Opinion | The need for a strong UN declaration on TB
India must push back against US attempts to keep critical language on ‘access-to-affordable treatment’ out of the declaration
There is a concerted effort to eliminate tuberculosis (TB) from the world. The shift in the global threat perception of the disease was evident at the first ever Global Ministerial Conference on ending TB in Moscow late last year. There, 120 nations adopted the Moscow Declaration, which included commitments on universalizing access to TB care, ensuring adequate financing of TB programmes, investing in research and development (R&D) and building mechanisms to review progress.
The ministerial conference helped define the narrative for a forthcoming high-level meeting (HLM) on TB at the UN general assembly, perhaps the biggest window for global action on TB in the foreseeable future. At the HLM, it is widely expected that a political declaration will be adopted by member-states that will include unanimous commitments along the lines of the Moscow Declaration.
However, the collaborative and inclusive spirit of the declaration is now reportedly under threat, with the US putting profit before public health and employing arm-twisting tactics to keep critical language on “access to affordable treatment” out of the declaration.
Last month, several media organizations broke the story that due to extreme US pressure, the latest draft of the political declaration no longer included references to the flexibilities contained in the 1994 World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) in the operative paragraphs. The global health community was justifiably alarmed. This part of the declaration would have affirmed the rights of developing countries to access affordable medicines via TRIPS flexibilities. On 26 July, South Africa pushed back and refused to approve the draft, thereby reopening the text of the declaration for negotiations.
South Africa’s bold stand has bought the developing world some time, but the battle is far from won.
The next few weeks will witness extremely tough rounds of negotiations to resist US efforts to remove all references to the TRIPS flexibilities from the declaration. Civil society groups in India and the US have taken up the fight, urging the Indian and American administrations to take concrete steps to strengthen the political declaration and ensure it is favourable to the needs of developing countries. It is now absolutely critical that these countries themselves, particularly India, come to the fore and persevere to retain the references.
When TRIPS was created in 1995, it introduced standards for protecting intellectual property rights to an extent previously unseen at the global level. It also incorporated important flexibilities, which included granting countries freedom to determine the grounds for issuing compulsory licences.
The right of countries to use these flexibilities to protect public health was confirmed in the 2001 Doha Declaration. Through compulsory licensing, countries can ensure that patents do not impede the protection of public health and that lifesaving drugs under a patent are made available to large populations at a cheaper and affordable price.
India used this provision when it issued its first compulsory licence in 2012 for the cancer drug Nexavar, driving down its cost to a tenth of the original. Similarly, South Africa, Rwanda and Brazil have been able to significantly lower the price of antiretroviral drugs, while Thailand has lowered the prices of drugs to treat heart disease and various forms of cancer.
The removal of the operative clause from the political declaration that refers to the commitments made in Doha to “protect public health and in particular, to promote access to medicines for all” is thus worrying. It endangers the rights of people in developing countries to access new lifesaving medicines. The TRIPS flexibilities were built in for the greater public good. Essential drugs are a matter of human rights; they must be made universally accessible to everyone who needs them.
This is especially true of TB drugs. TB is a curable disease. Yet, tragically, over 400,000 Indians die of it every year. The estimated 2.4 million patients who survive the disease have to bear the double burden of wage loss and productivity. Their families often have to take care of them; as a result, entire households can be pushed to the brink of poverty. This then affects children in the family, who are forced to drop out of school or seek employment. TB doesn’t merely ravage the body and mind of patients, it destroys the lives of their families too. Basic humanity and good conscience, therefore, demand that the concept of affordability take centre stage whenever we talk about the disease.
It is vital for India to showcase its leadership and stand firm against efforts to deny its TB patients access to essential medicines—now and in the future. The outcome of the forthcoming negotiations will be crucial to our efforts to eliminate TB by 2025. The tug-of-war over the declaration is a clear indicator that while concerted efforts are being made to eliminate TB, walking the last mile to ensure that target is achieved will take substantial effort.
It is this opportunity that India must seize to ensure that the declaration is meaningful and delivers on the promise to rid the world of TB.
Kalikesh Singh Deo is a member of Parliament.
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