“Taking an axe to IP rights will make it less likely that medicines will be developed for lower-income markets, or that new drugs are launched there. Evidence shows that medicines produced under compulsory licensing are very often more expensive than those procured via international agencies.”
Founded in 2006 by the governments of France, the United Kingdom and several others, and financed by a combination of a tax on airline tickets and government grants, Unitaid is one of the lesser known players in the crowded world of global health.
Unitaid’s most distinctive contribution is its Medicines Patent Pool (MPP), now approaching its tenth year of operation. It is a “one-stop shop” for patented medicines owned by different companies and available for voluntary licensing in low- and middle-income countries, so generic versions can be manufactured cheaply. At the moment, it focuses on medicines for HIV, malaria, tuberculosis and Hepatitis C.
Respecting existing intellectual property rights (IPRs) for new medicines is key to the success of the MPP, as it allows rights-holders of innovative medicines to widen access to their medicines in lower-income markets without compromising their markets in wealthier parts of the world from where they derive the majority of their profits. This in turn ensures the funds for the research and development that drives medical progress.
A Wrong Turn
Despite demonstrating how the market-based system of IPRs can be used to promote access to medicines, Unitaid has also started to pursue energetically what it describes as a “complementary” strategy of encouraging middle-income countries to undermine and attack IP rights.
Last year, it gave grants totalling $22 million to a number of non-governmental organizations (NGOs) to campaign in middle-income countries against IPRs for medicines, specifically to lobby governments to expropriate medicine patents via compulsory licensing. The thinking is that removing patent rights will promote access to medicines in countries beyond that which is already being achieved by the numerous multilateral initiatives such as the Global Fund.
Unitaid seems to have bought into the anti-market activism that dominates certain sections of the global health NGO community. In 2018, Unitaid financially supported the “Global Summit on Intellectual Property and Access to Medicines” in Marrakech, in which participants adopted extreme positions against IPRs for medicines and the global trade rules that govern them – denouncing them as “exploitation” driven by “greed”.
“The system is killing people, and will keep killing people unless we fight back,” a delegate from a Brazilian NGO, the Brazilian Interdisciplinary AIDS Association (ABIA), told the conference. “It’s time to accuse them of being criminals.” His colleague added: “The end of impunity is coming.”
This rhetoric is misguided. The reality is that intellectual property rights play a crucial role in promoting public health progress.
In the early 1980s, an HIV diagnosis was a certain death sentence. Thanks to market-driven innovation in HIV medicine, a person diagnosed with HIV can expect to live a normal life well into old age. Over the last decade, hepatitis C has gone from having no effective treatment to having multiple cures available that treat almost every genotype of the disease, all manufactured by competing companies using the patent system.
All of these advances are thanks to private companies competing in the marketplace under a framework of intellectual property rights.
The attacks on IPRs funded by Unitaid are unlikely to work in the long-run. Taking an axe to IP rights will make it less likely that medicines will be developed for lower-income markets, or that new drugs are launched there. Evidence shows that medicines produced under compulsory licensing are very often more expensive than those procured via international agencies such as the Global Fund.
And in the absence of IP rights, what company would make the investments required to launch a drug – conducting local clinical trials, educating doctors and patients, building supply chains and distribution networks, and conducting post-launch surveillance and so on? IP rights are necessary to protect these investments, particularly for lower-income countries where market-size will limit potential returns.
These initial investments are also vital for subsequent competitive generic markets, as the investments required to establish an innovative product within a market will help the rapid and widespread uptake of generic equivalents upon patent expiry.
A Counterproductive War
Despite its ongoing campaign to promote the use of compulsory licenses, Unitaid understands the power of working with the IP system to achieve global health goals. It has been a pioneer of public health-oriented voluntary licenses since 2010, using its MPP to gather together in one place patents on HIV, malaria and tuberculosis drugs for licensing in developing countries.
“Generic competition through public health licensing of patented products has been a game changer, especially for HIV”, according to Philippe Francois, Head of Sourcing and Supply Chain at the Global Fund.
“With the help of partners like the MPP, the Global Fund has accelerated access to key new products in the countries it supports, putting 18.9 million people on antiretroviral therapy for HIV in 2018, and providing more than 83% of HIV-positive mothers with ARV therapy to keep them alive and prevent transmission of the virus to their babies, up from just 1% in 2000.”
Given the success of voluntary access initiatives, it is troubling that Unitaid is apparently waging a counterproductive proxy war on patent rights via its grants to NGOs.
Ironically, these NGOs are promoting anti-IP policies to which Unitaid’s two biggest funders – France and the United Kingdom – are normally strongly opposed at multilateral forums such as the World Trade Organization.
Further, Unitaid’s controversial IP strategy stands in the way of its expansion to become a truly multilateral initiative by making it very difficult for pro-innovation countries such as Switzerland, Germany, Japan and the United States to contribute. As it stands, only six countries are board members, limiting Unitaid’s reach.
Instead of spending public funds on anti-IP lobbying, Unitaid should instead continue to explore the potential of voluntary licensing and other initiatives that work with, rather than against, the IP system to speed access to medicines in developing countries.
Collaboration not coercion should be the watchword, especially for a taxpayer funded international organization.
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