The Right to Health and Access to Medicines Anand Grover United Nations Special Rapporteur on the Right to Health Geneva, 11 th October 2010

Nearly two billion (1/3 of the world’s population) people lack access to essential medicines. [“WHO Medicines Strategy: Countries at the Core, ”, (2004)]. Unlike in high income countries, in low and middle income countries about 50% to 90% of the cost of medicines are paid by the patient out of pocket. ACCESS TO MEDICINES AND THE RIGHT TO HEALTH

The median coverage of health insurance is 35% in Latin America, 10% in Asia, and less than 8% in Africa. As a result, cost of medicines is one of the key Many factors affect access to medicines. In low and middle income countries, medicines account for 20-60% of the healthcare cost. [The World Medicines Situation, WHO, 2004]. [“Equitable Access to Essential Medicines: A Framework for Collective Action”, No. 8, WHO, 2004] In the case of HIV, it is presently estimated that around 15 million people living with HIV (PLHIV) need ARV treatment (based on the revised WHO Guidelines). However, as of the end of 2009, only 5.2 million PLHIV were receiving treatment. ACCESS TO MEDICINES AND THE RIGHT TO HEALTH

Recently published studies show that many people would be pushed into poverty on account of the prices of medicines, in particular branded medicines as they usually cost much more than their generic counterparts. [Niëns LM, et al, “Quantifying the Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the Affordability of Medicines in the Developing World”, PLoS Med 7(8) e (2010)] The world post-TRIPS continues to experience great problems with respect to access to medicines as the above numbers make clear. TRIPS is still very much an impediment to increased access, however many new access-limiting instruments should be of concern to advocates. ACCESS TO MEDICINES AND THE RIGHT TO HEALTH

ICESCR – Article The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness. Access to medicines is an integral part of the right to health. Core obligation of the right to health. (General Comment 14)

Human rights inextricably linked Traditionally, Civil and Political Rights are immediately enforceable Economic, Social And Cultural Rights are progressively realizable  not enforceable immediately Domestic courts in Latin America, Southern Africa and South Asia have abolished that distinction Progressive realization implies – Non-retrogression – Bench marks – Monitoring; and – Acc0untability

1.AAAQ (Availability, Accessibility, Acceptability, Quality) 1.Respect, Protect and Fulfill 2.Equality and Non-discrimination: Gender perspective, women, children/adolescents; marginalized groups ACCESS TO MEDICINES AND THE RIGHT TO HEALTH

IPR issues Inability of States to use TRIPS flexibilities Pressure to introduce TRIPS plus measures: India – EU FTA Anti-counterfeiting Border measures Investment Drug regulations - Palliative care drug/controlled meds Reduction of Funding Lack of technology transfer ACCESS TO MEDICINES: BARRIERS