1. A revised framework for global medicine access Sanjay Basu Reblaw X

2. The pipeline R&D Better treatment outcomes Market failure Lack of financing Monopoly pricing of medicines & tech Infrastructure inadequacy Social support & Adherence difficulties

3. Price v. production cost of key AIDS drugs Source: HMS, 2002

4. R&D spending? Source: Securities & Exchange Commission, 2003

5. Source: Jim Kim, Harvard Medical School, 2001

6. Source: Univ of Minnesota, 2001

7. World Pharmaceutical Market Source: IMS Health, 2002 Region% of market North America41.80% EU24.8 Japan11.3 L. America/Caribbean7.5 SE Asia5.0 Middle East2.6 E. Europe1.8 India1.8 Africa1.3

8. Rhetoric v. Reality TRIPs & the WTO Parallel importation –cross-border trade of patented goods Compulsory licensing –generic production, primarily for domestic market Special 301

9. What generics can help do… Source: Oxfam, 2003

10. The Doha Declaration “We recognize that WTO members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement.”

11. Information onslaught... PhRMA budget: $150 million/year $1 million for an "intellectual echo chamber of economists” $2.5 million in payments to research and policy organizations "to build intellectual capital” $17.5 million to fight price controls and protect patent rights in foreign countries and in trade negotiations $9.4 million for public relations Source: NYTimes, 1 June 2003

12. Intellectual echo chamber... Attaran and “off-patent essential medicines” Roger Bate and “Africa Fighting Malaria” DiMasi’s “$800 million” R&D figure Data exclusivity, diversion Source: Public Citizen, 2001

13. Post-Doha: USTR (originally with EU and Japanese support) broke initial deadline for negotiations 17-page decision Possible implementation by Canada?

14. The new USTR proposals: Chile – CAFTA – ARTA – FTAA – PPP Singapore – Indonesia/Thailand – ASEAN SACU

15. Positive trends... New infrastructure being built in southern Africa by Brazil March-ins through Bayh-Dole: Norvir Expansion beyond AIDS and into the United States: Xalatan glaucoma case Pooled R&D approach ( www.essentialinventions.org ) New non-market approaches: DNDi

16. More information… www.essentialmedicines.org www.accessmed-msf.org www.cptech.org/ip/health Dying for Growth: Global Inequality and the Health of the Poor (Kim et al., 2000) Pathologies of Power: Health, Human Rights and the New War on the Poor (Farmer, 2003) The Political Economy of Social Inequalities: Consequences for Health & Quality of Life (Navarro, 2002) Global Intellectual Property Rights: Knowledge, Access and Development (Drahos & Mayne, 2002)