Battle of commercial interests confound fight against noncommunicable diseases

The bigger issue in preparing the document, however, was how much to invoke the international trade agreements that indirectly have helped bring life-saving antiretroviral drugs to nearly 7 million people with HIV infection in low-income countries in the last decade.

In 2001, the World Trade Organization’s agreement on intellectual property, known informally as TRIPS, was amended in Doha, Qatar, to help developing nations gain access to AIDS drugs. The Doha Declaration said a poor country could force pharmaceutical companies to let manufacturers make generic drugs for use in low-income countries, in exchange for a small royalty.

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This option helped persuade U.S and European drug companies to voluntarily let offshore companies make versions of their high-priced drugs long before the patents expired. This prevented “compulsory licensing,” as the Doha mechanism is called, from becoming common practice.

The Doha Declaration referenced HIV, tuberculosis, malaria “and other epidemics.” Whether that might cover “epidemics” of noncontagious diseases such as diabetes and hypertension wasn’t mentioned — or probably even considered.

The document from this week’s U.N. meeting doesn’t mention the Doha Declaration, although it does mention “full use of TRIPS flexibilities.” It also doesn’t describe the noncommunicable diseases as epidemics; it calls them “a challenge of epidemic proportions.”

Many experts and activists interpret these omissions as evidence that rich countries don’t want their drug companies to be pressured into repricing cancer and heart medicines for the developing world as they were for antiretrovirals. There are far more drugs for noncommunicable diseases; many are pricier than AIDS drugs; and there are hundreds of millions more patients who could use them.

“We really believe that Doha was not meant to be so narrowly interpreted, that it was intended to address all public health crises,” said Krista L. Cox, a lawyer for Knowledge Ecology International, a four-person organization with offices in Washington and Geneva that campaigns for global health equity.

Pharmaceutical Research and Manufacturers of America takes a different view.

“Compulsory licenses are intended to be used to address health emergencies and to provide urgent access in situations where there is little or no availability of existing effective medicines,” said Jay Taylor a vice president of the trade group. “This situation is clearly not the case in the context of the growing burden of noncommunicable diseases . . . there are hundreds of low cost generic medicines to treat NCDs in low-income countries that simply are not getting into the clinics and pharmacies or into the hands of the patients that need them most.”

The organization’s member companies would work to provide those to needy countries, he said.

A summary of the negotiations, made available to The Washington Post on the condition it not be quoted directly, shows that U.S. negotiators at one point threatened to scuttle the document if it mentioned either TRIPS or Doha. A compromise was reached in which the former was included but not the latter, and also no reference to “epidemics.” This was viewed as giving future negotiators more flexibility in issues of compulsory licensing.

A U.S. government official familiar with the talks had a different account. The official said there was little debate over a Doha reference and that its absence from the final document is insignificant because Doha is part of TRIPS. As for “epidemics,” the official said, negotiators simply stuck to the medical definition, which requires contagion.

Asked about the Doha omission on Tuesday, the director-general of the World Health Organization, Margaret Chan, took a similar position: “Any member of the WTO can exercise the TRIPS flexibility, and that’s it.”

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