Health equity in economic and trade policies

Kenya is allegedly among the top ten developing countries in terms of revenue lost to the European Union and the United States. But what can be done? The author of this article makes a number of recommendations. At national level, he urges the Kenyan government to implement reforms to tax policy, trade policy, customs and laws and to promote inclusive growth. To make this work, he calls for both political will and active civil society participation. He calls on government to change the law to insist on maximum transparency for all international transactions, and for banks to give full disclosure to tax and relevant national authorities. The author argues for using the price filter model used by the United States Customs to monitor trade misinvoicing. The best solution, he notes, will be an international agreement for automatic exchange of tax information globally. In the meantime, he argues for Kenya to sign bilateral information exchange agreements with the major tax havens and secrecy jurisdictions, to be given information on accounts and companies registered in these jurisdictions that trade and do business with Kenya. He also argues for government to require all transnational companies to publish every year Kenya-specific accounts showing the profits or losses they make. Finally, he argues that Kenya follow the lead of Nigeria, which has sued major international companies for corruption and has been compensated through out-of-court settlements.

Creating “ownership” of seed through patents and intellectual property rights and imposing it globally through the World Trade Organisation, the author argues that the biotech industry has established a monopoly empire over seed and food. The author argues that the biotech industry is denying citizens the right to safe food and attempting to dismantle national laws on biosafety across Africa. The author argues that the public relations machinery of the biotech industry undermines counterarguments to GMOs by unfounded attacks on scientists. However she also points to growing citizens’ outrage, and to sovereign countries rejecting the industrial monopoly over food systems.

The United States National Institutes of Health has become the first patent holder to join the newly created Medicines Patent Pool, a project of the drug-purchasing mechanism, UNITAID. Public health organisations, such as Medicins sans Frontiers, hailed the move as key step in the right direction but said there is still much work to do. The pool is intended to be a ‘one-stop shop’ for licensing on generic versions of patented HIV medicines. The hope is that by cutting down on the complexity and cost that often surrounds the licensing process – particularly when one drug can carry several patents from several different places –the pool will reduce the cost and increase the speed at which generic medicines can be made available. It is also hoped that the ease of licensing will help ease also the development of affordable formulations specific to children and to conditions in poorer countries where they are often needed. According to Guy Willis of the International Federation of Pharmaceutical Manufacturers and Authorities (IFPMA), the UNITAID Patent Pool is part of an increasing trend towards open innovation in research and development to create new medicines.

To minimize the problems caused by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), academics, governments of low-income countries, many nongovernmental organizations, the World Health Organization (WHO) and other United Nations organizations pay special attention to the Agreement’s so-called flexibilities. The extent to which such flexibilities have already been incorporated into national laws and practice shows substantial variation. Several compulsory licenses – allowing a company to produce a patented product or process without the consent of the patent owner – have been issued for medicines, mainly to treat infections with human immunodeficiency virus. Most of these licenses have led to substantial reductions in the costs of treatment. The use of such licenses is not limited to low- and middle-income countries. Another important flexibility is provided by the definition of the standards of patentability, and the rigour with which they are applied in determining whether a claimed invention is patentable. Weaknesses or gaps in such standards can allow ever-greening by the pharmaceutical industry. Research has shown that the TRIPS flexibilities are poorly exploited and that much more could be done to align intellectual property protection with public health policies. To support the more extensive exploitation of the flexibilities provided by the Agreement on TRIPS, the author argues that a continuous effort from academics, governments, international and nongovernmental organizations is needed, observing that the health of a large part of the world’s population depends on timely and effective action.