[Random-bits] Access to medicine in developing countries -- hoping for change

[James Love]

http://www.huffingtonpost.com/james-love/access-to-medicine-in-dev_b_89151.html

The Huffington Post
February 29, 2008

Access to medicine in developing countries -- hoping for change

For his first seven years, Bill Clinton pursued an aggressive policy of
imposing tough intellectual property rules for developng countries, most
importantly in the area of new medicines, which were seen as an
important U.S. export. In 1994, I began a long effort to address the
flaws in this policy, working first with (Huffpo blogger) Rob Weissman,
Ralph Nader, and soon a few global public health groups, like Health
Action International and MSF, and local public health groups in Thailand
and South Africa. In 1998, through 1999, a global campaign advocating
the use of compulsory licenses on medicines was launched. By June of
1999, a small but very motivated and informed group of U.S. AIDS
activists began a campaign to disrupt the Gore campaign for President,
to protest Gore's direct involvement in bullying South Africa over
proposed changes in its patent laws.

With very few exceptions, the U.S. new media had ignored this issue,
until it became an unexpected but real problem for Al Gore. For the
first time, the U.S. public had some information about why the U.S. is
resented around the world, on this topic. The United States Trade
Representative and the U.S. Department of State, directed by President
Clinton and Vice President Gore, were forcing developing countries to
impose tough and costly monopolies on medicines, and directly reducing
access to medicines needed to prevent death and suffering. As an aside,
it was through this issue that I met Arianna Huffington. Although she
was then known mostly as a right wing allay of Newt Gingrich, she began
writing about the dispute over drug patents in Africa, and more
generally about the nature of corporate power, and her columns on this
topic helped change U.S. trade policy.

Both Gore and Clinton responded to the pressure from AIDS activists
(people like Paul Davis, Asia Russell, Mark Milano, Eric Sawyer, Bob
Lederer and many other brave and selfless persons whose names I am
ungratefully neglecting) and groups like ours, and by 1999, U.S. trade
policy was significantly modified, most dramatically in a well received
speech delivered by Bill Clinton on December 1, 1999, on world AIDS day,
at a chaotic WTO meeting in Seattle. Gore flipped too, and made peace
with the AIDS activists, who then supported his run against George W.
Bush.

The changes in Trade policy announced by Bill Clinton in December 1,
1999 began a moderation of a very bad trade policy, but only partly. For
example, in January 2001, in his last ten days in office, Bill Clinton
authorized a WTO case against Brazil, in order to stop Brazil from
issuing compulsory licenses on patents for the AIDS drug efavirenz, an
action dubbed "the Merck case" by USTR.

George W. Bush's election was initially not a disaster on the access to
medicines issue. Bob Zoellick, then the head of USTR, initially retained
the Clinton changes in trade policy, and to make a very long story
short, in November 2001, agreed to the Doha Declaration on TRIPS and
Public Health, which called for implementing patent laws in manner to
promote "access to medicine for all." Unfortunately, drug company CEOs
then began meeting directly with Karl Rove, and a much reigned in USTR
began a long pro-big-pharma drift that now features regular bullying of
developing countries on the drug patent issue.

Looking back, on his worst days, George W. Bush has had a better trade
policy on medicine patents than Bill Clinton did on his worst days. But
looking forward, it is quite important that the next president make some
big changes, and allow countries like India, Brazil, Thailand and others
to issue compulsory licenses on drug patents. More important, we need to
create a new global trade policy based upon public health needs, looking
to treaties on research and development, rather than the ever tougher
intellectual property rules. Resolutions that would support these
changes included Senate Resolution 241, and House Resolution 525.

We now have three leading candidates for President, and none of them
have agreed to co-sponsor Senate Resolution 241. But we have "hope" for
good things.

Hillary has clearly been influenced by a combination of her own
sensitivities to the health issue, and the increasingly deep commitment
of Bill Clinton, as an ex-president, to address concerns about access to
medicine in developing countries. Like many liberal Congressional
Democrats, Bill Clinton has often embraced a policy of AIDS
exceptionalism on these issues, which focuses on the needs to AIDS
patients, but does not necessarily extend this concern to other health
problems, such as the need for developing countries to have access to
new treatments for cancer or heart diseases. But many activists believe
that Hillary will be very good on this issue if she becomes president.
My own 16 year old son actually talked directly to Hillary about this
topic, during a February 7 visit she made at an Arlington High School.
Senator Clinton took a moment to personally express her support for poor
patients having access to new medicines, and she endorsed the use of
compulsory licensing of patents to make this possible.

AIDS activists have had some luck in getting Obama to offer some
encouraging words on this topic, as it relates at least to AIDS, and his
very bright Senate staff has given meetings on the topic, and seem
sympathetic.

For both Hillary and Obama, I should emphasize that huge efforts have so
far have failed to get either candidate to co-sponsor Senate Resolution
241. This is not entirely encouraging. But we have hope.

John McCain has shown a lot of independence from big pharma on domestic
issues, like parallel trade in medicines (importing cheaper brand name
drugs from Canada or Europe to benefit U.S. consumers). But he has yet
to directly address the trade issue in a constructive way, and the best
that can be said is that his unhelpful statements reflect a lack of
understanding. But, we hope that if he becomes president, he will do the
right thing.

This is a very important issue. Thailand is today being pressured by the
U.S. Department of State and the USTR to abandon compulsory licenses it
had earlier issued on patents on drugs for AIDS, heart disease and
cancer. Brazil is being pressured to not issue a compulsory license for
the Gilead drug tenofovir. Chile has been pressured over it's efforts to
import generic versions of an expensive leukemia drug. The USTR is
pressuring dozens of Latin American countries to abandon a pro-public
health position in a far ranging negotiation on public health,
innovation and intellectual property at the World Health Organization.
The U.S. government is trying to stop the World Health Organization from
offering useful technical assistance on patent issues to poor countries,
and opposes many measures that would promote greater access to safe
generic medicines.

These issues don't directly concern U.S. voters, but they are extremely
important. We are creating new global norms that will last several
decades, and impact billions of persons throughout the world. For people
who don't follow this issue very closely, this is what is at stake.
People who live in developing countries typically have average incomes
of anywhere from 1 to 20 percent of the US. And, within developing
countries, unskilled workers are far below the average. With monopolies,
drug companies typically choose prices that are only affordable for the
richest 1 to 20 percent of the populations. With generic competition
prices fall a lot (More than 95 percent for many important drugs), and
access is much better.

In the global battle over access to medicines, what side are these
candidates on? And what changes will they made if elected?

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_____________________________
James Love, Knowledge Ecology International (KEI)
http://www.keionline.org, mailto:james.love@keionline.org
voice +1.202.332.2670, fax +1.202.332.2673, US mobile +1.202.361.3040, Geneva mobile +41.76.413.6584