The TRIPS Agreement sets the minimum standard of intellectual property protection that must be implemented by governments, and takes the issue at least partially outside of the domestic policy sphere. Created minimum standards for patenting, copyrights, trade marks and trade secrets Based on industrial country standards developing countries had grace periods to bring their national legislation in line Exclusions from patentability Compulsory licensing and ‘government use’ still allowed
There needs to be a balance achieved between the right to protect intellectual knowledge, and the non-derogable right to health. Loff (2003, p8) argues that: A human rights approach to intellectual property would no doubt subordinate … corporate interest to [the] inalienable and permanent right to health.
Safeguards such as the provision for granting of compulsory licences to allow domestic production of patented drugs in situations that are deemed public-health emergencies, a position that was reaffirmed at the Doha WTO meeting in 2001 (WTO, 2001). Despite these supposed safeguards, there is much concern that they are unworkable by both human and manufacturing capacity-limited developing countries, and that they are often asymmetrically ‘negotiated’ away through bilateral and regional TRIPS+ agreements whereby rich countries protect the interests of their industries in exchange for aid or debt relief (MSF, 2006, Oxfam, 2003).
Globalisation and Health
Global health and
what are they, and how are they relevant
• What is global health?
• Is it different to international health?
• What is it not?
• What is globalisation?
• What is ‘driving’ it?
• TRIPS and the WTO
• Health worker Migration
A few initial points…
• Massive area
• Short amount of time
• More questions than answers!
• Do ask questions!
Global health IS NOT
• just Infectious diseases medicine
• ‘peeling onions’!
• Taking it further: actions
the big issues that matter
A (brief) definition
• We believe that global health is a broad discipline that
develops students' understanding of the local, national and
international determinants of health and healthcare delivery.
• Through studying global health, students examine
the wider influences of health such as poverty, debt,
globalisation, healthcare financing, human rights,
famine, environment, violent conflict and the
movement of populations. Global health draws
from a number of disciplines including politics,
economics, sociology, demography, anthropology,
epidemiology and philosophy.
What is globalisation?
• Economic globalisation:
–obstacles to trade and movements
between countries progressively
• Is it happening?
– World exports of goods and services almost tripled in
last thirty years
– Levels of commercial investment (FDI) have
– Daily turnover in world’s foreign exchange markets
has increase from $1 billion in 1970 to over $1 trillion
– Huge declines in transport and communication costs
• Why is it happening?
– Competition and the search for new
– Technological changes (particularly in the
– International policies and agreements (e.g.
Globalisation - broader definition
• Globalisation canalso be defined as processes that are
changing the ways in whichpeople interact across
boundaries, notably physical (such as thenation-state),
temporal (such as instantaneous communication via
email), and cognitive (such as cultural identity). The
resultis a redefining of human societies across many
spheres, economic,political, cultural, technological
and so on. As such, globalisationaffects the health of
different people in very different ways.How good or
bad globalisation happens to be for you will be
influencedby socioeconomic status, sex, education, age,
geographical location,and otherfactors.
» Lee, K et al. BMJ 2002;324:44 ( 5 January )
What are the effects?
• Economic growth
• Economic instability
• Rise in inequalities
• Effects of trade agreements – eg TRIPS
• Positive effects:
– (expected) increased openness of countries
to trade and investment
• Negative effects:
– un-preparedness of economies for global
– effects of instability
Changes in income inequalities
• Global distribution of income has
• At national level, many countries seem
to have experienced a worsening of
• Why? Could it be related to
•Related aspects of
Progress must be made. It is estimated
that by improving access to existing
medicines and vaccines, approximately
10 million lives could be saved every
year: 4 million in Africa and South-East
[DIFD, 2004, p8]
• estimated 1.7 billion people lack access to essential medicines
• unchanged for two decades (WHO, 2004)
• particularly concentrated in Africa and India;
– around 80% in low income countries
– remaining 20% are almost all poorest in middle income countries
• Currently over 150 members (and growing)
– Trade liberalisation
– Trade negotiations
– Dispute settlement
• Established 1st
• 1999: Failed to launch new round, Seattle
• 2001: Doha Round Launched
• 2003: Cancun…
• 2005: Hong Kong… struggling on
• (one aspect of) globalisation in action
• Uruguay 1994
• Legally binding
• AND enforceable
• Global patent protection (allows monopoly
production and sale for life of patent)
• ‘Our combined strength enabled us to
establish a global private sector-
government network which laid the
groundwork for what became TRIPS’
– Edmund Pratt, CEO, Pfizer
Trade vs Health
• 1998: first WHO guidance re implementation
• “considerable concern among the
pharmaceutical industry”, “that no priority
should be given to health over intellectual
Directorate General for Trade of the European Commission, 1998
• 1999: Seattle: Battles re Essential Medicines
• 2001: Doha Declaration – a success?
The Doha Declaration
“…while reaffirming our commitment to the
TRIPS Agreement, we affirm that the
Agreement can and should be implemented
in a manner supportive of WTO Members’
right to protect public health and, in
particular, to promote access to medicines for
• Go ahead for generic production/import?
Doha declaration 2001
• TRIPS should be interpreted in a manner
which supports governments’ attempt to
protect public health
– emphasised flexibility already in TRIPS
– extension for LDCs until 2016
– recognised problem of compulsory licensing in
countries with insufficient or no manufacturing
capacity and resolved to find a solution to this
Fast forward to 2007
• Doha declaration never used (but
– ? unworkable
• Countries without domestic generic
• WTO paralysis?
• India Glivec court case… watch out
• Regional free-trade agreements e.g. FTAA
– IP included under the agreement
– US proposals would
• restrict grounds for compulsory licensing
• extend patent holders monopoly beyond 20 years
• give five years ‘data exclusivity’ on pharmaceutical test
data, delaying entry of generics
• NGOs attempting to strengthen developing
countries’ capacity to make use of flexibilities
• Proposals for R&D funds for neglected
– raises issue of public sector R&D and how it is
• Drug donation; corporate social responsibility
or PR smokescreen?
Importance of networks
• US Commercial interests needed
support from across the world to make
• Surveillance + economic coercion
crucial to maintaining commercial power
in this area
• Weaker actors also have to create global
networks as a counterpoint
• Complicated issues…
… but important!
– Power relationships; trade and finance decision-
makers; commercial interests; governments
– increasing influence of CSOs