The last decade has witnessed a sharp acceleration in the processes of economic globalization, and a major increase in the number, and expansion of the scope, of international trade agreements. As economic globalization and international trade agreements have exerted an ever greater influence over national economies and regulatory policies, concern has grown about their potential impact on public health, especially in the developing world. While many of the trends of economic globalization and new requirements contained in trade agreements are easily identifiable, controversy remains, however, over their impact on public health.
Particularly important are trends and rules relating to intellectual property, which may have a direct impact on the cost and availability of medicines. As increasing numbers of countries, especially developing countries, fall under the disciplines of the World Trade Organization’s (WTO’s) Agreement on Trade-Related Aspects of Intellectual Property (TRIPS) and otherwise expand their intellectual property protections, the debate over the public health impact of these protections has intensified. Views on the subject vary from those who believe increased global trade and enhanced intellectual property protections naturally create public health benefits to those who fear that the failure to prioritize public health concerns in the process of trade liberalization will inevitably lead to public health harms.
The World Health Assembly, the highest governing body of WHO, gave the Organization the mandate to work in this area in its resolution WHA.52.19 on the Revised Drug Strategy.
Box 1. Resolution WHA.52.19 on the Revised Drug Strategy
This resolution requests the Director-General, inter alia,
to cooperate with Member States, at their request, and with international organizations in monitoring and analysing the pharmaceutical and public health implications of relevant international agreements, including trade agreements, so that Member States can effectively assess and subsequently develop pharmaceutical and health policies and regulatory measures that address their concerns and priorities, and are able to maximize the positive and mitigate the negative impact of those agreements. (Emphasis added)
At a meeting held in Bangkok, Thailand in February 2001, WHO initiated a process to monitor and analyse the impact of trade agreements on access to drugs in partnership with four WHO collaborating centres in Brazil, Spain, Thailand and the United Kingdom.
The meeting began with a series of opening statements, including one from Dr Supachai Panitchpakdi, who will assume the position of Director-General of the WTO in 2002. Excerpts of his remarks are included on page 9 of this report.
Following opening comments, the meeting undertook an intensive review of the WHO’s draft paper on “Globalization, TRIPS and Access to Pharmaceuticals.” The paper was significantly strengthened by incorporating revisions proposed by meeting participants. The final version of the paper is included on page 13 of this report.
The main emphasis of the meeting was to develop a framework of operations for a nascent Network for Monitoring the Impact of Globalization and TRIPS on Access to Medicines. The meeting resulted in the establishment of a steering committee to oversee the operations of the network, which will be made up of the four WHO Collaborating Centres. The members of the steering committee, as well as experts who participated in the Bangkok meeting as advisors in their personal capacity, are listed at the end of this introduction.
The meeting established that the network, through the individual and collective work of the Collaborating Centres, would undertake research that shed light on four questions:
* How is patenting affecting drug pricing?
* How are patents and enhanced intellectual property protections affecting the rate of introduction of generic drugs?
* Are TRIPS and expanded intellectual property protections spurring development of drugs for neglected diseases?
* Are TRIPS and expanded intellectual property protections contributing to an increase or decrease in transfer of technology and direct foreign investment in developing countries?
The meeting participants developed a harmonized model of selected indicators to be adapted according to the characteristics of different regions. These indicators are intended to offer important information though of course not definitive answers regarding the four questions, though they relate more to some of the questions than others. The template is included on pages 25-35 of this report.
• Each of the four Collaborating Centres will conduct research in their region or in the region in which they maintain expertise and contacts, using a version of the model of selected indicators adapted to their circumstances. The Collaborating Centres together will adapt, use and refine the model of selected indicators; publish and analyse the collected data; and conduct additional research and analysis on important trends in the interaction between globalization and access to drugs. The final section of the meeting report includes short summaries of the missions of each Collaborating Centre.