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	Will the UN backtrack on accessible medicine for all? by James Love, Nicholas Freudenberg Corporations and Health Watch   Will the UN backtrack on accessible medicine for all, by James Love.   The US and Europe are pushing the UN to flout the Doha Declaration, which improves poorer countries access to drugs.   In September, the United Nations convenes a high-level meeting to consider the "international aspect of public health" for non-communicable diseases (NCDs), with a particular focus on the social and economic impacts for developing countries.   The UN has been praised for undertaking this initiative, and there is considerable support for giving attention to the growing burden of cancer, diabetes, heart disease and other non-communicable diseases, not only in high-income countries, but everywhere. However, some of the issues are controversial, including those relating to intellectual property rights for new medicines, diagnostics and medical devices.   Last week, details of the negotiations were leaked that reveal the UN declaration on NCDs will be used to attack a ten-year-old agreement on intellectual property rights and public health.   The controversy involves the November 14, 2001, World Trade Organisation (WTO) Doha Declaration on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and public health.   Among other things, the Doha Declaration effectively gave WTO members more flexibility in designing patent and other intellectual property rules, and said that WTO members "should" implement their laws "in a manner supportive of WTO members right to protect public health and, in particular, to promote access to medicines for all".   This agreement was also the basis for subsequent changes in WTO rules on patents that allowed medicines to be exported to countries that lack local manufacturing capacity, and that deferred obligations to enforce pharmaceutical patents in the world"s least developed countries.   Big pharma and the Doha Declaration   In 2001, big drug companies bitterly fought the Doha Declaration, but the Bush Administration, reeling from 9/11 wanted to build bridges with the international community, and so accepted strong language on public health.   The Doha Declaration came about during a period of great concern over access to patented AIDS drugs. During both the 2001 negotiation and a follow-up WTO negotiation in 2002-2003, Pfizer, Merck, Abbott, and other big drug companies and their lobby groups - such as the Pharmaceutical Research and Manufacturers of America (PhRMA), the International Federation of Pharmaceutical Manufacturers & Associations, and the European Federation of Pharmaceutical Industries and Associations - tried to narrow the Doha Declaration to AIDS and a handful of other infectious diseases, or to exceptional public health emergencies.   The PhRMA position was decisively rejected in the WTO negotiations. Legally, the 2001 Doha Declaration, and subsequent amendments to TRIPS, applies to any disease. But in practice, the perceptions are as important as the legal reality. By continuing to assert that the Doha Declaration is in fact limited in various ways, US and European trade negotiators have tried to discourage the granting of compulsory licenses on patents for high-priced drugs for cancer and other non-communicable diseases.   The term "compulsory license" is used to describe cases in which governments or courts set aside the exclusive rights of a patent, and allow others to use inventions, normally in return for a royalty payment to the patent owner. In such cases, the patent is no longer an absolute monopoly to use the invention, but does ensure that patent owners are paid when the inventions are used by third parties..   The UN is being asked to backtrack from an important agreement to put "access to medicine for all" at the centre of trade policy. This comes at the same time that the United States and Europe are involved in all sorts of regional and bilateral trade negotiations that ratchet up intellectual property protections, making it harder to obtain affordable generic medicines.   Inequalities of access to medicine and healthcare are already shocking, and these trade pressures just make things worse. Negotiators at the UN meetings, public health groups, politicians, and the public need to push back and demand changes in global trade negotiations.   We need to move away from lobbyist-driven policies that pit innovation against access, to a new trade policy that reconciles both objectives. Eyes will turn next to the recommendations of the World Health Organsation"s Consultative Expert Working Group on R&D, to see if this can jump-start a new direction in global negotiations - one that puts people and human rights at the center of patent policy.   * James Love is the director of Knowledge Ecology International, an NGO that concentrates on knowledge governance and the management of knowledge resources.   September 24, 2011   Corporations seek to maintain profits at UN effort to reduce Chronic Diseases, by Nicholas Freudenberg.   While much of the world’s attention focused on the UN debate at the General Assembly, another issue that garnered less media scrutiny, even though its outcome could prevent millions of premature deaths in coming decades.   On September 19th and 20th, 30 heads of State and 100 other senior ministers and experts met at the UN General Assembly’s first high level summit on non-communicable diseases (NCDs) to discuss how to reduce the burdens of such conditions as diabetes, heart disease, cancer and chronic respiratory diseases.   