A revised framework for

global medicine access

Sanjay Basu

Reblaw X

The pipeline

R&DBetter treatment outcomes

Market failure

Lack of financing

Monopoly pricing of medicines & tech

Infrastructure inadequacy

Social support & Adherence difficulties

Price v. production cost of key AIDS drugs

Source: HMS, 2002

R&D spending?

Source: Securities & Exchange Commission, 2003

Source: Jim Kim, Harvard Medical School, 2001

Source: Univ of Minnesota, 2001

World Pharmaceutical Market

Source: IMS Health, 2002

Region % of market

North America 41.80%

EU 24.8

Japan 11.3

L. America/Caribbean 7.5

SE Asia 5.0

Middle East 2.6

E. Europe 1.8

India 1.8

Africa 1.3

Rhetoric v. Reality

• TRIPs & the WTO

• Parallel importation – cross-border trade of patented goods

• Compulsory licensing – generic production, primarily for domestic

market

• Special 301

What generics can help do…

Source: Oxfam, 2003

The Doha Declaration

“We recognize that WTO members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement.”

Information onslaught...

• PhRMA budget: $150 million/year• $1 million for an "intellectual echo chamber of

economists”• $2.5 million in payments to research and policy

organizations "to build intellectual capital”• $17.5 million to fight price controls and protect

patent rights in foreign countries and in trade negotiations

• $9.4 million for public relations

Source: NYTimes, 1 June 2003

Intellectual echo chamber...• Attaran and “off-patent essential medicines”• Roger Bate and “Africa Fighting Malaria”• DiMasi’s “$800 million” R&D figure• Data exclusivity, diversion

Source: Public Citizen, 2001

Post-Doha:

• USTR (originally with EU and Japanese support) broke initial deadline for negotiations

• 17-page decision

• Possible implementation by Canada?

The new USTR proposals:

• Chile – CAFTA – ARTA – FTAA – PPP

• Singapore – Indonesia/Thailand – ASEAN

• SACU

Positive trends...

• New infrastructure being built in southern Africa by Brazil

• March-ins through Bayh-Dole: Norvir

• Expansion beyond AIDS and into the United States: Xalatan glaucoma case

• Pooled R&D approach (www.essentialinventions.org)

• New non-market approaches: DNDi

More information…www.essentialmedicines.org

www.accessmed-msf.org

www.cptech.org/ip/health

Dying for Growth: Global Inequality and the Health of the Poor (Kim et al., 2000)

Pathologies of Power: Health, Human Rights and the New War on the Poor (Farmer, 2003)

The Political Economy of Social Inequalities: Consequences for Health & Quality of Life (Navarro, 2002)

Global Intellectual Property Rights: Knowledge, Access and Development (Drahos & Mayne, 2002)