In the developing world people are dying because medicines are too expensive, writes Mary Robinson
As I write this article I am in Botswana, at a seminar on the gender and human rights dimensions of HIV/AIDS, prior to travelling to Cancun for the World Trade Organisation (WTO) ministerial meeting. There, too, the issue of HIV/AIDS and human rights in Africa will be on the agenda.
The links between trade and HIV/AIDS are not always easily understood. But in Africa the connections are unmistakable. Consider the example of Uganda.
Once every month, more than 300 people meet in a field outside a government health clinic in a remote rural part of the country. Many have walked or cycled 30 kilometres or more along rugged dirt roads to reach the clinic.
Everyone is sick from HIV/AIDS but some are deteriorating towards death more quickly than others. Many are children. Everyone is desperately poor. In the open field, a not-for-profit group of health workers has set up for the day, providing food, counselling and medicines.
The health workers advise their patients to accept their situation and learn to live as positively and productively as possible. However, everyone in this field knows that medicines exist that could save or prolong lives, but are being sold at prices affordable only to the rich: the urban professionals in the capital Kampala, or foreigners.
Patented anti-retroviral (ARV) drugs are beyond these people's reach and even generic medicines, available from a few private clinics, are too expensive. Indeed, only 10 per cent of the people in Uganda who need treatment for AIDS are receiving it.
Sadly, this situation is far from exceptional. Throughout the developing world, people are dying from treatable diseases because medicines are too expensive.
On August 30th of this year, after many months of difficult negotiations, members of the WTO announced an agreement that they said would help very poor people to receive the treatment they need. The agreement will allow countries like Uganda, which are too poor to buy branded drugs and lack the capacity to produce their own versions, to import cheaper generic medicines to fight diseases such as HIV/AIDS, tuberculosis and malaria.
Equally important, the agreement permits the import of generic medicines to tackle other major killers such as cancer, diabetes and hepatitis which are all major public health problems in many developing countries. In Africa, such chronic diseases kill nearly two million people each year.
But this agreement, which requires burdensome procedures, is far from perfect. Non-governmental organisations such as Médecins sans Frontières and Oxfam, which have campaigned hard for a broad agreement, worry that the final import mechanism is so riddled with red tape, restrictions and conditions that governments will be deterred from using it.
Imperfect as it may be, the compromise deal nonetheless constitutes welcome progress. Encouragingly, several developing countries, including South Africa, have already announced that they believe the mechanism can work, and that they intend to use it.
We await the announcement from rich manufacturing countries that they stand ready to export affordable medicines to developing countries and make the necessary changes to their national patent laws.
Maintaining a legally secure, sustainable supply of generic drugs is vital to providing access to medicines in the developing world. First, resources can be stretched further to treat more people and save more lives if cheaper generics are used instead of expensive branded drugs. In addition, generic competition can bring down branded drug prices.
We have seen this in the cost reduction of AIDS treatments following the introduction of generic ARV drugs from India. Costs fell from $10,000-15,000 per patient per year to less than $300. In some cases, the mere threat of a compulsory licence is enough to bring down branded drug prices.
At present, new patented drugs for cancer, leukaemia and heart disease, to name just a few, are entirely out of the reach of patients in the developing world. This situation must change. It is unacceptable that the majority of the world's population should not have access to newer, more effective treatments for diseases that affect developing and developed countries alike.
Under international human rights treaties, ratified by the majority of the WTO's member-states, governments recognise the right of everyone to the highest attainable standard of health. For example, the International Covenant on Economic, Social and Cultural Rights, ratified by 147 countries, imposes on member-states an obligation to take steps for the "prevention, treatment and control of epidemic, endemic, occupational and other diseases".
Affordable medicines are crucial to achieving this right. Poor countries should be actively encouraged, and helped, to make full use of the new mechanism for importing generic medicines, not just for HIV/AIDS, but for other diseases as well.
Clearly, this long-awaited WTO agreement will not, of itself, suffice to resolve public health problems in poor countries. More funding is sorely needed not only to finance the purchase of essential medicines, but also to improve healthcare delivery systems in much of the developing world. Basic rights such as the right to adequate food, clean water, education and primary healthcare must also be secured to reinforce the benefits of affordable treatment.
Further improvements to the TRIPS agreement (on intellectual property rights) may be needed, if the deal fails to deliver on the key goal agreed at Doha of protecting public health and promoting access to medicines for all.
Nonetheless, the agreement in the WTO should be recognised as an encouraging step in implementing the fundamental right to the highest attainable standard of health. All WTO members should work together, as well as with international organisations, civil society and the pharmaceutical industry, both generic and research-based, to ensure that this agreement is fully implemented in order to benefit the people whose lives it was designed to save.