These conditions cause about 35 million deaths a year, of which 80 percent occur in low and middle-income countries and one quarter among people younger than 60 years. By 2030, NCDs will cause more than three quarters of all deaths in the world. While the UN has previously recognized HIV, tuberculosis and malaria as threats to economic development and global security, this was the first time the UN acknowledged that non-communicable disease also jeopardized economic well-being.   The NCD summit was an important step in shaping a coordinated global response to these conditions but unlike infectious diseases, where few organizations profit directly from their spread, powerful industries depend on encouraging consumption of products like tobacco, alcohol, unhealthy food and automobiles that have fueled epidemics of non-communicable diseases.   Thus, the summit previewed the great public health battle of this period. On one side are the public health professionals, advocacy organizations and local officials who have to cope with the rising tide of NCDs fueled by the growing consumption of tobacco, alcohol and unhealthy food. On the other are industries built on the model of profiting by promoting unhealthy lifestyles and products.   Participants in the UN meeting recognized this conflict. In his remarks, UN Secretary-General Ban Ki-moon observed that “there is a well-documented and shameful history of certain players in industry who ignored the science – sometimes even their own research – and put public health at risk to protect their own profits.” He went on to note that “there are industry players who have acted responsibly”.   In the lead up to the conference, industry lobbyists worked hard to persuade wealthy nations to look out for business interests. According to the Washington Post, a confidential summary of the negotiations on the summit’s political declaration showed that US negotiators threatened to scuttle the document if it even raised the issue of using trade agreements as a vehicle for protecting public health.   The Canadian Medical Association charged that Canada had been instrumental in removing a passage that would have limited the impact that food and alcohol corporations have on health policies and in failing to address trade-related barriers to global health.   A main issue dividing meeting participants was whether the 2001 Doha Declaration, which allowed low income countries to compel drug companies to allow generic drugs for use in their own countries, could be applied to drugs for NCDs. The Doha amendment refers to HIV, TB, malaria “and other epidemics”, language that led one activist to observe that this agreement “was not meant to be so narrowly interpreted… it was intended to address all public health crises.”   Jay Taylor, a vice-president of The Pharmaceutical Research and Manufacturers of America, explained the opposing position to the Post, “Compulsory licenses are intended to be used to address health emergencies and to provide urgent access in situations where there is little or no availability of existing effective medicines. This situation is clearly not the case in the context of the growing burden of noncommunicable diseases.”   Tellingly, the summit’s final statement does not use the word epidemic, even though the number of diabetes cases, for example, increased from 300 million worldwide in 2009 to 366 million in 2010.   Two other key issues led to conflict. The first was who should participate in the meeting. Industry insisted that “all sectors” of society should be represented while public health advocates argued industry participation was inappropriate.   One hundred forty three non-governmental organizations from around the world created the Conflicts of Interest Coalition and urged that the NCD summit and other forums for policy development should be “free from industry involvement” because of the “obvious conflicts of interest of interests associated with food, alcohol, beverage and other industries that are primarily answerable to shareholders.”   A second debate was whether international standards of corporate conduct should be voluntary or mandatory. Business favored voluntary codes, arguing companies were better equipped to implement standards and that mandates threaten jobs and economic growth. Public health activists pointed to the scientific evidence that voluntary standards rarely lead to meaningful changes in corporate behavior.   At the end of the meeting, many participants expressed disappointment. While the summit acknowledged "the fundamental conflict of interest between the tobacco industry and public health", no such statement was made about the food, alcohol, automobile or pharmaceutical industries. Unlike tobacco, these industries also produce products that contribute to health, but in recent decades they have increasingly followed the playbook of the tobacco industry: making campaign contributions and lobbying to oppose public health regulation, aggressively promoting unhealthy products in low and middle income nations when wealthy countries regulate their practices, and distorting scientific evidence that implicates their products in global epidemics.   In the final analysis, industry succeeded at the summit in avoiding direct challenges to its role in promoting disease and national governments refused to set specific targets for NCD reduction, a prerequisite for coordinated global action. These outcomes make it hard to be optimistic that the meeting opened a path for more forceful action to take on the world’s leading killers.   On the other hand, the UN meeting did show the potential for a global movement to challenge corporate influences on health.   