This open letter calls on WTO Members to strongly support the adoption of the text proposed by India and South Africa in their proposal for “Waiver from certain provisions of the TRIPS Agreement for the prevention, containment and treatment of COVID19” (Waiver Proposal), recognising the consensus that curbing the spread of COVID-19 demands international collaboration to speed and scale up development, manufacturing, and supply of effective medical technologies, with calls including from several Heads of State for medical products for COVID-19 to be treated as global public goods. Seven months into the pandemic, there is no meaningful global policy solution to ensure access, inequality in access to critical technologies, rejection by the pharmaceutical industry of the COVID-19 Technology Access Pool (C-TAP) launched by WHO to voluntarily share knowledge, IP and data, has been rejected by the pharmaceutical industry and intellectual property infringement disputes. While the TRIPS Agreement contains flexibilities that can promote access, many WTO Members may face challenges in using them promptly and effectively. The signatories argue that unless concrete steps are taken at the global level to address intellectual property and technology barriers, the above mentioned failures and shortcomings will replay as new medicines, vaccines and other medical products are rolled out.
Health equity in economic and trade policies
In this open letter to the Minister of Justice, Ugandan civil society organisations (CSOs) working in areas of intellectual property (IP) and access to medicines argue that the country’s intellectual property (IP) Bill does not make full and maximum use of the TRIPS flexibilities and therefore poses a threat to public health. Almost 90% of drugs in Uganda are imports, most of which are generic versions that need protection from patent owners who may want to stop their sale in a bid to sell their expensive brand name drugs instead; this would be a disadvantage to Ugandans as they will not be able to access cheap drugs. The CSOs call on government to reaffirm its 2001 Doha commitment to ensure that the TRIPS Agreement does not and should not prevent World Trade Organisation members like Uganda from taking measures to protect public health. The Industrial Properties Bill should take maximum advantage of the flexibilities detailed under the TRIPS Agreement and as provided by the Doha Declaration.
In a verdict that could ripple across the pharmaceutical industry, a U.S. jury in a federal lawsuit has ruled that Eli Lilly infringed a patent covering drugs that work through one of the body's basic biological pathways. The patent, issued in 2002, is claimed to cover any drug that works by influencing the action of an important protein in the body. Some critics have said that patents covering an entire pathway in the body, as opposed to a particular drug, could hinder drug development.
Mobility is the means by which many individuals and households seek security of income and livelihood: traders move between sources and markets, migrant workers go to mines, factories, towns and farms. Looking specifically at the experiences of women, both as street traders and domestic workers, the authors find that mobility is that is essential to securing these women's individual and household livelihoods increases their vulnerability to HIV. Research found that lack of information on HIV was one of the main factors in making them more vulnerable highlighting the need for HIV education initiatives targeted at specific migrant communities.
In her final address to the World Health Assembly (WHA) as WHO Director-General, Dr. Margaret Chan identified access to medicines as the most contentious issue of her decade-long tenure. That struggle was engaged, she said, “especially when intellectual property and the patent system were perceived as barriers to both affordable prices and the development of new products for diseases of the poor.” Dr. Chan also had advice for the delegates gathered before her at the Palais de Nations in Geneva: “Listen to civil society. Civil society are society’s conscience.” Just a few hours after Dr. Chan yielded the podium, a spirited demonstration was held outside the grounds of the Palais de Nation. Organised by the student-led advocacy group Universities Allied for Essential Medicines, the demonstrators called for the WHA delegates and the new director-general to listen to the WHA’s member states from Southeast Asia, Africa, and Latin America. Those nations have long called for WHO to prioritise the medicines issue. The term “de-linkage” was repeated by many panellists at an antimicrobial resistance discussion which happened at a side event. It describes a drug development model that is an alternative to the current intellectual property paradigm, where government-granted patent monopolies allow drug prices to be hiked to levels that are sometimes hundreds of times above the price of production. The justification for the high prices is that the price charged for medicines needs to fund research and development. Deliberately “de-linking” the R&D costs from the price of medicines bypasses those calculations, and instead undercuts the very foundation of the monopoly pricing argument. It calls for taking advantage of the already-significant government and philanthropic commitment to research and using it to fund non-profit R&D to a sufficient level that the price of medicines does not need to be connected to research costs. This would allow medicines to be far more affordable
The South African Food Sovereignty Campaign (SAFSC) and Co-operative and Policy Alternative Centre issued as press statement calling the outbreak of listeriosis in South Africa as a food horror of a profit-driven corporate food system, with limited state regulation. They blame the current corporate controlled food system for compromised health standards in South Africa, which has led to food horrors of not only listeriosis, but also obesity, hunger, malnutrition, child stunting and diabetes. The private sector with profit as its main motive, claims that it has solutions to end food crises, but these organisations say that it is perpetuating the very crises that the poor and vulnerable face on a daily basis, and that the listeriosis outbreak, as well as ongoing hunger, hiking obesity and diabetes rates and contamination of soils with pesticides, tell a story of the failure of the corporate food system to ensure adequate nutrition for all citizens, and the destruction of natural environments. The South African Food Sovereignty Campaign (SAFSC) calls for greater state regulation based on the People’s Food Sovereignty Act. This Act calls for the democratic planning of the food system, increased state regulation on destructive practices of the corporate controlled food system, prioritising local food supply over trade, a ban on advertising of all junk food, and greater reliance on small-scale food producers to feed citizens culturally appropriate and nutritious food.
The author of this paper argues for public-private partnerships to help deliver locally produced generics in Africa, and against protectionism in favour of open market access. He points to promising developments, such as experienced Indian and Western pharmaceutical firms undertaking original research and development and partnering with firms in African countries. He believes this investment by reputable companies should help ensure quality drugs are produced by furnishing the technical expertise that overcomes capacity constraints. Local production enterprises in Africa will allow international companies to diversify their supply sources, the author argues, guarding against potentially disastrous shocks such as a natural disaster that would destroy an Artemisia crop and send the price of artemisinin-based malaria drugs skyrocketing. Local production partnerships could encourage trade, especially because the bulk active ingredients needed to produce them still come most efficiently from abroad. Partnerships between foreign pharmaceutical firms and African companies may also help train a pool of skilled workers, improving a country’s long-term development prospects.
The author of this paper argues for public-private partnerships to help deliver locally produced generics in Africa, and against protectionism in favour of open market access. He points to promising developments, such as experienced Indian and Western pharmaceutical firms undertaking original research and development and partnering with firms in African countries. He believes this investment by reputable companies should help ensure quality drugs are produced by furnishing the technical expertise that overcomes capacity constraints. Local production enterprises in Africa will allow international companies to diversify their supply sources, the author argues, guarding against potentially disastrous shocks such as a natural disaster that would destroy an Artemisia crop and send the price of artemisinin-based malaria drugs skyrocketing. Local production partnerships could encourage trade, especially because the bulk active ingredients needed to produce them still come most efficiently from abroad. Partnerships between foreign pharmaceutical firms and African companies may also help train a pool of skilled workers, improving a country’s long-term development prospects.
International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap. This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing. Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias?: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector. The findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.
In this article, Ndlovu asks, how should countries like South Africa go about making sure that people – particularly poor people where the burden of non-communicable diseases is highest – have access to healthy food? Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities. The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded. The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”. The results showed how fast-food outlets and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets. Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas. The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice. Local as well as national government structures have the authority to license and control food retailers. Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area. Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. The authors indicate that there is a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable.