Health issue: The art of playing God?

Yanuar Nugroho, Director, The Business Watch Indonesia, Surakarta, yanuar-n@unisosdem.org

Having less money means less opportunity to survive -- to keep alive. We are in a world in which death and life are no longer "natural," but "manufactured.

The association of pharmaceutical industries in the United States, PhRMA, quoting last year's World Health Organization report, describes how diseases quickly and harshly kill people -- 4 million people die annually due to respiratory infection, 2.2 million from typhus-cholera-dysentery, 1.7 million from tuberculosis, 1 million from malaria, 900,000 from blood-fever and 3 million from AIDS-related diseases.

And what is the "progress" of medical discoveries? From 1975 to 1996, 1,223 new kinds of medicine were developed, but only 13 types were designed to cure the disadvantaged of major tropical diseases. The greatest proportion of production costs for medicine was allocated to research into cosmetics, obesity and other beauty-related medicines.

In 1998, of a total budget of US$70 billion allocated for research carried out by the giant pharmaceutical corporations, only $300 million (0.43 percent) went on AIDS vaccine research and $100 million (0.14 percent) on malaria research (The Economist, Nov. 10, 2001).

Unless we admit that health has been in the arena of profit- making, we will not be able to understand this irony. This is all about an accumulation of power and money that sacrifices everything for its own sake.

In 1999, of a total 33 million people living with AIDS, 26 million (78.8 percent) were in Sub-Saharan Africa. Yet, the market for pharmaceutical products in Sub-Saharan Africa was only 1.3 percent of the world total. The poor here could not afford expensive, patented medicines -- there is an intellectual property right that must be taken into account in the pricing policy.

In the ongoing 5th WTO Ministerial Meeting in Cancun, Mexico, the issue of Trade-Related Intellectual Property Rights (TRIPS), especially related to public health, is among the central themes. The issue is how to ensure that patent protection for pharmaceutical products does not prevent people in poor countries from having access to drugs, while maintaining the patent system's role in providing incentives for research and development into new medicines. Are these two objectives compatible?

Flexibilities, such as "compulsory licensing," are indeed in the TRIPS Agreement. Governments can issue compulsory licenses to allow a competitor to produce the product or use the process under license, but only under certain conditions aimed at safeguarding the legitimate interests of the patent holder. Parallel importing -- where a product sold by the patent owner more cheaply in one country is imported into another without the patent holder's permission -- is also possible.

But countries' laws differ on whether they allow parallel imports. The TRIPS Agreement simply states that governments cannot bring legal disputes to the WTO on this issue. In addition, these flexibilities do not have to be applied. They are sometimes used as a means of bargaining. The threat of a compulsory license can encourage a patent holder to reduce the price.

But some governments are unsure of how these flexibilities would be interpreted and how far their right to use them would be respected. All the WTO's African members are among those pushing for clarification -- the consequence is about life and death. The generic versions of patented medicine, for example, are not permitted for 20 years!

In the main declaration, WTO stressed that it was crucial to implement and interpret the TRIPS Agreement in a way that supported public health -- by promoting access to existing medicines and the creation of new ones. Yet, in a separate declaration, they still disagree on the phrase, "countries still unable to produce pharmaceuticals domestically can import patented drugs made under compulsory licensing."

Clearly, it has an indirect impact on countries unable to make medicines and which therefore need to import generics, like Africa for AIDS medicines. They would find it difficult to find countries that could supply them with drugs made under compulsory licensing.

The global pharmaceutical industry is worth US$ 300 billion nowadays. As of 1997, the largest pharmaceutical market was developed countries -- the U.S. and Canada (36.1 percent of the world total), followed by Europe (29 percent) and Japan (15.9 percent). Poorer countries followed: Latin America (7.7 percent;), Asia, minus Japan (7.3 percent), the Middle East (1.9 percent), Africa (1.2 percent) and Australia-Pacific (0.9 percent).

A multilateral solution should therefore be decided at Cancun as it now seems that industries in the health sector only belong to those who can pay.

It seems we are playing with life and death; we are dangerously playing at being God. Let's stop it.

The writer is also lecturer at Sahid University in Surakarta, and a researcher at Uni Sosial Demokrat, Jakarta.