Health equity in economic and trade policies

Antibiotic Resistance in the Food Chain: A Developing Country-Perspective
Founou L; Founou R; Essack S: Frontiers in Microbiology, 2016, doi: https://doi.org/10.3389/fmicb.2016.01881

Food animals are considered as key reservoirs of antibiotic-resistant (ABR) bacteria with the use of antibiotics in the food production industry having contributed to the global challenge. There are no geographic boundaries to impede the worldwide spread of ABR, and limitations in the interventions in one country could compromise the efficacy and endanger containment policies implemented in other parts of the world. Multifaceted, comprehensive, and integrated measures complying with the One Health approach are argued to be imperative to ensure food safety and security, effectively combat infectious diseases, curb the emergence and spread of ABR, and preserve the efficacy of antibiotics for future generations. Countries are urged to follow the World Health Organisation, World Organisation for Animal Health, and the Food and Agriculture Organisation of the United Nations recommendations to implement national action plans encompassing human, (food) animal, and environmental sectors to improve policies, interventions and activities that address the prevention and containment of ABR from farm-to-fork. This review covers (i) the origin of antibiotic resistance, (ii) pathways by which bacteria spread to humans from farm-to-fork, (iii) differences in levels of antibiotic resistance between developed and developing countries, and (iv) prevention and containment measures of antibiotic resistance in the food chain.

Antibiotic Resistance in the Food Chain: A Developing Country-Perspective
Founou L; Founou R; Essack S: Frontiers in Microbiology, 2016

Food animals are considered as key reservoirs of antibiotic-resistant bacteria with the use of antibiotics in the food production industry having contributed to the actual global challenge of antibiotic resistance (ABR). There are no geographic boundaries to impede the worldwide spread of ABR. If preventive and containment measures are not applied locally, nationally and regionally, the limited interventions in one country, continent and for instance, in the developing world, could compromise the efficacy and endanger ABR containment policies implemented in other parts of the world, the best-managed high-resource countries included. Multifaceted, comprehensive, and integrated measures complying with the One Health approach are thus imperative to ensure food safety and security, effectively combat infectious diseases, curb the emergence and spread of ABR, and preserve the efficacy of antibiotics for future generations. The World Health Organisation, World Organisation for Animal Health, and the Food and Agriculture Organisation recommend implementing national action plans encompassing human, (food) animal, and environmental sectors to improve policies, interventions and activities that address the prevention and containment of ABR from farm-to-fork. This review covers (i) the origin of antibiotic resistance, (ii) pathways by which bacteria spread to humans from farm-to-fork, (iii) differences in levels of antibiotic resistance between developed and developing countries, and (iv) prevention and containment measures of antibiotic resistance in the food chain.

Are generic drug seizures to developing countries legal?
Mara K and New W: Intellectual Property Watch, 6 March 2009

Developing nations, led by Brazil and India, continue to press strong concern over seizures of legitimate shipments of generic pharmaceuticals destined for poor patients in the developing world. Brazilian Ambassador to the WTO, Roberto Azevêdo, told reporters that flexibilities developing countries have under WTO rules on intellectual property rights may be ‘jeopardised’ and that the possibility of a dispute settlement case was not ruled out. He said that as many as a dozen developing countries made statements in support of the concerns, and two of those countries spoke on behalf of the African Group and the Least Developed Countries group, each of which have dozens of members. However, the European Union denies any conflict with WTO rules in its efforts to catch shipments of counterfeits.

Are patents impeding medical care and innovation?
Gold ER, Kaplan W, Orbinski J, Harland-Logan S and Marandi S” PLoS Medicine 7(1), 5 January 2010

The international debate around patents has been largely framed in terms of ‘protection for’ versus ‘access to’ intellectual property (IP), according to this article. If the framing of the debate shifts to a focus on research and development, this is likely to strengthen the leverage of developing countries to change the dynamics of IP negotiations in trade agreements, the authors argue. In fact, shifting the entire debate from IP rights to the research and development (R&D) gap may help tackle the fundamental problem of a monopoly-based innovation and access system. One example is nonexclusive licensing practices, such as those used by the not-for-profit Drugs for Neglected Diseases Initiative. The initiative finances R&D up front and offers the outcome of its research on a nonexclusive basis to generic producers, allowing for technology transfer and competition among multiple producers. Furthermore, universities currently hold important patents on many life-saving drugs, which prompted Universities Allied for Essential Medicines to propose that when a university licenses a promising new drug candidate to a pharmaceutical company, it should require that the company allow the drug to be made available in low income countries at the lowest possible cost. Another alternative to overcoming current patent barriers is the use of patent pools, as proposed by the World Health Organization, Médecins Sans Frontières, and UNITAID. Here, a number of patents held by different entities, such as companies, universities, or research institutes, are pooled and made available to others for production or further development. The patent holders receive royalties that are paid by those who use the patents. The pool manages the licences, the negotiations with patent holders, and the receipt and payment of royalties, in a manner that facilitates access to medicines in low income countries. The author proposes that other innovative policy proposals, such as the Heath Impact Fund (a strategy to create a publicly funded ‘pot of gold’ that would attract the private sector to create R&D innovations that effectively address priority global heath needs), be implemented. However the author argues that using patents as the financial incentive to encourage the pharmaceutical industry to develop drugs for the world's poor is of limited use, given that the market is nonexistent as neither governments nor patients can afford the end product.

