[Ip-health] Thomas Pogge comment on debate on HIF

[James Love]

If Thomas Pogge had posted this as a text message, rather than as
attachment of a word file (the list does not accept binary attachments),
it would have gone though.  Here is Thomas Pogge's most recent comment.


-------- Forwarded Message --------
From: thomas.pogge@yale.edu
To: ip-health-admin@lists.essential.org
Subject: message for listserv
Date: Mon, 24 Nov 2008 07:12:19 -0500

I got an automatic reject message, probably because I did something wrong i=
n
submitting. If you want to include my message, it is attached.
Thank you.
Thomas Pogge

----- pasted rom word file attachmet----------

Allow me a comment on the debate with Jamie Love, which has become
rather more public and a little more acrimonious than Aidan and I would
have preferred.

We should bear in mind that we all share the same fundamental ends and
values by reference to which we may disagree about the best way forward.
We all share in common the ultimate commitment to ending the disastrous
cycle of poverty and ill health among the world=E2=80=99s poor with all
deliberate speed. Aidan and I recognize Jamie's efforts in this regard
and we support much - perhaps all - of what he has been proposing. And
Jamie would, I believe, support the Health Impact Fund (HIF) proposal if
he understood more fully how it is supposed to work and perhaps after
we=E2=80=99ve refined it a bit more with any
remaining criticisms he may make in mind. The HIF book Aidan and I have
written with a team of other researchers (downloadable from
www.healthimpactfund.org) reflects our best thinking at the time, and we
are ready and eager to learn and refine on the basis of your
constructive critique.

Jamie is right to oppose paying health impact rewards to innovators in
exchange for their promise to sell a medicine at a price they declare to
be =E2=80=9Creasonable.=E2=80=9D But, as Aidan has subsequently explained, =
this is not
our proposal. The HIF would pay health impact rewards to innovators in
exchange for their promise to sell a medicine wherever it is needed at a
price no higher than the lowest feasible cost of production and
distribution. Registrants will often want to sell even below this price
in the expectation that their losses on such sales will be outweighed by
the enlarged health impact they would achieve by reaching additional
poor patients.

In determining the highest permissible price, the HIF would rely not on
the registrant=E2=80=99s say-so, but would use expert estimates informed by
tenders from generic firms. The registrant could accept the most
favorable tender or produce the medicine itself. Many registrants would
prefer to outsource production because, given the low sales price, doing
so would not (as it does today) run the risk of illicit copies being
produced and marketed. Given this tendency to outsource production and
given that the HIF would stimulate the invention of additional medicines
that would not have existed without the HIF, it is quite possible that
generic drug producers would have more business rather than less if the
HIF were to be adopted.

It is also worth noting that the innovators collecting HIF rewards need
not be corporate giants in affluent countries. Firms in developing
countries are likely to be quite competitive when it comes to developing
new medicines for diseases concentrated in the developing world, because
they have better access to the relevant patient population. Moreover,
because such diseases have heretofore been under-researched, the
difficulties of achieving genuine pharmaceutical advances will generally
not be as formidable as they are with the already well-researched
diseases of the affluent.

Creation of the HIF could thus provide additional manufacturing
contracts for generic companies as well as enhance innovative capacities
in the developing countries. It need not in any way compete with the
creation of patent pools many of you have been promoting, which Aidan
and I fully support. Indeed, HIF registrants could even use patent pools
to engage additional generic manufacturers. The combination of the HIF
with the patent pool would enable the registrant to offer an open
license without royalty payments, since the registrant would continue to
receive payments based on the global health impact of the patented
medicine, whether sold by it or by a generic licensee.

The same basic point I have just made about Jamie=E2=80=99s critique can al=
so be
made about other critics on this listserv. Mickey Davis, for example,
has criticized the idea that patent holders should simply report on what
health impact they have achieved and then be paid on this basis. We
fully agree that this idea would be entirely unhelpful for those lacking
vital medicines who are our sole ultimate concern. And the HIF proposal
certainly does not involve reliance on such self-assessments. It does
require data from companies about what they produce and where it goes.
But it also involves comprehensive checks as well as collection of a lot
of other data about the actual health impact of a medicine.

Similarly, Riaz Tayob writes that: =E2=80=9CWithout having read the book as
such, from the excerpts it is clear that there is an assumption (much
like Wall Street bankers subprime mess) that patents provide the
"market" with appropriate incentives upon which to make allocative
decisions on R&D spend.=E2=80=9D The
assumption indeed deserves critique - but again, this assumption is not
one the HIF proposal is making but an assumption the HIF proposal is
firmly rejecting. (In fact, if we made this assumption, there would be
nothing left of our proposal.) We propose adding a second incentive for
R&D spending which would reward new medicines on the basis of their
global health impact. On this second track, what matters is not whether
someone is willing and able to buy the medicine but whether the medicine
actually works for a patient (whose benefiting counts equally regardless
of how poor she or he may be).

To conclude. Let us remember that we share the same ultimate moral
commitment to global public health and let us discuss our differences in
a constructive spirit. Aidan and I will be grateful for any constructive
criticism we receive and we will revise and refine to make our proposal
as suitable as possible to the shared purpose it is meant to serve.
Open, informed, constructive debate is supported also by the spirit of
the access-to-knowledge movement which, I think, is not well-served by
policing listservs or by efforts to shut people up by accusing them
without evidence of being stooges of the pharmaceutical industry who are
aiming to derail patent pools or other worthy initiatives. (I did write
that prospects of implementation matter and that, other things being
equal, a proposal is better if it is less unacceptable to the
pharmaceutical industry. Is this wrong? Why?) To repeat one last time,
Aidan and I strongly support patent pools and view them as synergetic
with the HIF proposal.


Thomas Pogge


--
James Love, Director, Knowledge Ecology International
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