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Health care systems | B2 chapter recognizes that the pharmaceutical sector has largely been shaped by a powerful and politically influential corporate sector intent on protecting its own interests (see Box B2.3). Civil society needs to mobilize when these interests conflict with the social aims of equity and health for all, and the chapter concludes with recommendations for action. Intellectual property rights, monopolies and high prices The price of new medicines is largely governed by an intellectual property rights (IPR) regime that grants patents to any company that registers a new medicine. Patents are granted by governments and give a company monopoly power to manufacture and sell a medicine free of competition from any other manufacturer in that particular country. This monopoly power allows the patent-holder to set a price many times greater than the cost of production. Patents are usually granted for a fixed period after which other companies are permitted to manufacture generic versions of the same medicine. Big Pharma argues that patents are vital incentives to companies to invest in pharmaceutical research and development. It also says the revenue from profitable products can be used to support research into new treatments for diseases, ‘including those which particularly affect the developing world’ (IF- PMA 2005). Initially, IPRs were governed internationally by the Paris Convention and administered by the World Intellectual Property Organization (WIPO). However, in 1986, the developed countries, led by the United States, brought IPR issues into the realm of trade policy and negotiations. Although certain developing countries argued that IPRs were not free trade issues, the developed countries, supported by Big Pharma, pushed through the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) in 1994 under the auspices of the World Trade Organization (Drahos and Braithwaite 2004). Developing countries gave up their resistance to the Agreement in the face of the overwhelming influence of the US, EU and Japan. The power imbalance of negotiations is reflected by the fact that only about ten developing countries actually sent intellectual property experts to the TRIPS negotiations (Matthews 2002). TRIPS stipulates that by January 2005, all member states of the WTO must grant patents on all medicines for a period of 20 years. Whereas patents were previously granted by governments on a country-by-country basis, there is now a single and standard patent agreement that applies to all countries. A particular concern is the potential impacts on countries, such as India and China, that are important sources of generic medicines, including antiretrovirals. There is presently a campaign against the amendment to Indian patent 104
7 Selling medicines at the back of a bus. law which will potentially destroy the generic drugs manufacturing capacity in India (Sen Gupta 2005). A degree of flexibility has been built into TRIPS, following intensive lobbying by civil society and some developing country governments. This led to Medicines 105
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About this book Today’s global he
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Global Health Watch 2005-2006 An al
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Contents Boxes, figures and tables
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C2.1 The facts about disability 180
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Illustrations 1 Medicine cannot dea
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Acknowledgements The following indi
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London School of Hygiene and Tropic
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Victoria, Canada; Centre for Health
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Foreword New reports on different a
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Introduction Origins The Global Hea
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Child malnutrition, death and disab
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Human rights and responsibilities A
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impacting on health. The Watch hope
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part a | Health and globalization T
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Health and globalization | A1 and h
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Health and globalization | A1 in 20
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Health and globalization | A1 is gl
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Health and globalization | A1 peopl
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Health and globalization | A1 numbe
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Health and globalization | A1 and p
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Health and globalization | A1 econo
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Health and globalization | A1 Box A
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Health and globalization | A1 half
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Health and globalization | A1 appro
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table a1 Key health concerns with W
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Health and globalization | A1 Healt
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Health and globalization | A1 merci
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Health and globalization | A1 thems
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Health and globalization | A1 Even
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Health and globalization | A1 • A
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Health and globalization | A1 non-v
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Health and globalization | A1 27-28
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Health and globalization | A1 Jenki
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Health and globalization | A1 Satte
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Health and globalization | A1 WHO (
Page 72 and 73: and regulatory authorities mandated
Page 74 and 75: Health care systems | B1 4) selecti
Page 76 and 77: Health care systems | B1 • And si
Page 78 and 79: Health care systems | B1 • declin
Page 80 and 81: Health care systems | B1 user charg
Page 82 and 83: Health care systems | B1 focus on t
Page 84 and 85: Health care systems | B1 for health
Page 86 and 87: Health care systems | B1 their cont
Page 88 and 89: Health care systems | B1 health car
Page 90 and 91: Health care systems | B1 ing servic
Page 92 and 93: Health care systems | B1 Box B1.7 G
Page 94 and 95: Health care systems | B1 many of th
Page 96 and 97: Health care systems | B1 the lack o
Page 98 and 99: Macro-economic factors Impoverished
Page 100 and 101: Health care systems | B1 HALE 2000
Page 102 and 103: Health care systems | B1 But improv
Page 104 and 105: Health care systems | B1 high-incom
Page 106 and 107: Health care systems | B1 Structural
Page 108 and 109: Health care systems | B1 the high t
Page 110 and 111: Health care systems | B1 and histor
Page 112 and 113: Health care systems | B1 norms (Loe
Page 114 and 115: Health care systems | B1 Foster M,
Page 116 and 117: Health care systems | B1 Toole M et
Page 118 and 119: B2 | Medicines Introduction Essenti
Page 120 and 121: Health care systems | B2 of new med
Page 124 and 125: Health care systems | B2 the fourth
Page 126 and 127: Health care systems | B2 agenda thr
Page 128 and 129: Health care systems | B2 nonetheles
Page 130 and 131: Health care systems | B2 decision o
Page 132 and 133: Health care systems | B2 for the an
Page 134 and 135: Health care systems | B2 expenditur
Page 136 and 137: Health care systems | B2 Medawar C
Page 138 and 139: Health care systems | B3 between he
Page 140 and 141: Severe shortage Low density Moderat
Page 142 and 143: Health care systems | B3 sector and
Page 144 and 145: Health care systems | B3 to the US,
Page 146 and 147: Health care systems | B3 500 400 30
Page 148 and 149: Health care systems | B3 have been
Page 150 and 151: Health care systems | B3 to underta
Page 152 and 153: B4 | Sexual and reproductive health
Page 154 and 155: Health care systems | B4 10 Policy-
Page 156 and 157: Health care systems | B4 women and
Page 158 and 159: Health care systems | B4 of funding
Page 160 and 161: Health care systems | B4 debate on
Page 162 and 163: Health care systems | B4 the sexual
Page 164 and 165: Health care systems | B4 perspectiv
Page 166 and 167: Health care systems | B5 genome res
