Montréal statement on the human right to essential medicines

Cambridge Quarterly of Healthcare Ethics

Volumn 16, Issue 1, 2007, Pages 97-108

  Pogge, Thomas ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

CANADA; ECONOMICS; EDUCATION; HEALTH SERVICE; HUMAN; HUMAN RIGHTS; PATENT; REVIEW; STATISTICS;

EDUCATION; HEALTH SERVICES NEEDS AND DEMAND; HUMAN RIGHTS; HUMANS; INTELLECTUAL PROPERTY; QUEBEC;

EID: 33947395240     PISSN: 09631801     EISSN: 14692147     Source Type: Journal    
DOI: 10.1017/S0963180107070107     Document Type: Review

References (26)

1. As used in the statement and in the comment, the term medicines covers pharmaceuticals used for medical treatment or prevention (vaccines), and essential medicines are understood as those that can have significant effects on patients' basic functionings or survival prospects.
2. During the life of its primary patent, the patent holder can take out additional patents on a wide range of often trivial or irrelevant aspects of a successful drug, such as its packaging or dosing regimen. Having been applied for later, these additional patents outlast the primary patent. They ensure that, even after the primary patent expires, the patent holder retains the right to be notified by any firm planning to commence generic production of the drug. Once notified, the patent holder can then threaten or initiate legal action that, though it has no chance of ultimate success, can delay commencement of generic production by several years or even deter generic production altogether. See NIHCM Foundation. Changing pattern of pharmaceutical innovation; 2002. Available at: www.nihcm.org.
3. Among the pharmaceutical research tools for which patents have been granted are expressed sequence tags (ESTs), restriction enzymes, screening systems, techniques related to DNA sequencing, and single nucleotide polymorphisms (SNPs). For details, see Rai AK, Eisenberg RS. Bayh-Dole reform and the progress of biomedicine. Law & Contemporary Problems 2003;66(1):289-314 (also available at: www.law.duke.edu/journals/66LCPRai).
4. United Nations Development Program. Human Development Report 2005. New York: United Nations Development Program; 2005:24,44 (also available at: hdr.undp.org/reports/global/2005).
5. United Nations Development Program. Human Development Report 1998. New York: Oxford University Press; 1998:49.
6. World Health Organization. The World Health Report 2004. Geneva: WHO Publications; 2004:120-5 (also available at: www.who.int/whr/2004).
7. United Nations Children's Fund. The State of the World's Children 2005. New York: United Nations Children's Fund; 2005:inside front cover (also available at: www.unicef.org/sowc05/english UNICEF 2005).
8. World Bank. World Development Report 2006. New York: Oxford University Press; 2005: 292-3.
9. It may be inappropriate to use the expression "free riders" for very poor people who enjoy, at no cost to anyone, some public benefit. Kevin Outterson has proposed to speak here of "fair followers" instead. See Outterson K. Fair followers: Expanding access to generic pharmaceuticals for low- and middle-income populations. In: Cohen JC, Illingworth P, Schuklenk U, eds. The Power of Pills: Social, Ethical, and Legal Issues in Drug Development, Marketing, and Pricing. London: Pluto Press; 2006.
10. Editorial. India's choice. The New York Times 2005 Jan 18.
11. This pattern emerged in the United States after Congress, in 1980, passed the Bayh-Dole Act, which allows pharmaceutical companies, professors, and clinicians to cash in on patented applications of basic research done at universities or at the National Institutes of Health. For a brief account with further references, see note 3, Rai, Eisenberg 2003. See also Angell M. The truth about the drug companies. The New York Review of Books 2004;51(12):52-8 (also available at: www.nybooks.com/articles/17244)
12. and Light D. Basic research funds to discover new drugs: who contributes how much? In: Burke MA, de Francisco A, eds. Monitoring Financial Flows for Health Research 2005: Behind the Global Numbers. Geneva: Global Forum for Health Research; 2006:29-46.
13. Goozner M. The $800 Million Pill: The Truth Behind the Cost of New Drugs. Berkeley and Los Angeles: University of California Press; 2004. ch. 8;
14. Angell M. The Truth about the Drug Companies: How They Deceive Us and What to Do about It. New York: Random House; 2004, ch. 10.
15. White man's shame. The Economist 1999;Sept 25:89.
16. See note 13, White man's shame 1999.
17. This kind of relentless pressure goes a long way toward explaining why no poor country has ever tried to issue a compulsory licence for a patented medicine, despite the fact that such compulsory licences are theoretically permissible pursuant to paragraph 6 of the 2001 Doha Declaration.
18. This compares to about $80 billion the poor countries receive annually (2004) in official development assistance. See www.oecd.org/document/9/ 0,2340,en_2649_33721_1893129_ 1_1_1_1,00.html.
19. AIDS drugs and second-line tuberculosis medicines are prominent examples.
20. Global Forum for Health Research. The 10/90 Report on Health Research 2003-2004. Geneva: Global Forum for Health Research; 2004:122 (also available at: www.globalforumhealth.org).
21. Trouiller P, Torreele E, Olliaro P, White N, Foster S, Wirth D, Pécoul B. Drugs for neglected diseases: A failure of the market and a public health failure? Tropical Medicine and International Health 2001;6(11):945-51;
22. Drugs for Neglected Diseases Working Group. Fatal Imbalance: The Crisis in Research and Development for Drugs for Neglected Diseases. Geneva: MSF and Drugs for Neglected Diseases Working Group; 2001:11 (also available at: www.msf.org/source/access/2001/fatal/ fatal.pdf).
23. Pogge T. Human rights and global health: A research program. In: Barry C, Pogge T, eds. Global Institutions and Responsibilities. Oxford: Blackwell Publishers; 2005:190-217.
24. The absence of such incentives under the present rules gravely undermines the effectiveness even of donated drugs delivered into poor regions. See United Nations Development Program. Human Development Report 2001. New York: Oxford University Press; 2001:101 (also available at: www.undp.org/hdr2001).
25. This opposition was dramatically displayed when a coalition of 31 pharmaceutical companies went to court in South Africa to prevent their inventions from being reproduced by local generic producers and sold cheaply to desperate patients whose life depended on affordable access to these retroviral drugs. In April 2001, their attempted law suit collapsed under a barrage of worldwide public criticism. See Barnard D. In the High Court of South Africa, Case No. 4138/98: The global politics of access to low-cost AIDS drugs in poor countries. Kennedy Institute of Ethics Journal 2002;12(2):159-74.
26. I am assuming here that the contribution of the rich countries would be spread over some 200 million tax-paying households, which is roughly the number of households in the European Union. The contribution of typical tax-paying households in the rich countries would be much lower (under $25 per million premature deaths avoided), if all rich countries agreed to cooperate.