One result of the WTO Ministerial Conference in Doha was a declaration on Trade Related Intellectual Property Rights (TRIPS) and Public Health. The Declaration could have great significance for the Greater Caribbean in its fight against AIDS and other epidemic diseases. Consider the experience of AIDS vs. Anthrax in terms of the impact of TRIPS on the public health response.

The TRIPS Treaty of 1994 forms part of the agreement setting up the WTO. One effect is to oblige developing countries to respect patents held by transnational companies, while allowing for special exemptions in cases of emergency.

South Africa has been arguing that it has an AIDS emergency. Some 5.3 million people  are HIV positive, over 10 percent of the population. In sub-Saharan Africa as a whole, 25 million people are infected.

Patented drugs are available to slow the advance of AIDS, at a cost to the individual patient of US$10,000-$15,000 per year. Cheaper generic substitutes can be manufactured at one-hundredth of the cost.

So the South African government passed a law in 1997 to allow the cheaper drugs to be imported and/or manufactured. Its legality was immediately challenged by 39 international drug companies, citing the TRIPS agreement.

In April 2001, after a huge campaign mounted by the South African government, AIDS activists and NGOs, the drug companies withdrew their opposition to the Act.  Time elapsed: four years. AIDS-related deaths in South Africa are estimated at 139,000 per year.

It took less than one month after the emergence of the recent anthrax scare in the U.S. for the manufacturer of Cipro, the leading antidote, to agree to halve its price to the government in the interest of public health. Canada went further and licensed the manufacture of a generic substitute, effectively suspending the Cipro patent on the grounds of a national health emergency. No one has legally contested the Canadian action.

So far there have been five confirmed deaths from anthrax in the US and none in Canada.

>Double standards, or differential application? The Doha declaration on TRIPS and Public Health marks a significant advance by way of clarification. It states that each WTO member has the right to grant compulsory licenses (which allow generics to be manufactured), the freedom to determine the grounds upon which such licences are granted, and the right to determine what constitutes a national emergency, “it being understood that that public health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics, can represent a national emergency or other circumstances of extreme urgency”.

The Caribbean sub-region (independent islands, Guyana, Suriname and Belize) has the highest incidence of AIDS after sub-Saharan Africa. Of 34 million people, 460,000 are believed to be infected. 

But most countries lack the manufacturing capabilities in pharmaceuticals that are needed to make effective use of compulsory licensing. They would need to engage in “parallel importing” perhaps making special arrangements with suppliers in countries like India and Cuba, which have technological capabilities in this area.

The Doha Declaration recognizes that most developing countries face this problem. It instructs the TRIPS Council to find an expeditious solution and to report to the WTO General Council on the matter by the end of 2002. 

If the Greater Caribbean wants to use the Declaration to help strengthen its campaign against AIDS and other epidemic diseases, it will need strong representation in the TRIPS Council in the coming months.

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Prof. Norman Girvan is Secretary General of the Association of Caribbean States. The views expressed are not necessarily the official views of the ACS.