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Updated On: Monday, November 20 2017

Azevêdo: International community must work together to fulfil the right to health

Content by: World Trade Organization
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Excellencies,
Ladies and gentlemen,

Good morning – and thank you for inviting me to join you today.

The constitution of the World Health Organization stresses that enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.

I want to take this opportunity to explain how the World Trade Organization contributes to realising that right.

I know that the perception among some will be that the WTO is – at best – an observer in this conversation. Or – at worst – that global trade rules put commercial interests above health needs.

But this is not the case. I believe the WTO has a constructive role to play. And so I want to address this perception today.

Historically a lot of attention has been paid to the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights – the TRIPS Agreement – and understandably so.

The Agreement has been the focus of human rights discussions for many years. But the starting point for any conversation on the TRIPS Agreement should focus on how it can work to achieve its objective. And that objective is to promote both innovation and also the transfer and dissemination of new technologies to the community at large. If this desired balance is achieved, we would have a mutual benefit to both IP right holders and society - it would not be a zero-sum trade-off.

This is a critical concern in the area of medicines and medical technologies. Innovation is vital – we remain in constant need of new treatments as diseases evolve. But innovation without effective and equitable access to medicines is of little use to those in need of treatment. Without proper access to medicines, innovation is pointless.

Therefore the Agreement provides for protection of legitimate new pharmaceutical inventions, while also working to promote access to medicines. It is mandatory, for example, that patent holders fully disclose how to make their inventions work in practice, so that others may immediately implement the patented invention.

The Agreement also explicitly provides a number of exceptions and limitations. It recalls that patent rights are not absolute and can be curtailed to safeguard the public interest.

And it stresses that all this should be done "in a manner conducive to social and economic welfare, and to a balance of rights and obligations".

So, it is all about striking this delicate balance.

On the one hand we must ensure fair access to medicines, while on the other we need to continue supporting the necessary innovation to stimulate new breakthroughs.

So of course the TRIPS Agreement is the basis for much of our work here. But actually the WTO has gone much further to improve access to much-needed medicines.

The 2001 Doha Declaration on the TRIPS Agreement and Public Health was a major milestone.

The trade ministers of the world came together in Doha and recognized the gravity of public health problems afflicting developing countries. They stressed that the TRIPS Agreement had to be part of a wider national and international effort to address those problems.

This declaration sent a strong political signal that public health policy is a central concern for intellectual property and trade rules. Since then we have worked with our sister agencies towards greater policy coherence and close collaboration on public health issues. This 'coherence agenda' clearly includes recognition of the profound significance of the human rights dimension.

And in fact the Doha Declaration led to the first ever legal amendment to WTO trade rules.

It is significant that the WTO's first amendment was not about pursuing trade opportunities or market access. Rather, its aim was to enhance access to medicines in the most vulnerable countries.

Under the previous system, the rules restricted how generic medicines that were produced under compulsory licences could be exported.

So if you couldn't produce the medicines domestically, the rules made access to medicines under compulsory licensing quite difficult.

This meant that the poorest could face the biggest hurdles in accessing essential drugs.

The amendment gave legal certainty that generic medicines can be produced under compulsory licences expressly for export to countries with no pharmaceutical production capacity – or those with limited capacity.

And it ensured that those medicines can be imported in satisfactory quantities.

In this way, it created a new tool to help some of the most vulnerable people suffering from diseases such as HIV/AIDS, tuberculosis or malaria, along with other public health problems afflicting the developing world.

This amendment was agreed in 2005. But when I became Director-General in 2013 – eight years later – it still hadn't entered into force. And it didn't look like it was going to for a very, very long time.

So I made this a priority.

It was the African Group of WTO members who had fought for and won this amendment. And so, with those (and other) members we launched a campaign to put the amendment into force.

And this required acceptance from two thirds of the WTO's 164 members. In 2013 we still had a long way to go to cross the finish line.

We worked very hard to raise awareness of this issue and push governments to act. As a result, 43 new acceptances were filed since then.

And I'm very happy to say that in January this year, we were successful – we finally crossed the threshold required for entry into force.

It was a big moment – and now members may use the amendment as a practical procurement tool.

While these issues around intellectual property have been central to the debate, notably in the human rights community, there is a range of other linkages between trade and health; there is a range of ways that we have been working on to ensure that trade in medicines flows as freely and as fairly as possible.

Actions to reduce costs and delays of shipping medicines internationally are particularly important.

For some LDCs, the average distance that their imported medicines travel exceeds eight to ten thousand kilometres.

World Bank figures tell us that on average it costs Sub-Saharan African countries around 1,000 US dollars to import a container. That's seven times higher than the average for high income countries.

Procedural delays take 250 hours on average for Sub-Saharan Africa, rising to almost 1,500 hours in some cases. In contrast, for most high income countries it’s in single figures only - so just a few hours.

These trade costs and delays translate directly into barriers to access medicines.

For this reason, the WTO's recent Trade Facilitation Agreement will play an important role in easing access to medicines.

This Agreement targets the costs and delays I just mentioned in a very practical way. It helps the poorest the most. And it ensures that support will be provided to those countries that need help in implementation.

The Agreement even contains clauses on perishable goods. So this covers many medicines, such as vaccines with limited expiration dates.

It is also important to look at the effect of tariffs on access to medicines.

Such tariffs can affect the medicines themselves or the ingredients that go into them. They can hike up costs at an early stage in the production and distribution of medicines. These costs are then amplified as medicines pass through the chain of procurement.

The WTO provides a legal framework for members to cut tariffs on medicines in a non-discriminatory way. In fact, a number of members have agreed to eliminate such tariffs entirely.

I do not suggest, of course, that these trade-related measures are sufficient in themselves, or that they offer an alternative to other urgently needed interventions and initiatives. But trade can and must play its part, at the policy level and in practice.

Our close cooperation with WHO and WIPO is essential here. So too is our cooperation with the wider UN family towards meeting the Sustainable Development Goals.

There can be no higher calling for the international community than to work together to fulfil the right to health.

It is a priority for us all – and that includes the WTO.

We will continue doing all we can to ensure that trade supports the fulfilment of this right.

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