E-DRUG: Making trade work for public health
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[see http://www.bmj.com/cgi/content/full/319/7219/1214\]
BMJ 1999;319:1214-1214 ( 6 November )
Editorials
Making trade work for public health
WTO talks in Seattle offer an opportunity to get public health on the
trade agenda
Recent trade disagreements over hormone treated beef, genetically
modified foods, and antiretroviral drugs have captured the public
interest and revealed the tensions between national public health
policies and the need to comply with trade agreements overseen by the
World Trade Organisation. A new round of global trade negotiations
will be on the agenda next month at the World Trade Organisation's
ministerial conference, and the World Health Organisation will attend
the talks to ensure that the voice of public health is heard.
The World Trade Organisation is the forum for negotiating trade
agreements and resolving trade disputes between countries. It was
established in 1995 to provide the institutional and legal foun-
dation for the multilateral trading system, which is designed to
permit trade to flow as freely as possible worldwide without
undesirable side effects. The underlying assumption is that human
welfare will increase through economic growth fuelled by trade
liberalisation.
The General Agreements on Tariffs and Trade (GATT), adopted in 1948,
focused on reducing tariffs on traded goods "at the border." Over the
past 50 years, though eight rounds of trade talks, the multilateral
trading system has expanded to include matters beyond the border and
trade in services and intellectual property rights. The dispute
settlement system created by the GATT has been strengthened.1 In
resolving disputes the World Trade Organisation, though recognising
the need to protect public health, favours practices that promote the
least trade restrictive measures.2
Four specific agreements have important implications for public
health. The agreement on the trade related aspects of intellectual
property rights sets minimum standards of protection for intellectual
property rights including patents, copyrights, trademarks, and
industrial designs. A major debate concerns incentives to create
knowledge and the desirability of treating knowledge as a global
public good and of decreasing the knowledge gap between countries.3
The agreement has implications for the production and access to drugs
and vaccines.4 Will more effective patent protection lead to new drugs
being developed for diseases affecting the poor in developing
countries or will it increase the current lack of access by raising
prices? Questions are also being asked about the "patentability" of
traditional medicines that have been in the public domain for
centuries as well as of new drugs, diagnostic agents, and therapies
resulting from the application of biotechnology.
The agreement on the application of sanitary and phytosanitary
measures affects national policies for food safety. For countries to
restrict trade they have to show scientific evidence of risks to
health, though the agreement does allow countries to implement
provisional measures in the absence of available scientific evidence.
Current discussions centre on whether precautionary measures should be
taken to protect health even when "current" scientific evidence shows
the safety of traded foods.
The agreement on technical barriers to trade has implications for the
production, labelling, packaging, and quality standards of
pharmaceuticals, biological agents, and foodstuffs. Most agreements
stipulate that products must be compared to "like" products without
considering production methods or practices, creating a potential bias
against the adoption of health and safety regulations if these add to
production costs.5
The general agreement on trade in services covers the movement of
consumers and providers across borders to receive and supply health
care, foreign direct investment in health, and the emerging area of
ecommerce and telehealth. Increased trade in health services could
open the sector to increased competition, bringing with it needed
technology and management, and for some countries, increased export
earnings. It could also deepen current inequities in access and
promote the migration of skilled health professionals from already
underserviced areas.
The agenda for the new round of global trade negotiations may include
changes in existing provisions or the negotiation of new rules in
areas such as investment, competition, and the environment and on
specific issues such as trade related aspects of biotechnology (such
as genetically modified organisms). The World Bank and others have
called for these negotiations to be more equitable to reflect more the
interests of the developing world and to ensure an "early harvest" of
benefits for low income countries (JE Stiglitz, Geneva, 1999). These
talks also present an opportunity to make the World Trade Organisation
more sensitive to health issues. In particular the negotiations to
increase the openness of trade in health services (due to start in
January 2000) provide the public health community with an opportunity
to ensure that trade agreements improve access to good quality health
services, particularly for poorer populations.
Trade openness can contribute towards a more equitable distribution of
economic benefits and a just society, but this requires linkage of the
trading system to sound social policies, including the recognition of
health as a global public good. By developing a closer relationship
with the World Trade Organisation, the World Health Organisation is
trying to ensure that public health interests are represented on the
trade agenda.
Nick Drager, medical officer.
Department of Health in Sustainable Development, World Health
Organisation, Geneva
1.
Croome J. Guide to the Uruguay Agreements. Geneva: World Trade
Organisation, 1999.
2.
Correa C. Public health and multilateral trade agreements. Geneva:
World Health Organisation, 1999.
3.
United Nations Development Programme. Human development report. New
York: UNDP, 1999.
4.
Velasquez G, Boulet P. Globalisation and access to drugs.
Perspectives on the WTO/TRIPS agreement. Health economics and
drugs. Geneva: World Health Organisation, 1998.
5.
Koivusalo M. World Trade Organisation and tradecreep in health and
social policies. In: Helsinki: STAKES, 1999.
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