June 7 PACHA meeting

[James Love <love@cptech.org>]

Last nights meeting of the International Issues subcommittee of
Presidential Advisory Council on HIV AIDS (PACHA) went well, as far as I
could tell, given the fact that this was a new topic for the Council. 
There was a surprisingly large turn out, including members of the
Council who were not on the subcommittee, and many NGOs.  Apparently the
US government (USG) was asked to explain its position, and refused
(declined) to send anyone.  It was Tom Bombelles from PhRMA, me, Jacob
Gayle from the World Bank, Dr. David Wilpson (MSF-Thailand) and Eric
Sawyer (Act Up!, Health Gap coalition, etc), plus a pretty extensive and
free discussion.   The meeting lasted from 4 pm to about 6:30 pm, and
was covered by some press and what appeared to be a free lance video
crew doing a documentary.

CPT asked PACHA to recommend that:

1.      The US government should end trade related opposition to
parallel
importing of essential medicines,

2.      The US government should end trade related opposition to
compulsory
licensing of essential medicines, so long as countries abide by
WTO/TRIPS Article 31 safeguards.

3.      The Department of Health and Human Services (DHHS) should enter
into
an agreement with the World Health Organization, permitting the WHO to
use US government intellectual property rights in government funded
medical inventions to broaden access to essential medical technologies
in less developed countries.


Eric Sawyer made a simliar request on behalf of the Health Gap
coalition. 

Bob Fogel, the subcommittee chair, did a very nice job of moving the
meeting along and facilitating the discussions. AIDS experts like Paul
Boneberg, David Hoos and Daniel Berman made good contributions to the
discussions, and the council itself was very animated, interested and
engaged.  

PhRMA did not dispute that parallel imports or compulsory licensing were
legal under trade agreements like the WTO/TRIPS, but claimed they were
bad policy.  PhRMA said that drug prices were not a barrier to access. 
(I believe HL Menken once said that when someone says it is not about
the money, its usually about the money).  According to Bombelles, the
real problem is the government's lack of willingness to pay, since drugs
are such a good value for society.  At one point Bombelles made the
puzzling claim that India does not manufacture or export AZT or other
HIV drugs.  Bombelles held out Brazil as a good model to follow,
apparently because the Brazil government is paying for HIV/AIDS drugs. 
The World Bank also mentioned Brazil as a good model.

Dr. Wilson's presentation about the Thai case was very moving, but there
were unanswered questions about the ddI case in Thailand.  MSF was not
sure why the Thai national drug company had not manufactured ddI, and
what had transpired between the Thai and BMS over ddI.  I have heard
rumors that BMS claims to have offered deep discounts for ddI in
Thailand, perhaps to avoid generic production from the Thai government,
but this was not discussed in the meeting, and elements of the Thai case
remain a bit of a mystery.   The case of Fluconazole was discussed,
where the removal of exclusivity last september lead to a decrease in
the price of the drug by 93 to 95 percent in nine months, following the
introduction of 2 generic versions in the Thai market.

Interesting to me was the presentation by Jacob Gayle, who is a CDC
employee, on loan to UNAIDS, where he is a liason to the World Bank.  
Gayle read what appeared to be a prepared statement, apparently on
behalf of Debrework Zewdie <dzewdie@worldbank.org>, a World Bank
employee.  Jacob Gayle began by chastisting those who claim that
compulsory licensing is *the* solution to the AIDS crisis (who are these
people?  I later asked), and went on to state all the reasons why
compulsory licensing is not important.   In my opinion, most of Gayle's
statement on compulsory licensing could have been written by PhRMA or
the USTR, in terms of minimizing the importance of price or intellectual
property rights as barriers to access, but he stopped short of saying
countries should not do compulsory licensing, and he seemed to
acknowledge that it might have some non-zero role.  Then he said that
UNAIDS, the World Bank, Unicef, WHO, UNESCO, UNFPA and UNDCP are comming
out with a joint policy on compulsory licensing.   I asked if the World
Bank and these other international organizations would cut off aid to
countries that did not conform to the World Bank et. al. "policy" on
compulsory license.  Gayle said that this would be out of character for
the World Bank, a view that others did not share. In the break I asked
Jacob for a copy of his prepared remarks and he said there were none,
and that he was speaking from notes.

Gayle's statement raises some interesting issues.  Can groups like
UNICEF, UNAIDS or others that seek to raise money from the drug
companies alienate their donors by issuing positions in favor of
compulsory licensing?  If this is a problem, what role should they play
in trying to set international norms on these issues?  Who will be
consulted by the World Bank, UNICEF, UNAIDS and others on this policy
statement?  Will the USG simply use its clout in these agencies to
undermine the World Health Assembly's revised drug strategy?  One bit of
evidence that some caution is warrented would be the decision by UNICEF
and the WHO to release a publication on intellectual property the day of
the WHA vote on the revised drug strategy, that was distributed by the
IFPMA during the meeting, and referred to by the IFPMA as a document
that reflected the IFPMA views. 

In general, however, the real news from the meeting was the very
favorable response of the subcommittee memebers to the concerns about
current US trade policy and access to essential medicines.  It appears
as though PACHA will be meeting with US government trade officials to
discuss these matters further.  Apparently USG trade officials are
asking that these discussions be more private, and shielded from the
press and activists, but there does appear to be some support for having
USG trade officials address these topics in a future public meeting.  I
would hope that PACHA could endorse the idea that the USG enter into an
agreement with the WHO on access to USG intellectual property on
essential medicines, an action that would seem to be positive step that
the Administration could take that does not involve appropriations and
simply uses intellectual property rights the USG already owns but is not
using.  

Much credit goes to David Hoos for working with the Council to move this
on the PACHA agenda, to Bob Fogel for his leadership within the Council,
and to the many activists who have pushed this isssue forward.  This
should be the beginning of a new initative with the PACHA, and it would
seem to make sense to think about the next meeting in October.  

   Jamie
-- 
James Love, Director, Consumer Project on Technology
I can be reached at love@cptech.org, by telephone 202.387.8030,
by fax at 202.234.5176. CPT web page is http://www.cptech.org