq’ty 85:1. Year 2000, $125 trillion total. (James B Davies et al.: WIDER 2006)

16. 15 Defenses of the Existing Global Institutional Order Causally inert (“explanatory nationalism”) (Nearly) best of all possible designs with respect to human-rights fulfillment

17. Defenses Defeated The Negative Case: The fallacious argument from differential trajectories

18. 17. Global Institutional Order National Institutional Schemes of the Various Developing Countries Poor and Vulnerable Citizens in the Developing Countries

19. The P ositive Case (3 P ’s) P rotectionism against the poor P harmaceuticals at monopoly prices P rivileges: Borrowing, Resources, Treaties, Arms

20. 19 Global Institutional Order Governments of the More Powerful (G-7) Countries National Institutional Schemes of the Various Developing Countries Citizens of the More Powerful (G-7) Countries Poor and Vulnerable Citizens in the Developing Countries 4 Privileges Protectionism Pharmaceuticals

21. Rules Governing Medical Research Under the TRIPs agreement, inventors of new drugs can get a 20-year global monopoly. This regime prices most new drugs beyond the reach of the global poor. It also skews medical research toward the affluent: Diseases accounting for 90% of the global disease burden receive only 10% of all medical research worldwide. Pneumonia, diarrhea, tuberculosis and malaria, which account for over 20% of the global disease burden, receive less than 1% of all public and private funds devoted to health research. Of the 1556 new drugs approved between 1975 and 2004, only 18 were for tropical diseases and 3 for TB.

22. Rules Governing Medical Research 2 One obvious alternative is a regime under which inventor firms can choose to be rewarded in proportion to the impact of their invention on the global disease burden. This solution would end the morally untenable situation of the drug companies, which must now, to recover their costs, price life-saving medications out of the reach of vast numbers of poor patients. The solution would align the interests of inventor firms and the generic drug producers. The former would want their inventions to be widely copied, mass-produced, and sold as cheaply as possible, because this would magnify the health impact of their inventions. If new drugs were sold at the competitive price, near the marginal cost of production, many poor patients would gain access to drugs they now cannot afford. And affluent patients would gain as well, by paying substantially less for drugs and medical insurance. This solution would also greatly expand research into diseases that now attract very little research: dengue fever, hepatitis, meningitis, leprosy, trypanosomiasis (sleeping sickness and Chagas disease), river blindness, leishmaniasis, Buruli ulcer, lymphatic filariasis, schistosomiasis (bilharzia), malaria, tuberculosis, and many more. In time, this one rule change alone would easily halve the number of annual poverty deaths.

23. 22 The Consent Objection Governments of poor countries often - lack expertise - lack bargaining power - lack democratic legitimacy Most of those suffering are children Human rights understood as inalienable

24. 23 Injustice of an Institutional Order An institutional order is unjust if all four are true: The institutional order is causally associated with a massive human-rights deficit. This causal association is foreseeable. This causal association is reasonably avoidable through some alternative design of this institutional order. This avoidability is foreseeable (we can know that the alternative institutional design would do much better in giving participants secure access to the objects of their human rights).

25. 24 Human Rights as Moral Claims on (Global) Institutional Arrangements “Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized” (Article 28) Universal Declaration of Human Rights

26. 25 Individual Moral Claim A human right to X gives you a moral claim against all others ― and them a correlative negative duty ― that they not harm you by cooperating, without compensating reform and protection efforts, in imposing upon you an institutional order under which you lack secure access to X as part of a foreseeable and foreseeably avoidable human rights deficit.

27. 26 Moral Responsibility When an institutional order is unjust (by foreseeably producing massive and foreseeably avoidable human-rights deficits), then those who – without compensating reform and protection efforts – are actively cooperating in designing or imposing this order are harming (violating the human rights of, violating a human-rights-correlative negative duty toward) those who suffer the avoidable human-rights deficits.

28. 27 Human Rights and Correlative Duties

29. 28 Prospect for Reform Governments and corporations are under continuous counter-moral pressures not merely from ordinary profit motives, but also from their competitive or adversarial situation and from fairness considerations: Each party may reasonably judge that it cannot afford to forgo wrongdoing or to act well, because such unilateral self-restraint would place it at an unfair competitive disadvantage vis-à-vis its less scrupulous competitors.

30. 29 How Much Would It Cost?