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Rising Powers, Emerging Markets: Implications of Multipolarity for Intellectual Property Rules, Access to Medicines and Global Health By Suerie Moon, MPA, PhD School of Public Health & Kennedy School of Government, Harvard University Global Health Diplomacy Network Conference
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Rising Powers, Emerging Markets: Implications of Multipolarity for Intellectual Property Rules, Access to Medicines and Global Health By Suerie Moon, MPA, PhD School of Public Health & Kennedy School of Government, Harvard University Global Health Diplomacy Network Conference Chatham House, London, 28 June 2011
Overview • Introduction • 1999-2010: How have middle-income countries (MICs) shaped global IP rules for health? • 2011-?: How will MICs shape the future global IP regime? • Access to medicines for NCDs • Conclusions: the challenge for global health diplomacy
1. Introduction: North-South politics of intellectual property • Pre-1994 international patents regime: • Flexible, with policy space for tailoring to country context • 1994 WTO TRIPS* Agreement • Harmonized to Northern standards, • Reduced flexibility, shrank policy space re: medicines patents • Critique: patent monopolies medicines prices ↑ • Critique: no R&D into diseases of the poor • Political bargain: IP protection for market access • North-South divide * World Trade Organization Agreement on Trade Related Aspects of Intellectual Property Rights
1. Introduction: North-South politics of access to medicines The Access to Medicines Crisis: • 1999-2001: global social reaction against TRIPS, triggered by HIV pandemic and high drug prices • 2001: WTO Doha Declaration: health before patents • 2002-2010: increased access to HIV medicines via more flexible approach to patent rules • By 2011, increased flexibility in: • Formal international law • Formal national laws • Informal rules and norms • Practices by governments (North & South) & companies
Figure 2. Overall ARV market share (volume) for Indian generic, non-Indian generic, and originator (brand) manufacturers, 2003-2008 Figure 4. Countries reporting purchases of Indian generic ARVs in 2008 Source: Waning, Diedrichsen, and Moon (2010)
Generic Competition and HIV Treatment Scale-Up $2700 $10,400 Source: Medicines Patent Pool, June 2011
2. How have MICs shaped global IP rules for health?: Strategies & Roles • Which countries?: Argentina, Brazil, Ecuador, India, Indonesia, Kenya, Malaysia, Philippines, South Africa, Thailand, Zimbabwe, others • Re-framing of IP from economic to social issue: • 1998: South Africa and World Health Assembly • 2001: Brazil & UN Human Rights Commission • Mobilization of normative power via global CSO networks • Mobilization of expert power via global expert networks • Exercise of state regulatory power • 2002, 2007, 2009 South African Competition Commission • Domestic factors in key MICs: • Civil society, Parliament, generics industry, Constitutional right to health • Multipolarity: MICs growing economic & political power
Economic power shifts Changes in export markets:
Economic power shifts Changes in export markets:
3. How will MICs shape the future global IP regime? 1999-2010: North v South • Re-framing of IP rules • Normative claims & shift • Mobilization of CSOs and expertise • Rise of multipolarity • Coattails effect for LICs/LDCs 2011- ?: Multipolar System • IP rules re-framed as social issue • Normative shift consolidating • Experts & CSOs networked • MICs ↑ economic power • MICs ↑ power in global rule-making • R&D capacity in some MICs ↑ • MICs as emerging markets ↑ • Health demands in MICS ↑ • Demands for global R&D burden-sharing ↑
Which way for the MICs on IP? • MICs ↑ economic power • MICs ↑ as global rule-makers • MICs ↑ health demands • Limited R&D capacity in most MICs • Demands for global R&D burden-sharing • R&D capacity in some MICs ↑ • MICs as emerging markets ↑ • Pharm industry consolidation • Demands for global R&D burden-sharing Stringent (eg TRIPS+, lengthened or strengthened monopolies) Flexible (eg compulsory licensing, strict patentability standards) Domestic Political Contests
4. Access to medicines for NCDs in MICs “Double burden of disease (CDs+NCDs)” in MICs ↑ Demand for healthcare & coverage ↑ NCD drugs w therapeutic advance = demands for access (price ↓) NCD drugs = market growth for industry (price ↑) Short-Medium Term Political Conflict: North + Patent-based industry vs MICs TRIPS Political Bargain Under Increasing Strain Medium-Long Term ?
4. Access to medicines for NCDs in HICs Demand for healthcare & coverage ↑ NCD drugs w therapeutic advance = demands for access (price ↓) NCD drugs = market growth for industry (price ↑) Medium-Long Term ?
5. Conclusions: The Challenge for Global Health Diplomacy Short-Medium Term: • Identifying solutions to access problems Medium-Long Term: to negotiate new global rules & institutional arrangements for: • Equitably sharing the global burden of financing medical R&D • Ensuring widespread, global access to new medicines • Providing sufficient, predictable resources for innovation that meets priority health needs • Investing resources efficiently • Amending or re-negotiating global rules that do not deliver the above. Ongoing: WHO Consultative Expert Working Group on R&D
5. Conclusions: Implications for the future • MICs can increasingly challenge IP rules that favor the North some protection for health gains & for LDCs/LICs • Domestic political contests in MICs over defining national interest; will health have a voice? • Ongoing North-MICs political conflict in foreseeable future • MICs will face growing expectations to contribute to R&D that benefits other/all countries. • MICs can shape alternative global arrangements for ensuring sufficient financing, equitable access, and needs-driven R&D • Challenge for all diplomats: negotiate a better global system for medical innovation & access in LICs, MICs, and HICs
