The signing of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement in the Uruguay round of the World Trade Organization negotiations has stirred a heated policy debate on how TRIPS will impact the access to essential medicines in developing countries. This conference volume portrays various views on this timely topic held by academics, policy makers in the developed and less developed world, representatives of non-governmental organizations, and the pharmaceutical industry. The aim of the collected articles is not to provide a definite answer, but to present various viewpoints on the issue and emphasize the complexity of the debate.
The book, edited by Dr. Brigitte Granville, consists of three main parts, with 15 chapters in total. The first part discusses the economics of the TRIPS agreement and its impact on the access to essential medicines in poor economies. The second part offers a glimpse into whether and how various developing countries have adjusted to the pharmaceutical imperatives of the TRIPS agreement. The final part of the book discusses how less developed economies can deliver effective health care while complying with the TRIPS provisions.
The first part of the book nicely discusses the economics of increased intellectual property rights and access to essential medicines in developing countries. The chapter by Owen Lippert provides an overview of the topic and the welfare analysis of TRIPS for poor countries. The author argues that although price increases associated with better patent protection in poor countries will lead to static welfare losses, the poor countries will gain in the long run due to increased pharmaceutical innovation (worldwide and domestically) and the availability of new products. While Lippert agrees that the issue of access to pharmaceuticals needs to be addressed, he argues that recent proposals by the World Health Organization and the Africa Group may not suffice because they mainly focus on additional regulation of the pharmaceutical industry. In Lippert's view, better intellectual property rights combined with lower regulation of pharmaceuticals can solve the access problem. The chapter by Oxfam offers a more negative view of the welfare implications of TRIPS. Oxfam argues that TRIPS will not only increase the prices of existing medicines in poor countries, but also won't promote additional R&D investment in diseases specific to poor countries because these markets are too small to cover the fixed cost of R&D regardless of the state of the intellectual property rights.
Several chapters suggest that the effect of TRIPS on poor economies will depend on a country's domestic generic substitution policy before TRIPS, and domestic infrastructure and technical resources. In particular, F.M. Scherer and Jayashree Watal provide an excellent examination of the economic implications and limitations of several channels, such as compulsory licensing and parallel imports and price controls, through which countries can access relatively cheap pharmaceuticals while complying with TRIPS. The authors suggest that countries such as India, with a viable domestic pharmaceutical industry, large domestic market, and sufficient infrastructure and technical resources, will likely experience a bigger economic shock because of TRIPS, but might also benefit from increases in future domestic innovation. In addition, these countries can continue to produce generic substitutes of on-patent drugs through compulsory licensing, but they need to ensure that the TRIPS rules are respected and pay the patent holders a reasonable license fee. Scherer and Watal also emphasize the need to allow free international trade in these generics substitutes for the poor countries that lack the conditions necessary to develop a viable domestic industry, since these generics might be the only way the world's most vulnerable societies secure access to cheap pharmaceuticals.
Given the uncertainties in how TRIPS will affect access to essential medicines discussed in the first part of the book, the case studies in the second part of the book on whether and how various governments in developing countries have reacted to TRIPS are extremely valuable. For example, a chapter on Brazil written by Jorge Bermudez shows that a country like Brazil with a relatively adequate health infrastructure and viable domestic generic industry, can provide free access to antiretroviral medicines using predominately domestic resources and compulsory licensing. Ensuring access to antiretroviral drugs in a country like Uganda (ch. 10, by Dorothy Ochola), on the other hand, requires heavier reliance on international aid, product donations of patented products, and reliance on imports of generics from countries like India. The three articles in the final part of the book address ways in which developing countries can provide effective health care while complying with TRIPS and thus nicely complement the aforementioned case studies.
Overall, the book does an outstanding job at portraying various dimensions of the relationship between intellectual property rights and the access to pharmaceuticals. However, the reader is at times surprised by the lack of discussion of the systematic empirical evidence on the topic. An exception is an outstanding article by Keith Maskus and Mattias Ganslandt that empirically examines whether parallel imports have led to a convergence of prices between low and high-priced markets within the European Union and whether parallel imports have hampered the R&D efforts of pharmaceutical firms. In general, this book would have benefited from greater discussion of whether one can draw parallels between the experience of the developed countries that have recently strengthened their intellectual property rights, which various chapters of the book often cite, and those in the less developed world. In addition, while different parts of the book refer to specific provisions of the TRIPS agreement, the book would have benefited from a chapter that focuses on the provisions of TRIPS and their legal interpretation more systematically.
Overall, the book is an excellent collection of different views on the impact of TRIPS on the access to essential medicines. The articles are thought provoking, intellectually stimulating, and nicely portray the complexities of the relationship. As a result, the book is an invaluable resource for anyone with interest in international health policy, the pharmaceutical industry, or trade related aspects of intellectual property rights.