A few world leaders spoke out forcefully. Torphong Chaiyasan, the Deputy Minister of Health for Thailand, told the meeting that “many large companies contributed to the non-communicable disease problem and continue to try to weaken public health policy.” The organizations that signed on to the Conflict of Interests Statement represent tens of thousands of health activists from around the world. "I am very, very optimistic about the creation of a social movement.   The evidence is clear that it can be done," George Alleyne, a physician who once headed the Pan American Health Organization, told the Washington Post earlier this week. Today corporations have more resources and power to shape health than this emerging movement,but the future health of the world depends on changing that equation.   (Nicholas Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health at Hunter College and founder and director of Corporations and Health Watch, an organization that monitors the impact of corporate practices on health).   Sep 2011   Binding steps needed to curb unhealthy food industry, by Olivier de Schutter.   The United Nations Special Rapporteur on the Right to Food has called for taxing unhealthy food, regulating harmful marketing practices and standing up to the food industry, urging world leaders to end a state of affairs that kills nearly 3 million adults each year.   “Voluntary guidelines are not enough. World leaders must not bow to industry pressure,” Olivier De Schutter said in a statement on the eve of the 19-20 September high-level General Assembly meeting on curbing non-communicable diseases (NCDs), such as cancer, diabetes, heart disease and stroke, and chronic lung disease, which are influenced by modifiable lifestyle risk factors such as the consumption of processed foods.   “It is crucial for world leaders to counter food industry efforts to sell unbalanced processed products and ready-to-serve meals too rich in transfats and saturated fats, salt and sugars. Food advertising is proven to have a strong impact on children, and must be strictly regulated in order to avoid the development of bad eating habits early in life.”   Mr. De Schutter noted that the globalization of food supply chains means an increased supply of junk food such as energy-rich, nutrient-poor products processed with transfats to ensure a long shelf life – which are particularly attractive to poor consumers because they are cheap – with “dramatic” consequences for public health, affecting disproportionately those with the lowest incomes.   According to the UN World Health Organization (WHO), at least 2.8 million adults die each year as a result of being overweight or obese, with 44 per cent of diabetes, 23 per cent of ischaemic heart disease and from 7 to 41 per cent of certain cancers attributable these factors.   Mr. De Schutter noted that unhealthy diets are one of the reasons why public health expenditures increased by 50 per cent over the past 10 years in member countries of the Organization for Economic Co-operation and Development (OECD).   “World leaders need to crack down on the marketing practices and public policy gaps which contribute to unhealthy diets and consign people to debilitating diseases,” he said. He also cited the need to tackle farm policies that make some foods more available than others, for example by providing subsidies that encourage production of grains rich in carbohydrates but relatively poor in micronutrients at the expense of fruits and vegetables.   “If we are serious about tackling the rise of cancer and heart disease, we need to make ambitious, binding commitments to tackle one of the root causes – the food that we eat,” he said. “It is unacceptable that when lives are at stake, we go no further than soft, promotional measures that ultimately rely on consumer choice, without addressing the supply side of the food chain.”   WHO Assistant Director-General Ala Alwan noted that NCDs cause over 63 per cent of all the world’s deaths Visit the related web page
	Banning cluster munitions: from political vision to practical action by International Committee of the Red Cross   Statement by Mrs Christine Beerli, vice-president of the International Committee of the Red Cross. Second Meeting of States Parties to the Convention on Cluster Munitions, Beirut, 11 – 16 September 2011.   Mr President, Ladies and Gentlemen,   Since the Meeting of States party to the Convention on Cluster Munitions has moved from Laos to Lebanon, it is perhaps worth reflecting on the experience of these two countries in addressing the dreadful impact of cluster munitions on their populations.   The massive use of these munitions in both countries occurred more than three decades apart. But the results were the same: widespread contamination from unexploded submunitions and large numbers of civilian casualties.   Laos has faced an overwhelming clearance burden for over three decades now. Lebanon, with a far smaller contaminated surface, is still clearing after five years.   In the three decades between the end of the war in Laos and the end of the war in Lebanon, the legacy of cluster munitions and the ensuing harm to populations was repeated as additional countries or regions became contaminated including Afghanistan, Chechnya, Eritrea, Ethiopia, Iraq, Kosovo and Serbia.   Nearly 30 other places around the world suffered the same fate. The problem in Laos was largely forgotten outside that country. Cluster munitions were generally accepted as an essential weapon and the unacceptable harm they cause was viewed as unavoidable.   