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Moyeen Khan: a rebel with a cause

He publicly trounced Bangladesh's strategy to reduce poverty before several top officials who helped draw it up. Now Bangladesh's controversial government minister Dr Moyeen Khan explains why.

Behind closed doors at the World Trade Organization, delegates called for time out in March from a 15-month diplomatic fight over drugs and public health. They have already missed their December deadline to end the wrangle – with African and other developing countries in one corner fighting for greater access to medicines, and the United States in the other keen to protect its pharmaceutical industry from a drop in profits.

The delay has left many delegates frustrated and worried about what this will mean for the millions who are too poor to afford essential medicines. The WTO's 40 African members are particularly concerned, having experienced the worst public health problems in recent years.

"More people will be dying the longer we prolong a decision [on access to drugs]," Ambassador BG Chidyausiku of Zimbabwe and former coordinator of the Africa Group at the WTO, told the Geneva-based South Bulletin.

The Africa Group's position, strongly supported by Brazil, Thailand and India who produce cheap versions of patented drugs, is that "public health must take precedence over commercial considerations", says Khalid Sebdi, first secretary of the Moroccan mission in Geneva which is heading the Africa Group.

The talks revolve around exceptions to the WTO's Trade Related Intellectual Property Rights (TRIPS) agreement. Under the agreement all 146 WTO members must pass patent laws giving drug patent holders – usually Western pharmaceutical companies – the right to say where their drugs will be sold and at what price.

At the heart of the dispute is the so-called Doha Declaration, agreed in November 2001, which says governments faced with public health problems can allow local producers to take over a patent, produce a patented drug and sell it at affordable prices. The patent holder is paid a token sum.

The US wants countries to be allowed to use TRIPS exceptions only when they face health "emergencies" caused by a short list of specific diseases. The "compromise" list includes HIV/AIDS, malaria, ebola, dengue, tuberculosis, cholera and typhoid.

The Africa Group has the most at stake in these negotiations. According to the World Health Organization (WHO), half the population in sub-Saharan Africa has no access to essential drugs. Most medicines are bought privately, and the real cost of drugs is huge. The same treatment for tuberculosis represents 500 working hours in Tanzania, 20 in Thailand and just 1.4 in Switzerland.

"We want no more lists of diseases – Doha was very clear on that," says Sebdi.

South African delegate Faizel Ismail, citing the WHO, adds: "Any disease can become a major health problem."

According to Michael Bailey, senior policy advisor at Oxfam International, "It is the new patented drugs that are the big point of contention, for it is they that will help with heart disease and cancer."

In theory the TRIPS agreement already includes exceptions for countries to use during health "emergencies" but, as many African countries have learnt through bitter experience, the reality is very different.

One of the starkest examples of this was in 2001 when the US fought South Africa's decision to use TRIPS exceptions to import cheap Indian-made AIDS drugs. South Africa had five million people living with HIV/AIDS at the time.

What the Doha Declaration achieved was an acknowledgement that countries should be free to use the exceptions to protect their public health, and not only in times of emergency.

In an effort to break the WTO deadlock, French non-governmental organisation Médecins sans Frontières (MSF) is holding a major consultation at the end of April in Geneva. The goal is to take the discussion away from the WTO and entrust it to the WHO, where it could be carried on in terms of public health instead of trade and patent protection.

Ellen 't Hoen, coordinator for policy, advocacy and research in MSF's Access to Essential Medicines Campaign, says the WHO convention would establish the principle of access to essential drugs for all.

The WHO has already drawn up a list of "essential" drugs for each of its member countries, and any of these drugs would automatically merit special consideration, including exceptions to patent protection regime.

Ali Toufiq of Bangladesh, which co-ordinates the least developed countries at the WTO, dislikes the idea. "I doubt that this will produce the desired results," he says. In his opinion, the WHO is under the thumb of the pharmaceutical industry, which would influence the drafting of a convention and its implementation. The WTO, on the other hand, is "member driven", he says.

Developing country delegates at the WTO are holding their ground on another key trade issue: agriculture. On March 28 talks collapsed after developing countries insisted that Western members stick to their original agreement of cutting farm subsidies and opening up their markets to agricultural exports.

Most developing countries were reluctant to join the 2001-5 Doha round of trade negotiations – they felt they got a raw deal at the last round. In an attempt to get them on board, Doha was dubbed a "development round" by the WTO, with agriculture and access to drugs being central to the talks.

If the negotiators fail to resolve these two issues by 2005, the credibility of the WTO will be severely dented. The impact on people in sub-Saharan Africa could be far worse.

Chidyausiku of Zimbabwe says of the drugs negotiations: "If the problem that prevails today in sub-Saharan Africa were to be in Europe, the response to that problem would have been different. It smacks of racism by developed countries, that have the resources, towards those people who are dying."

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10/18/2006

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