Last week’s 2015 Social Forum led by the UN Office of the High Commissioner for Human Rights (OHCHR) called for urgent action to facilitate access to medicines. In particular, the functioning of the intellectual property system was put into question. A number of recommendations were drawn by the secretariat after having been identified by participants.
The focus of the 2015 Social Forum, taking place from 18-20 February, was access to medicines. The theme of the forum was in accordance with decision 26/28 of the 26th session of the UN Human Rights Council from 10-27 June 2014. The report of the forum is expected to be presented at the Human Rights Council session in June.
The meeting came on the eve of today’s Equal Access Initiative meeting being held in Geneva with many leaders of the public health community.
On the second day of last week’s forum, three “breakout discussion groups” were organised around the following themes: financing access to medicines and universal health coverage; intellectual property regimes and access to medicines; and health systems strengthening, capacity building, community engagement and empowerment. The agenda of the meeting is here.
Human Rights Should Supersede IP Rights, Participants Say
The rapporteur for the discussion group on intellectual property regimes and access to medicines gave a precise account of issues and proposals identified during the discussions.
The challenge, the rapporteur said, is to generate incentives for the development of medicines for diseases affecting in particular developing countries. A “sad reality,” she said, is that the lack of access to medicines is now also affecting developed country populations, such as in the European Union and in the United States. There is a need to stop adopting a false division of the world as a pretext to avoid sharing knowledge, she said.
She said compulsory licences have been successfully used to reduce drug prices, citing the case of Ecuador (IPW, Guest Post, 12 September 2014), but that pressure from patent owners has to stop. The group suggested that good practices should be compiled and analysed and then brought to the Council for further consideration, she said.
Using political pressure to undermine the use of flexibilities should be considered as a violation of human rights, the group said, and the use of voluntary licensing should be taken into account but not at the price of affecting other flexibilities. Moreover, it is important to make a difference between voluntary licences signed by private companies where the content is not known, and voluntary licences negotiated by the Medicines Patent Pool (MPP).
The group also stressed the need to address the particular issue of middle-income countries, which are excluded from the MPP agreements. “Middle-income countries” is an artificial concept that does not take into account the uneven distribution of income within those countries, she said.
The lack of access to off-patent drugs even for those on the essential drug list remains an issue, she said and it has been said that even if 95 percent of essential drugs are out of patents, the remaining 5 percent represent a significant amount of a country’s health budget. This problem is likely to increase as the WHO is expected to revise its essential drug list, which could include cancer drugs still under patents, she added. Future biologic drugs will also represent a challenge as they are very costly, and the discussion needs to be forward-looking.
Another concern in the field of new antibiotics, the group said, is the proposal by some companies to have lifelong patents. Any new antibiotic under such a regime would become unmanageable, they said.
As an alternative to current R&D financing, the group proposed that public funding be used for R&D and that prizes be awarded for innovation. In particular, this could prove to be a good incentive for indigenous research. Alternative mechanisms such as de-linking the cost of R&D from the price of health technologies should be further explored, the group found.
It is the state responsibility to ensure the right balance between health, intellectual property and trade. However the right to health should supersede all other rights, according to the group. The group also referred to the Global Commission on the HIV and the Law and its recommendations, and proposed that they are framed in the language of the right to health.
States should be urged to prepare human rights impact assessment when considering entering trade, investment and other international agreements which contain stricter intellectual property rights than those included in TRIPS, she said.
The abolition of the patent system for life-saving medicines for developing countries should be considered, she said, as well as a treaty on R&D using Article 19 of the WHO constitution [pdf], which says that the World Health Assembly “shall have authority to adopt conventions or agreements with respect to any matter within the competence of the Organization.”
Gavi, Global Fund, MSF on Promoting Access to Medicines
Geoff Adlide, director of advocacy and public policy for Gavi, the Vaccine Alliance, said the public-private partnership is shaping vaccine markets to ensure adequate supply of appropriate vaccines at affordable prices. Gavi works only with lowest income countries (73), he said. Its governance includes major UN agencies, civil society, the vaccine industry and developing countries governments, he added.
By increasing volumes and the number of manufacturers supplying Gavi, the organisation encourages competition “creating a healthier market,” he said, adding that Gavi now uses 15 manufacturers from 11 countries of production.
Developing countries are asked to co-finance vaccines, and as economies grown, contributions are raised until the country graduates from Gavi’s help. This has been pointed out by many as representing a serious issue for graduating countries having to face higher prices for vaccines. Adlide said Gavi is currently working on the issue.
Nana Boohene, procurement and supply specialist for the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the Global Fund works in 140 countries.
The global health landscape is changing, she said. There are now some 100 middle-income countries accounting for 5 billion of the world’s 7 billion people, where 75 percent of the world’s poor now live, and where the greatest disease burden lies. Many people in such countries cannot afford to access essential health commodities and services, she said.
Rohit Malpani, director of policy and analysis at the Médecins Sans Frontières (MSF, Doctors without Borders) Access to Medicines Campaign, presented MSF’s “PUSH, PULL, POOL: Accelerating Innovation and Access to Medicines for Tuberculosis” project (3P), aimed in particular at multi-resistant tuberculosis.
Malpani described the current hurdles for multi-resistant tuberculosis patients: a two-year treatment involving more 14,600 pills to swallow, highly toxic side effects, low success rate and high costs.
The 3P project includes push funding to finance R&D activities, pull funding to incentivise R&D activities through the promise of financial rewards on the achievement of certain R&D objectives, and the pooling of IP to ensure open collaborative research and fair licensing for competitive production, according to MSF.
A roundtable on good practices in promoting access to medicines, gathered representatives of civil society, international organisations, and industry.
In particular, Hans Rietveld, director of Market Access & Capacity Building for Novartis Pharma AG, described the company’s effort on access to malaria medicine. Soraya Ramoul, director Access to Health for Novo Nordisk, advised that civil society and industry, instead of “pointing fingers at each other,” should find ways to collaborate on the issue of access to medicine.
Also on the panel was James Love, director, Knowledge Ecology International, who said in his intervention that “efforts to regulate drug company monopolies are failing. They are failing to curb abuses of monopolies, and they are weak partly because of the political power that these monopolies create.” He said that contrary to progress made in expanding access to treatments for HIV in developing countries, such is not the case for cancer treatments.
Recommendations by participants
Concluding the session the OHCHR secretariat made a list of some concrete recommendations which emerged from the session. In particular:
One message is coming out of the session, the secretariat said: no man or woman or child should die in the 21st century due to the lack of access to medicines.