The humanitarian problems caused by cluster munitions were supposed to be addressed through technical innovations such as “safety mechanisms” to improve their reliability.   Lebanon"s experience changed everything. It showed the world that, with modern delivery systems, millions of submunitions could contaminate vast areas in a matter of days. It demonstrated that old cluster munitions continue to fail massively and that even more modern “safety mechanisms” don’t always work. It illustrated the impact that contamination can have on every aspect of civilian life, from food production to reconstruction to health care in areas with a desperate need for these services.   Widespread media coverage made the world pay attention. Within months, 25 States called for a new instrument of international humanitarian law to address this problem.   When that initiative was blocked, the Oslo process opened the way to prohibiting cluster munitions that cause “unacceptable harm” to civilians. In many ways the Convention on Cluster Munitions was born of the suffering these weapons caused in Lebanon.   The States Parties and Signatories can be justly proud of what they have achieved in a relatively short time. The use of cluster munitions has been stigmatized, and this fact is having an impact also on the practice of States that are not yet able to join this Convention. The forceful response by States Parties and various organizations to the recent use of cluster munitions in Libya and in the Thai-Cambodian confrontation has served to further strengthen this stigmatization.   Substantial new commitments have been made to help severely affected States and to address the needs of other States Parties. The combined effect of the Vientiane and Beirut meetings of States Parties will be to ensure that progress in stockpile destruction, clearance and victim assistance is reported, monitored and supported through formal and informal meetings each year.   Though daunting tasks remain, particularly in the most severely affected countries, the States Parties must maintain their confidence in the historic value and impact of the norms they have created.   The priorities of the International Committee of the Red Cross at this meeting in Beirut and in the broader process of implementing the Convention are: firstly, rapid implementation of time-bound commitments in the fields of clearance and stockpile destruction.   Secondly, ensuring measurable progress in victim assistance in the most severely affected States Parties, and thirdly, universalization of the Convention and the norms it contains.   Regarding the Convention’s time-bound commitments, the Beirut Progress Report provides us with valuable insight into the implementation of the Vientiane Action Plan. Although the plan was adopted only 10 months ago, the trends identified are very encouraging.   They show that nearly 65 million submunitions have already been destroyed as a direct result of the Convention. States Parties with obligations for clearance are taking steps to address the impact of cluster munitions in their countries.   Most are developing or implementing the plans, budgets and mechanisms to fulfil the Convention"s requirements in these areas.   Regarding victim assistance in the most severely affected States, experience has shown that the key to success remains national ownership, the involvement of survivors in setting victim assistance priorities and long-term support from international agencies and donors.   This last element is essential because the most severely affected countries are also among the poorest.   Progress in the areas I have just mentioned will also depend on ensuring that all implementation activities, whether formal or informal, focus on the real challenges for specific countries.   It is not guidelines but specific plans, projects and resource allocation that will ensure full implementation of the Convention. It is encouraging to note that the Beirut Progress Report shows a number of States Parties and Signatories assigning funds to implementation.   We encourage all States and regional donor organizations to continue this trend. Far more resources will be needed in the years ahead.   In the field of universalization, the past 10 months have witnessed a steady increase in the number of States party to the Convention – up from 46 to 61.   This reflects the constant efforts by many States Parties, the Cluster Munitions Coalition, the United Nations and the International Committee of the Red Cross. But we believe that States can do even more by actively promoting this Convention regionally and through the various multilateral forums of which they are members.   We would also expect States Parties and Signatories not to condone, encourage or agree to the continued use by other States of precisely the same cluster munitions, including those with a single safety feature, that they have banned in this Convention.   These weapons were prohibited by States Parties to the Convention on Cluster Munitions on the basis that these weapons cause “unacceptable harm to civilians”.   The road from Vientiane to Beirut has been travelled in a mere 10 months. But the road from Laos to Lebanon took more than three decades.   The work of this meeting, and of States Parties in the coming months and years will help determine whether, in three more decades, the cluster munitions banned by this Convention are still causing “unacceptable harm to civilians”.   States Parties and Signatories have made the political choice by joining the Convention. Our task now is to move from political vision to practical action. Visit the related web page
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