24 November 2011, 15:11
by Robert Walgate
The chemistry of power. That’s what a stellar line-up of executive directors and directors general – the top men and women, by any name – of international agencies concerned with global health and pharmaceuticals displayed at the World Trade Organization in Geneva yesterday.
And the result of the reaction? Some personal enlightenment and rapprochement among the leaders, but also a realization that their power might not be so great as you might think, that the world is changing – rapidly – beneath their feet, and that they are having to dance faster and faster to keep upright.
That’s my conclusion ten years after the celebrated Doha Declaration on the TRIPS Agreement and Public Health 2001, from an extraordinary debate among the leaders of WHO, WTO, WIPO, UNAIDS, UNITAID, GAVI and IFPMA (the International Pharmaceutical Manufacturers’ Association), to name but a few.
The debate was organized by the Global Health Programme of the Graduate Institute, Geneva, and inspired by Ruth Dreifuss, former chair of the WHO Commission on Intellectual Property Rights, Innovation and Public Health. Her brief conclusion: innovation in pharmaceuticals is in need of radical change. Innovation doesn’t work where the market fails, and “the challenge for next ten years” is how to complete a new system for innovation and access.
Pascal Lamy, for example, DG of WTO, was extremely candid about the limits of WTO power – international agreements can simply be ignored, he said.
And indeed, bilaterally negotiated TRIPS+ agreements, such as the EU-India Free Trade Agreement, are beginning to place restrictions on generics. This won’t affect the current generation of drugs – but will control the second and third line drugs, which (participants heard) are 7-19 times more expensive than current treatments.
Generic antiretrovirals (ARVs) for treating HIV/AIDS, 80% of them from Indian companies, have forced down ARV prices by a factor of 100 since 2001 – essentially as a result of ignoring intellectual property (IP) on the ARV molecules. Creating and profiting from IP had been and remains the central business model of the pharmaceutical industry. But the industry was forced to accept competition from generics when a group of ARV manufacturers tried to force Nelson Mandela’s government in South Africa to raise drug prices, causing global outrage.
Doha was another consequence, leading to flexibilities in the TRIPS agreement in cases of public health need – but, in practice, they require complex national legislation to be enacted, and have only been used once, by Canada.
Michel Sidibé, Executive Director of UNAIDS, praised the dramatic rise in numbers of patients under treatment – from 300 000 in 2001 to 7 million today, but pointed out that this was still only half the need, and raised the spectre of the growing requirement for 2nd and 3rd line treatments. And Margaret Chan, Director General of WHO, facing donor-driven “reform” and funding cuts, took the opportunity to shame the greed of tobacco companies who sell and kill, and demand access to drugs for the poorest.
But Michel Kazatchkine, Executive Director of the Global Fund announced – in response to a question – that they were in “unprecedented financial crisis”. The GF is suspending the 11th round of funding, he said, because donors had not come up to the mark. Next year, the GF will face a US$2 bn shortfall, said Kazatchkine. So a global AIDS crisis could loom again, despite NIH research showing that treatment has a major impact on reducing HIV transmission.
The world is in economic meltdown and it’s hitting world health. It’s also hitting the pharmaceutical industry. Industry doyen Brian Tempest said the industry was “in total fear” of being able to create the innovation that will lead to profit growth.
And IFPMA Executive Director Eduardo Pisani said at the Geneva meeting that they were eager and ready to embrace new models for innovation – public-private partnerships and more, like the EU’s recent plan for joint R&D on antibiotics.
For some further ideas on rethinking innovation, check Knowledge Ecology International, and WIPO’s Re:Search which was launched just last week (click right).
Conclusion? Ten years after Doha there’s a storm of change ahead, for industry, patenting, world health funding – and patients. But change creates opportunity, and a feeding frenzy around the corpse of current practice must develop that could change world health for the better, if new models of innovation, financing and access are adopted – or the worse, if the storm is ignored.
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