The recent landmark decision of the Supreme Court of India, rejecting patent protection for Glivec, a cancer drug from Novartis, and providing access to cheap generic drugs to protect public health and the rights of patients, is in line with the Doha Declaration. Glivec, a drug used for treating Leukemia, costs US $ 4,000 a month in its branded form, while the generic version is available in India for around US $ 73 (Republica, April 1). This ruling has set an important precedent that essential drugs are not just another consumer product but a human right, and that patients are harmed by patents.
The case of Novartis can be taken as an example of structural violence as defined by Prof. Johan Galtung, where a certain social structure or institution harms people by preventing them from meeting their basic needs. Since structural violence affects people differently in various social structures, it is very closely linked to social injustice. Violence in our times is directed towards civilian populations, even in peaceful domains such as healthcare, where the objective of scientific research is not violence but human welfare. Scientific research which tries to establish its monopoly on knowledge leads to multiple violences such as violence against the subject of knowledge, the object of knowledge, the beneficiary of knowledge, and against knowledge itself.[break]
There is no denying that this form of violence is perpetrated by forces outside the health sector, among which trade is one of the most important and insufficiently recognized. Behind the slogan of “free trade”, subsidized grain is dumped on the markets of poor countries, destroying the livelihoods of small farmers. Comparative advantage is generated by poverty wages, deadly working conditions, and environmental degradation. The links to health outcomes are obvious. But perhaps the most adverse consequences for health arise from provisions in trade agreements that are designed to restrict access to generic medicines. Lack of access to essential medicines due to high price denies patients’ human right to proper medical treatment. Access to essential medicines is an important aspect of development. It was part of the Alma Ata Declaration of 1978, and is one of the six targets of Millennium Development Goals 8.
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The effect of stringent intellectual property protection in the pharmaceutical market is contentious, focused in recent years on the World Trade Organization’s (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). In January 1995, the TRIPS agreement established global minimum standards for the protection of intellectual property, including a minimum 20 years patent protection on pharmaceuticals. Compliance was postponed until 2005 for developing countries and 2016 for least developed countries.
TRIPS provides high standards of protection that ensure recognition of pharmaceutical patents for products and processes.
The high cost of many medicines is largely due to the international patent system, which grants monopoly protection to the innovator of a product, who can then completely control the price of the medicine, where it will be sold, and in what quantities. However, there is no justification to further increase such protection in countries with weak scientific and technological infrastructures, or where a large part of the population is poor. Advocates of intellectual property argue that such protection is necessary to provide incentives for research. But Dr. Marcia Angell, the former editor-in-chief of The New England Journal of Medicine writes in her book The Truth About the Drug Companies that drug companies spend far more money on advertising and marketing than on research, far more on research for lifestyle drugs than on life-saving drugs, and almost no money on diseases afflicting poor countries, such as malaria. The reason is economics: companies direct their research where the money is, regardless of the value to society. Poor people cannot pay for drugs, so there is little research on their diseases, no matter what the costs to society.
Such inequalities in power and influence between countries leave many vulnerable to the pressure of protecting broad trade and economic interests over health. Since most of the pharmaceutical industry is based in a few developed countries, developing countries are under considerable political pressure from the governments of developed countries representing the interests of pharmaceutical corporations. The developing countries are forced to not invoke the flexibilities on TRIPS agreement. Such pressures from global corporate houses push developing countries to adopt policies in line with the global financial system. Governments of rich nations use compulsory licensing, thereby placing trade interest above health of the poor people.
For instance, if a manufacturer can change one molecule and get another 20 years of patent rights, and convince physicians to prescribe that instead of generic medicines, then why would an industry spend huge amounts of money to invent brand new drugs? A great majority of new drugs are not new at all, but variations of older drugs already in the market. Such gross inequity is a shocking feature of the global pharmaceutical industry.
Millennium Development Goals 8 recognizes that pharmaceutical sector has an indispensable role to play in relation to the right to health and access to medicines. For example, one of the targets of Goal 8, is “in cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries.” Enhancing access to medicines must be understood as a shared responsibility by the pharmaceutical sector. The fact that international trade affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue that the global health community can no longer ignore.
The author is a PhD student of preventive medicine and epidemiology at University of Oslo, Norway
sherpalhamo@yahoo.com