Page 168 and 169: Health care systems | B5 drugs base
Page 170 and 171: Health care systems | B5 Complete f
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Health care systems | B5 when a tes
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Health care systems | B5 are allowi
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Health care systems | B5 of life sc
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part c | Health of vulnerable group
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Health of vulnerable groups | C1 me
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Health of vulnerable groups | C1 pr
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Health of vulnerable groups | C1 Th
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Health of vulnerable groups | C1 Ca
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Health of vulnerable groups | C1 Bo
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Health of vulnerable groups | C1 Pa
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Health of vulnerable groups | C2 DP
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Health of vulnerable groups | C2 di
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part d | The wider health context T
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D1 | Climate change Introduction En
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increasing quantities are now causi
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development, local availability foo
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14 Droughts threaten the food secur
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Protocol can meet their targets by
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15 Transport and travel are major d
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• Redesign trade rules. Governmen
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D2 | Water Access to enough clean w
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water consumption worldwide. Each p
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table d2.1 Top corporate players in
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16 Protesting against the privatiza
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Box D2.3 Regulating private water c
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The private sector overestimates th
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Box D2.7 US citizens told to boil t
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to water. Worse still, it does this
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References Barlow M, Clarke T (2002
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D3 | Food Undernutrition is by far
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Functional and Productive Capacity
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table d3.1 Corporate control of US
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keting and processing means that sm
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average Indian family of four reduc
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Bank’s US$ 93.5 million loan to C
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Avery N, Drake M, Lang T (1993). Cr
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D4 | Education Some 135 million chi
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ledge about health-care practices a
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2005, and on present trends about 4
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Box D4.3 Programmes that aim to emp
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• per capita public spending fall
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unable to recruit 9000 badly needed
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Gordon D et al. (2003). The distrib
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D5 | War War has an enormous and tr
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19 Chechnya destroyed. War has wide
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initiated a ‘war on terrorism’.
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an explosive force equivalent to ab
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the risk of their misuse and divers
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Box D5.3 An agenda for peace The Ha
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Machel G (1996). Impact of Armed Co
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part e | Holding to account: global
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E1 | World Health Organization The
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The sources consulted worldwide in
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Box E1.1 Milestones in WHO history
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aised by his attempts to revitalize
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• stronger internal focus on perf
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21 WHO - up in the clouds? Reaction
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in favour of so-called ‘vertical
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to speak openly, while bullying and
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velop a unified, purposeful health
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to medicines, and the mobilizing ro
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Recommendations WHO’s core purpos
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doctors, and more people with exper
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E2 | UNICEF In 2005, Carol Bellamy,
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In sum, for almost a decade, childr
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prompted a global debate on how to
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E3 | The World Bank and the Interna
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22 World Bank: the centre of world
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approach to conditionality is being
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tal policies should explicitly refe
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E4 | Big business This chapter deal
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23 The Marlboro Man was described b
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dedicated funding [Articles 5.6 and
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grass roots in building government
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24 A pack of Cerelac cereal food pu
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USAID has also funded work on breas
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(from whatever its source, and howe
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These trends in taxation are underp
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Norway Denmark Netherlands Luxembou
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Global aid trends - allocation Wher
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weapons, vehicles and military trai
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table e5.1 Value (in £) of new DFI
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OECD (2005). Development Co-operati
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25 Breaking the chains of debt: pro
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Box E6.1 Zambia: inflation or death
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have met the Fund’s conditions, a
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E7 | Essential health research Rese
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Developing national health research
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for African Medical Editors (Certai
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Neither the consultations leading u
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Box E7.4 Asking the social-politica
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• global architecture for health
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part f | Conclusions Global Health
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current debt relief mechanism - the
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agreement, and taking health and he
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ity of the now-developed countries
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tion and water are experiencing sim
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