E-drug: Health can take precedence over trade issues
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[Copied as fair use. HH]
BMJ 2002;325 460
http://bmj.com/cgi/collection/medicine_in_developing_countries
Health can take precedence over trade issues, says report
Sanjay Kumar, New Delhi
In the ongoing tension between the quest for profits and people's
health care, "health can take precedence over trade issues," reassures
a new joint study by the World Health Organization and the World
Trade Organization (WTO).
"If necessary, governments may put aside WTO commitments in order
to protect human life," said the new report, WTO Agreements and
Public Health. The principal coordinator of the study was Miguel
Rodriguez Mendoza, deputy director general of the WTO.
According to WTO jurisprudence, human health has been recognised
as being "important in the highest degree," the report also said.
Serious concerns have been raised that globalisation and the opening
of trade barriers advocated under various WTO agreements could pose
a serious threat to public health. The study says that countries have a
right to restrict imports or exports of products when it is necessary to
protect the health of humans, animals, and plants. Despite the
liberalisation of services, countries retain the right to introduce
regulations so that they can meet national policy objectives in areas
such as health.
Some of the key WTO agreements with health sector implications
relate to the technical barriers to trade, sanitary, and phytosanitory
measures (covering the safety of human, animal, and plant health),
trade related intellectual property rights (TRIPS), and the general
agreement on trade in services (GATS).
In several developing countries, there has been apprehension that
implementing the TRIPS agreement with stringent patent protection
would lead to unaffordable prices of new patented drugs such as the
new, effective drugs to combat HIV/AIDS, malaria, and tuberculosis
invented after 1995.
The study says that some helpful mechanisms are open to countries.
These include compulsory licensing by the government to authorise the
use of an invention without the consent of the patent holder, and the
use of parallel imports, which enable a country to take advantage of
products available in another country at a lower price. The study,
however, recognises the concern that after 2005, countries such as
India may not be able to export cheap generic equivalents of drugs, as
they will come under the TRIPS patent obligation.
The report also highlights the way some developing countries, such as
Cuba, India, and the Philippines export their doctors and nurses while
earning foreign exchange remittances, filling supply gaps in the West
but also causing enormous losses to governments on investments
made in training health professionals.
"An increase in the `brain drain' of health professionals leaving
low-income countries to work in high-income countries can worsen
health personnel shortages in developing countries," says the report.
But developing countries could legitimately levy taxes on those leaving
countries or require deposits or financial guarantees to minimise the
cost of the brain drain. Although advocating liberalisation, the study
also calls for greater regulation: "Greater, not less, regulation has
accompanied more open markets in financial services and
telecommunications, and this will be essential for health services as
well," it says.
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