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Public health triumphs at WTO Conference.

PARIS—The Ministerial Conference of the World Trade Organization (WTO) that ended on November 14 in Doha, Qatar, resulted in a declaration that puts public health before commercial interests where pharmaceutical patents are concerned. For more than 3 days, discussions on public health and the need to ensure access for all to essential medicines dominated the trade talks. This was quite surprising, especially considering that pharmaceuticals were not even on the agenda of the last Ministerial Conference, held in Seattle in December 1999. The result is regarded by almost everyone as a victory for public health concerns with regard to pharmaceutical patents. As reported here last year ( JAMA. 2000;283:321-323), the key WTO treaty related to pharmaceutical innovation and access is the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement. The TRIPS agreement requires that all WTO members pass national intellectual property laws that provide patent protection with a minimum 20year term. In the case of pharmaceuticals, while patent protection is important for innovation, the granting of a monopoly for production and sales for 20 years undoubtedly harms access, particularly because of higher prices for drugs. The most visible issue in this regard during the last 2 years has been access to HIV/AIDS drugs in developing countries. The major potential protection for public health concerns in the TRIPS agreement is a provision allowing compulsory licensing, by which a country may use the subject matter of a patent without authorization of the patent holder (ie, in practice, may produce a desired drug). The agreement’s vagueness on when compulsory licensing is allowed had led to a number of problems, including the much-publicized lawsuit brought by the international pharmaceutical industry against the South African government for having a provision in its medicines law allowing compulsory licensing. (The suit was dropped by the industry under international public pressure and protests). The just-completed Ministerial Conference dealt with such ambiguities.