Sir--Your Jan 25 Editorial (p 269)
1 rightly
scrutinises the interests of the World Trade Organization (WTO). The
present dispute about whether developing countries can override
patent laws and import cheap generic drugs is a hypocritical
exercise of power by major pharmaceutical-producing countries. The
key principle of the WTO is non-discrimination, but this is exactly
what is being advocated.
All parties seem to accept that a country can compulsory
licence a product on public health grounds if they produce that
product in their own country. But if a country does not produce the
drug but imports it, because the country is small or poor, then the
more powerful countries will decide which conditions apply. This
situation is clearly discriminatory.
It should be remembered that the Agreement on Trade-Related
Aspects of Intellectual Property Rights has strict regulations to
make the issuing of a compulsory licence very demanding. These
regulations would still be in force irrespective of how a drug is
obtained--ie, by local production or importation. For developing
countries to accept the principle that the WTO could define which
health conditions could be subject to a compulsory licence would
compromise their national sovereignty.
The actions of the European Union, Japan, and the USA in
proposing a limited list of diseases that could be subject to
compulsory licences for importing countries, while retaining
absolute rights for themselves to compulsory license any product for
any disease, is a shameful act of hypocrisy. Although it is possible
that no compulsory licence will ever be issued, it is the
possibility of doing so that empowers countries to negotiate on
something like a level playing field. Take away this sovereign
national right from non-producing countries and they will be
powerless to resist exploitation.
Richard Laing
Department of International Health, Boston University School of
Public Health, Boston MA 02118-2526, USA (e-mail:richardl@bu.edu)
1 Editorial. Whose interests does the World Trade
Organization serve?
Lancet 2003;
361:
269.
Sir--Your Jan 25 Editorial
1 and the Viewpoint by
Michael Friedman and colleagues (Jan 25, p 341)
2 address
crucial issues about access to drugs in developing countries. In
rural parts of India, access to drugs is compounded by other factors
that make delivery of appropriate medical care difficult.
HIV-1 infection is a major health issue that affects the
rural population of India.
3 Although antiretroviral drugs
are available at a cheap rate, many treating doctors are not well
trained about appropriate use of these drugs and follow-up.
Furthermore, the cost of initial investigations deters most patients
with HIV-1 infection or AIDS from seeking appropriate treatment.
Efforts to provide cheap drugs to developing countries are to be
welcomed, but these countries should also make an attempt to provide
affordable investigation facilities.
In India, about 70% of the population live in rural villages.
But at primary health centres in villages, even simple
treatments--for example wound-dressing materials--are inadequate.
Furthermore, on admission to hospital, patients at times have to buy
such basic medical equipment as saline bottles and the intravenous
set. The only thing that is free is a bed on the floor and a stained
sheet.
The training of health-care professionals is another problem
in rural India. At many primary health centres, the posts of medical
officer are vacant. Poor salaries and inadequate resources mean that
clinicians do not want to join government health centres in rural
areas. Those health-care professionals who do work in villages are
often unaware of recent advances in the medical profession. Even
today, few medical officers know about the basic investigations and
treatments for HIV.
There are many non-governmental organisations and charitable
trusts throughout India. However, many such institutes seem to
benefit the trustees rather than public for whom tax free grants are
released. Despite large grants for HIV/AIDS, no HIV kit for testing
is available at primary health or cottage hospitals. Greater
transparency is needed to avoid corruption in so-called charitable
health institutes and organisations. Grants should not be released
to such institutes unless the contribution of trustees and
researchers is clear in the form of financial or practical support
for health initiatives or publication in peer-viewed
journals.
4
Facilities and opportunities provided by the World Trade
Organization, WHO, and other organisations to improve health care in
developing countries will only succeed if these countries tackle the
many issues that affect the health of a nation.
H S Bawaskar
Bawaskar Hospital and Research Center, Mahad Raigad, Maharashtra
402302, India (e-mail:himmatbawaskar@rediffmail.com)
1 Editorial. Whose interest does the World Trade Organization
serve?
Lancet 2003;
361:
269.
2 Friedman MA, Den besten H, Attaran A. Out-licensing: a
practical approach for improvement of access to medicine in poor
countries.
Lancet
2003;
361: 341-44. [
Text]
3 Bawaskar HS, Bawaskar PH. Clinical profile of HIV in rural
western Maharashtra.
J Assoc Physicians
India 2001;
49: 388-89. [
PubMed]
4 Kumar S. AIDS campaigner on trial for testing vaccine on
people.
Lancet 1999;
353:
1686.
