Pricing and the Pharmaceutical Industry What’s Realistic? What’s Smart? What’s Right?

India versus the US: the Current State of the Pharma Battle March, 2014: trade dispute between India and the US over patentability criteria March, 2014: trade dispute between India and the US over patentability criteria There is also a push by US industry associations to designate India as a "priority foreign country” with the aim of using the threat of trade sanctions to exert undue pressure on India. There is also a push by US industry associations to designate India as a "priority foreign country” with the aim of using the threat of trade sanctions to exert undue pressure on India. India is a critical producer of affordable medicines, and competition among generic drug manufacturers here has brought down the price of medicines for HIV, TB and cancer by over 90% India is a critical producer of affordable medicines, and competition among generic drug manufacturers here has brought down the price of medicines for HIV, TB and cancer by over 90% (MSF – Access Campaign)

February 2014 tactics India is currently on the U.S. government's Priority Watch List - countries whose practices on protecting intellectual property Washington believes should be monitored closely. India is currently on the U.S. government's Priority Watch List - countries whose practices on protecting intellectual property Washington believes should be monitored closely. The U.S. industry trade group Pharmaceutical Research and Manufacturers of America (PhRMA) believes Washington should take a tougher line by downgrading it to a Priority Foreign Country, a classification for the worst offenders, which may trigger possible actions, sources said. The U.S. industry trade group Pharmaceutical Research and Manufacturers of America (PhRMA) believes Washington should take a tougher line by downgrading it to a Priority Foreign Country, a classification for the worst offenders, which may trigger possible actions, sources said. (At issue, drugs that treat cancer, HIV, diabetes, hepatitis, leukemia) (At issue, drugs that treat cancer, HIV, diabetes, hepatitis, leukemia)

The Story Impinges on fundamental questions of our humanity: our deepest motivations, our “essential” nature Impinges on fundamental questions of our humanity: our deepest motivations, our “essential” nature Vast cast of characters Vast cast of characters Complicated laws and ambiguous provisions for exceptions Complicated laws and ambiguous provisions for exceptions Global markets, inter-connectedness of nations; in short, a complex terrain Global markets, inter-connectedness of nations; in short, a complex terrain

Major Questions/ Themes Is health care a human right? Is health care a human right? Should we help poor countries, even if they mismanage their resources? Should we help poor countries, even if they mismanage their resources? Isn’t it essential to reward innovations? Isn’t it essential to reward innovations? Isn’t it wrong to steal someone else’s idea? Isn’t it wrong to steal someone else’s idea? What is a country’s responsibility to its citizens? What is a country’s responsibility to its citizens?

Cast of Players Multinational pharmaceutical companies Multinational pharmaceutical companies Governments of the United States, Germany, and the United Kingdom Governments of the United States, Germany, and the United Kingdom Governments of India, Thailand, Brazil, and South Africa Governments of India, Thailand, Brazil, and South Africa Generic manufacturers like Cipla Generic manufacturers like Cipla HIV/AIDS patients HIV/AIDS patients Non-governmental organizations (NGOs) and other activists Non-governmental organizations (NGOs) and other activists

The Conflict On the one hand, the need to reward those who invest time, money, and resources to invent new medications On the one hand, the need to reward those who invest time, money, and resources to invent new medications On the other hand, the need to make these medications available to the poor, who cannot afford to pay market prices On the other hand, the need to make these medications available to the poor, who cannot afford to pay market prices

The Plot The incentive of patents The incentive of patents TRIPS, established in 1995 TRIPS, established in 1995 Doha Declaration, articulated in 2001 Doha Declaration, articulated in 2001 WTO deadline for compliance, 2005/6 WTO deadline for compliance, 2005/6 Compulsory Licensing (invoked by Thailand in 2006 for efavirenz) Compulsory Licensing (invoked by Thailand in 2006 for efavirenz) Least Developed Nations (LDCs), compliance 2016 Least Developed Nations (LDCs), compliance 2016 Differential pricing Differential pricing

Doha Declaration “TRIPS Agreement does not and should not prevent Members from taking measures to protect public health.” “TRIPS Agreement does not and should not prevent Members from taking measures to protect public health.” WTO Members have the right to make full use of the safeguard provisions of the TRIPS Agreement in order to protect public health and enhance access to medicines for poor countries. WTO Members have the right to make full use of the safeguard provisions of the TRIPS Agreement in order to protect public health and enhance access to medicines for poor countries.

Possibilities for Action Yusuf Hamied and Cipla Yusuf Hamied and Cipla Impact of activists Impact of activists Thomas Pogge’s recommendation to give innovators incentives to “do good”– reconciling profit with morality Thomas Pogge’s recommendation to give innovators incentives to “do good”– reconciling profit with morality Your role as an individual—what can YOU do? Your role as an individual—what can YOU do?