Deadlock on access to cheap drugs at global trade negotiations.

At the end of 2002, the United States rejected a compromise proposal aimed at giving developing countries without local manufacturing capacities access to affordable life-saving drugs. At a December meeting at the World Trade Organization (WTO) in Geneva, negotiators of several of the 144 WTO members expressed their regret about the failure to reach an agreement by the intended deadline, which was the end of last year. Eduardo Perez Motta, Chairman of the WTO Trade-related Aspects of Intellectual Property Rights (TRIPS) Council and author of the compromise proposal, even apologized to sufferers from diseases in the developing world for the failure to come up with a viable solution. Meanwhile, in an attempt to reinvigorate the stalled negotiations, European Union (EU) Trade Commissioner Pascal Lamy put forward another compromise solution. The bone of contention is the export of generic versions of drugs protected by patent to developing countries that lack manufacturing capacity to produce the generics themselves. At their fourth conference in Doha, Qatar, in November 2001, WTO ministers adopted a Declaration on TRIPS and public health. The agreement, usually referred to as the Doha Declaration, allowed poor countries to produce urgently needed drugs even if the drugs in question are under patent protection, a procedure known as compulsory licensing. Even back then, however, WTO negotiators admitted there was a shortcoming in the Doha Declaration: the contentious paragraph 6 the Declaration bluntly states that ‘‘members with insufficient or no manufacturing capacity could face difficulties in making effective use of compulsory licensing ... We instruct the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002’’. This is because, according to TRIPS guidelines, drugs made under compulsory licence are intended predominantly for the domestic market, that is, not for export. But the recent TRIPS Council meeting failed to deliver one, even though a compromise proposal, drafted and circulated by Perez Motta, was on the table. At the end of lengthy argument, theUnited States was the only country that refused to endorse the proposal. The US delegation considered the compromise — which did not restrict the range of diseases covered — to be too broad in scope, and insisted that instead the agreement should be limited to drugs forHIV/AIDS,malaria, tuberculosis and similarly infectious epidemics. According to a statement by the United States trade representative Robert Zoellick, issued on 20 December, such a focus on infectious diseases would reflect the original intentions of the Doha Declaration. That is not the way Ellen T’Hoen of Médecins sans Frontières (MSF) sees it. ‘‘Already in Doha the United States tried to limit the scope of diseases,’’ she pointed out. ‘‘None of those proposals of theirs made it through those negotiations. As a matter of fact, paragraph 4 of the Doha Declaration is very clear about this point: no limits [in terms of disease range]. In a way these attempts open up the whole Doha Declaration again.’’ For T’Hoen the latest developments represent a ‘‘tragic U-turn in the health–trade debate.’’ T’Hoen is not alone in her critique. Celine Charveriat of Oxfam says: ‘‘The fact that the European Union and the United States argued that developing countries should not have access to affordable generic drugs for asthma and diabetes, which kill and debilitate millions in these countries, proves that profits still come before people’s lives and that the WTO has powers totally beyond its competence.’’ The United States interpretation of the Doha Declaration also raised eyebrows at WHO. ‘‘Our understanding of the Doha Declaration is that it is fairly inclusive,’’ says Jonathan Quick, head of Essential Medicines at WHO. ‘‘The idea of either the WTO or the WHO having a single global list [of diseases] is difficult to reconcile with the changing and diverse epidemiology of the world.’’ That is why, in a statement on 17 Sep-