If you listened closely, you might have heard a collective sigh of relief following the World Trade Organization meeting in Doha, Qatar, in mid-November.
The 142 member countries knew that any progress on a new round of global trade talks could founder on a single contentious issue — patent protection. But in a surprising twist, the meeting may have produced the most significant public health event of the year, perhaps of the decade: an agreement that allows poor countries to make or import generic versions of the patented drugs they need.
The Trade-Related Aspects of Intellectual Property Rights rules, which guarantee 20-year patents on medicines, have been contentious for years. Developing countries argue that they make it nearly impossible for them to get the drugs needed to deal with HIV and other epidemics. For poorer countries, increased access usually means making cheaper knock-off versions of drugs or importing them from countries that do make them. Neither practice is viewed with much enthusiasm by the industrialized countries, where most of the research and manufacturing is done.
But both northern and southern countries seem to agree on one thing — that drug patents are key obstacles for poor countries. With an estimated 25 million HIV-infected people living in Africa amid crumbling or nonexistent public health systems, the drugs and the means to deliver them — trained physicians and clinics — are both in short supply.
The Doha agreement surprised many observers. “This would have been unthinkable 6 months ago, or 6 weeks ago, or even 6 days ago,” said Ellen 't Hoen of Médecins Sans Frontières, one of many groups pushing for expanded access to essential drugs.
The main difference this year was the different landscape that existed after Sept. 11, when Western governments suddenly had to deal with public health fears of their own. For instance, threats by Canada and the US to override patents on Bayer's Cipro in order to stockpile drugs to counter a perceived bioterrorism threat had all the earmarks of a double standard: telling poor countries that they couldn't act in a similar way in the face of the AIDS epidemic would be hypocritical.
History may show that the Doha declaration began an unprecedented end to restricted access to essential drugs and that it embodied principles benefiting both drug companies and the developing world. Observers say the declaration will be deemed a success if it leads to what both of these parties say is needed: easier access to the tools needed to end the poverty and hopelessness that give rise to infectious disease and to ensure health for all.
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