The Trans-Pacific Partnership and Access to Medicines
“Owning Ideas” has been on hiatus for the past few weeks as we worked out some editorial procedures for the Rock blog. But, now that that’s taken care of, like Frank Costanza…
The big political news over the past few weeks has been the shutdown of the federal government. One of the small footnotes to this latest national political circus was the cancellation of a scheduled trip President Obama was going to make to the Asia-Pacific Economic Cooperation (APEC) Summit, which concluded Oct 7. This may not seem like a very consequential event overall, just the sort of trip that presidents always make. But in fact it comes in the middle of a very interesting time for US-East Asia relations. After years of negotiations, talks over a proposed regional trade agreement, the Trans-Pacific Partnership (TPP), are set to conclude at the end of the year. The TPP is an example of a general trend towards regional trade agreements (as opposed to the process of multilateral, global trade liberalization that created the World Trade Organization, but has stalled over the previous decade.) If it goes through, the TPP will be the largest regional trade deal ever struck, with huge economic consequences for its signatories. And due to some controversial intellectual property provisions, introduced at the behest of the United States, it may have huge consequences for the health of millions of residents of developing countries in East Asia.
How can a trade agreement affect the health of millions of people a world away? The short answer is: by restricting manufacture and sale of generic versions of essential medicines, such as drugs that treat malaria and tuberculosis, and anti-retroviral medication for the treatment of HIV/AIDS. Patents on these sorts of drugs give their holders exclusive rights to make and market them, for the duration of the patent. This means that the holder of a pharmaceutical patent can charge very high prices for the drug, because there is no competition from other manufacturers. When the patent expires, generic drug manufacturers can then step in and make versions of the drug, which usually results in a decrease in price.
The TPP has the potential to dramatically impact the health of residents of signatory countries because it contains a number of controversial provisions to strengthen pharmaceutical patents on essential medicines. What’s more, these provisions run counter to what has been the growing trend in international trade policy to loosen regulations on essential medicines, a trend that began with the now-legendary Doha Declaration of the WTO in 2001. For this reason, groups such as Doctors Without Borders, as well as members of Congress, have expressed concern over the intellectual property provisions in the TPP.
The controversy over the TPP is merely one illustration of a general problem, possibly one of the most serious ethical problems of our time – the lack of access to life-saving medicines in developing countries, which contributes to millions of deaths a year. That “millions” is not an exaggeration. Lower respiratory infections, HIV/AIDS, malaria, tuberculosis, and chronic diarrheal diseases are all among the top ten causes of death for residents of low-income countries, and are all treatable (or curable) with adequate medication. For example, chronic diarrheal diseases due to common infectious agents like rotavirus are a leading cause of death of children in developing countries, but in the United States and other developed countries are easily treated with medications on hand in every doctor’s office.
It should be obvious that, if the existence of patent protections on pharmaceutical products is responsible for this level of harm, then we should all have serious doubts about the morality of granting pharmaceutical patents for drugs that treat diseases like malaria, and especially about extending these protections into poor and developing countries. On the other hand, the economic benefits of trade agreements like these are substantial, especially for countries that are net exporters and through the agreement gain access to markets in rich countries (like the United States) for their goods. Figuring out what to do about the TPP thus requires a complicated (and tragic) discussion about how to balance different sorts of harms and benefits (economic benefits vs. harms to health, long term gains in welfare vs. short term lossess through lack of access to medicines, benefits to future generations vs. harms to presently living persons.) This is an enormously complex topic, and one that I will revisit again in this series. There are very few other topics involving intellectal property that are as significant, ethically speaking.
(NB: Due to some changes in the editorial procedures for the Rock blog, ‘Owning Ideas’ is converting from a weekly series to an occasional (ideally, every other week) one. I will be extending it throughout the year, though, so same amount of total posts, just spread out over a longer period of time.)