No deal in sight on cheap drugs for poor countries

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:465
  1. Fiona Fleck
  1. Geneva

    Trade talks broke down last week after the United States, under pressure from its powerful pharmaceutical lobby, rejected revised proposals to give poorer nations access to cheap, lifesaving drugs.

    It was the second time negotiators from the 144 member nations of the World Trade Organisation (WTO) tried to rescue a deal after the United States blocked it in December, forcing member nations to miss their deadline for agreement at the end of 2002.

    The deal is aimed at saving the lives of millions of people in poor developing countries with illnesses such as AIDS, malaria, and tuberculosis who die each year because their countries cannot afford the drugs needed to treat them.

    Diplomats said it was unlikely that a compromise would be reached before September, when WTO trade ministers gather in Cancun, Mexico, for their biennial meeting, because agreement is probably now only possible on the highest level.

    “If it hadn't been for the US there would have been a solution that would have satisfied everyone else long ago, but now positions have become entrenched,” said a UN official who was close to the talks.

    Diplomats said that further delay will cost millions more lives and could fuel anti-globalisation protests such as those seen at the WTO Seattle meeting in 1999.

    “If they [the Unites States] wait until Cancun it will become a politically explosive issue and they will run the risk of raising public opinion against them,” said Faizel Ismail, the head of South Africa's delegation to the WTO.

    The United States has faced widespread criticism for blocking the deal, but diplomats say some other countries with big pharmaceutical industries, such as Switzerland, Germany, and France, were secretly relieved that the deal did not go ahead in its current form.

    Meanwhile developing countries with generic drug industries, such as India and Brazil, have also been criticised for blocking a compromise with the United States.

    At issue are the drug patents that protect pharmaceutical companies' multimillion pound business. Trade ministers of WTO member nations agreed at their last meeting—in September 2001 in Doha, Qatar—to waive patents under certain circumstances so that cheap generic copies of such drugs could be produced which poor countries could afford.

    Under the Doha Declaration, a country that could not afford to pay market prices for such drugs may issue “a compulsory licence” compelling a patent holder to license a producer to manufacture cheaper generic versions of the patented product. The producer could be based in the licensing country but would usually be in another developing country with the capacity to manufacture drugs, such as India, Brazil, or China.

    Washington fears that drugs produced under compulsory licence for poor countries may be diverted to richer, more developed countries to undercut drug markets—something most countries argue is hypothetical and should be handled separately if it happens.

    But the chief sticking point is Washington's fear that poor countries might abuse the system and issue compulsory licences on lifestyle drugs, such as sildenafil (Viagra), or on drugs for non-infectious illnesses such as diabetes or asthma.

    The United States wants the deal to be limited to 17 of the world's “worst” epidemic diseases. Developing countries reject this, saying it is impossible to predetermine which are the “worst” and insist they should be allowed to decide public health priorities for themselves. A proposal for the World Health Organization to decide whether a poor country qualified for this status has also been rejected.

    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to to receive unlimited access to all content on for 14 days.
    Sign up for a free trial