Are TRIPS protectionism at their worst?
Editorial: The Lancet 9555(369): 2, 2007

The article describes international campaigns that are trying to defend the access of poor people in the world to pharmaceuticals. Both campaigns are calling for the rules of a World Trade Organization agreement called Trade Related Aspects of Intellectual Property to be upheld. The pharmaceutical company Novartis is bringing the government of India to court for not granting a patent to the company for the cancer drug imatinib mesylate. India only grants patents for medicines that are new and innovative. The Government Pharmaceutical Organization of Thailand wishes to make a generic version of the drug efavirenz. The US government and the pharmaceutical company Merck believe that the Thai government should have asked Merck's permission first before developing the drug.

Asian countries set the trend for affordable generics
Khor M: Third World Network, 22 October 2012

Recent government actions by Indonesia and India to issue compulsory licenses will enable access to cheaper medicines in Asia to treat serious ailments, especially HIV and AIDS, cancer and hepatitis B. The supply of generic medicines, either through import or local production, has been the major method of reducing prices and making medicines affordable. In 2003, Malaysia became the first developing country to issue a compulsory license to a local firm to import medicines from India to treat HIV and AIDS, with Indonesia, Thailand and India following suit. In September 2012, Indonesia issued compulsory licenses to enable local manufacturers to make, import and sell generic versions of seven patented drugs used for treating HIV, AIDS and hepatitis B. The author suggests that countries in Africa follow this precedent.

Asian Peoples’ Tribunal on Poverty and Debt
International People\'s Forum versus the World Bank and International Monetary Fund (IMF)

This petition was prepared in time for the annual meeting of the IMF-World Bank, 19-20 September in Singapore. The Tribunal received a petition from peoples’ organisations, citizens groups, social movements and NGOs from various countries in Asia seeking justice for the impact of debt on the lives, livelihood and well-being, human rights of the peoples of Asia, on the environment, ecological systems, economies and political affairs of many countries in the region. The same petition charges the IMF, World Bank (WB) and ADB of responsibility for the intensification of poverty and deprivation, violation of basic human rights, in addtion to other faults. By so doing, signataries hope that they will be compelled to review their actions and calculate and quantify the damages wrought by their policies or people.

Assessing regional integration in Africa 3: Towards monetary and financial integration in Africa
Economic Commission for Africa: 2008

From the 1960s to the present, many African integration groupings have emerged and faded away. Within the various integration groupings, the development of trade has been a major objective pursued through programmes aimed at achieving a free trade area, a customs union and a common market. But outcomes of decades of experimentation with integration in Africa have on balance remained modest. For instance, African trade statistics continue to paint a generally modest picture of trade between regional economic communities (RECs), as well as intra- African trade. The countries generally lack a strong industrial capacity to produce diversified manufactured goods for trade within regional markets. Many of the multiple national currencies in Africa lack convertibility and efforts towards monetary, financial and physical integration have not been very promising. The cost of doing business in the continent is generally high, due in part to infrastructure gaps, duplicative border procedures and cumbersome paper requirements. Paperless trade still remains a distant objective. The free movement of people and the right of establishment have progressed in some RECs, but remain a paper objective in many other African subregions.

Assessing regional integration in Africa III
Economic Commission for Africa: 2009

Macroeconomic stability, monetary and financial integration are crucial for successful regional cooperation and integration. Both processes make decisive contributions to the creation of a conducive environment for economic growth, promotion of trade and boosting of investor confidence, hence the importance of pursuing prudent fiscal, monetary, exchange rate and debt policies at the national level and of harmonising these policies at the subregional and regional levels. Arguably, these policies should be situated within the socio-political, technological and international development setting of the countries, and indeed of the continent at large. The strengthening and deepening of the financial sector, including the establishment of vibrant capital markets, will also greatly facilitate the flow of funds and help anchor macroeconomic policies. Moreover, strong national and subregional capital markets would play a catalytic role in attracting foreign direct investment and promoting cross-border investment flows. This report also provides a brief ‘progress report’ on the developments in Africa’s regional integration.

AU Health Ministers Meeting speaks out on TRIPS

An AU Health Ministers meeting was held in Gaborone, Botswana 13-14 October 2005. On TRIPS, the final statement of the meeting said:
- UNDERTAKE to pursue, with the support of our partners, the local production of generic medicines on the continent and to making full use of the flexibilities in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPs) and the Doha Declaration on TRIPS and Public Health;
- CALL UPON our Ministers of Trade to seek a more appropriate permanent solution at the WTO that revises the TRIPS agreement and removes all constraints, including procedural requirements, relating to the export and import of generic medicines;
- CALL UPON Member States and Regional Economic Communities to ensure that TRIPS plus provisions which go beyond TRIPS obligations are not introduced in bilateral / regional trade agreements or in economic partnership agreements.

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