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Econometica Milano
Global Justice and Health:Intellectual Property Rights versus
Access to Essential Medicines
Thomas Pogge
Professor of Political Science, Columbia University
Centre for Applied Philosophy and Public Ethics, Australian National University
Centre for the Study of Mind in Nature, University of Oslo
2
Our Shared Commitment
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control” [Article 25(1)].
Universal Declaration of Human Rights
3
Human Cost of Poverty TodayAmong 6450 million human beings (2004), about
830 million are undernourished (UNDP 2006, p. 174),
2000 million lack access to essential drugs (www.fic.nih.gov/about/summary.html),
1100 million lack access to safe drinking water (UNDP 2006, p. 33),
1000 million lack adequate shelter (UNDP 1998, p. 49),
2000 million have no electricity (UNDP 1998, p. 49),
2600 million lack adequate sanitation (UNDP 2006, p. 33),
799 million adults are illiterate (www.uis.unesco.org),
211 million children (aged 5 to 14) do wage work outside their family — 8.4 million of them in the “unconditionally worst” forms of child labor, which involve slavery, forced or bonded labor, forced recruitment for use in armed conflict, forced prostitution or pornography, or the production or trafficking of illegal drugs (ILO: A Future Without Child Labour, 2002, pp. 9, 11, 17-18).
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One Third of all Human Deaths— some 18 million per year or 50 000 daily — are due to poverty-related causes, cheaply preventable through food, safe drinking water, rehydration packs, vaccines or other medicines. In thousands:
diarrhea (1798), malnutrition (485),
perinatal (2462) and maternal conditions (510),
childhood diseases (1124 — mainly measles),
tuberculosis (1566), meningitis (173), hepatitis (157),
malaria (1272), tropical diseases (129),
respiratory infections (3963 — mainly pneumonia),
HIV/AIDS (2777), sexually transmitted diseases (180)
(World Health Organization: World Health Report 2004, 120-5).
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Distribution of Deprivations
Nearly all the deprived are persons of color.
Children under age five account for 10.6 million or 59% of avoidable deaths each year from hunger and diseases (UNICEF: The State of the World’s Children 2005).
Women and girls are substantially overrepresented among the deprived (UNDP: Human Development Report 2003, pp. 310-330; UNIFEM; UNRISD 2005; Social Watch: Unkept Promises, 2005).
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Death Toll of Century's Atrocitieshttp://users.erols.com/mwhite28/war-1900.htm
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Millions of Deaths
5.5
7.5
9
15
20
30
50
300
0 50 100 150 200 250 300
Korea and Vietnam1951-54, 1965-74
Congo Free State 1886-1908
Russian Civil War 1917-22
World War One 1914-18
Stalin's Repression1924-53
Mao's Great LeapForward 1959-62
World War Two 1939-45
Worldwide PovertyDeaths 1990-2007
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Income Poverty Relative to the World Bank’s “$1/day” and “$2/day” Poverty Lines
“$1/day” ($1.075/day PPP 1993) AmountsPer Year
“$2/day” ($2.15/day PPP 1993)
Poverty Line
Poverty Gap
ConsumptionPoverty
LinePoverty Gap Consumption
$393 PPP 1993
or today ca.
$560 in USA
28.4 percent$112PPP1993
or today ca.
$159 in USA
71.6 percent$281PPP1993
or today ca.
$401 in USA
In US$ PPP,per Person
$786 PPP 1993
or today ca.
$1120 in USA
42 percent$330PPP1993
or today ca.
$470 in USA
58 percent$456PPP1993
or today ca.
$650 in USA
$70 to $280, depending on
purchasing power of poor
country’s currency
$20 to $80, depending on
purchasing power of poor
country’s currency;typicallyca. $40
$50 to $200, depending on
purchasing power of poor
country’s currency; typicallyca. $100
At market exchange rates,
per Person
$140 to $560, depending on
purchasing power of poor
country’s currency
$60 to $240, depending on
purchasing power of poor
country’s currency; typicallyca. $120
$80 to $320, depending on
purchasing power of poor
country’s currency; typicallyca. $160
ca. 1089 million
extremely poor people;(17% of
humankind)
ca. $44billion(versus $35142
billion social product of the rich countries
containing 16% of humankind)
ca. $109 billion
(ca. 0.25 percent of the $45,000 billion global product)
Aggregates(1 billion = 1000
million)
ca. 2735 million
very poor people;(43% of
humankind)
ca. $330 billion(versus $35142
billion social product of the rich countries
containing 16% of humankind)
ca. $440 billion
(ca. 1 percent of the $45,000 billion global
product)
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100 140 160 280 330
5117
27500
0
4000
8000
12000
16000
20000
24000
28000
US$ per person per year (2001)
<PPP$1/day(1087m)
PPP$1/day <PPP$2/day(2735m)
PPP$2/day median ($925PPP 1993)
globalaverage
high-income(1000m)
www.iresearch.worldbank.org/PovcalNet/jsp/index.jsp
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Shares of World Population:Income: Poorest Households versus Richest Countries
16%
43%41%
Persons in thepoorest households(1% of globalincome, or about$440 billion)
Persons in therichest countries(79% of globalincome, or about$35,529 billion)
Others (20% ofglobal income, orabout $9,000 billion)
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Shares of Global Income:Income: Poorest Households versus Richest Countries
1%
79%
20%The poorest households(43% of humankind)
The richest countries(16% of humankind)
Others (41% ofhumankind)
Calculated in terms of market exchange rates so as to reflect
the avoidability of poverty. Rich-Poor Ratio over 200:1.
Decile Inequality Ratio 320:1 (Milanovic 2005, pp. 111-12).
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Reported Changes in Population Below $1/Day:
China and the Rest of the World (Chen and Ravallion 2004)
0
200
400
600
800
1000
1200
Millio
ns
of
Pers
on
s
1987 2001
Year
Rest of theWorld below$1/ day
Chinese below$1/ day
13
Reported Changes inPopulation Below $2/Day:
China and the Rest of the World(Chen and Ravallion 2004)
0
400
800
1200
1600
2000
2400
2800
Millio
ns
of
Pers
on
s
1987 2001
Year
Rest of theWorld below$2/ day
Chinese below$2/ day
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-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
cumulative real per capita gain/loss over 1990-2001
period
1st 2nd 3rd 10th 20th 30th 40th 50th high-income
countries
Percentiles of World Population Based on Consumption ExpenditureMilanovic: Bottom ventile lost 20% 1988-93 and another 23 % 1993-98 in real terms
15
Shares of Global Wealth:Poorest versus Richest Households
15%
8.8%
39.9%
30.7%
4.2%1.9%
Percentiles 40-100
Percentiles 20-40
Percentiles 10-20
Percentiles 5-10
Percentiles 1-5
Top percentile
Calculated in terms of market exchange rates so as to reflect the avoidability of poverty. Decile Ineq’ty 2837:1. Quintile Ineq’ty 85:1.Year 2000, $125 trillion total. (James B Davies et al.: WIDER 2006)
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Defenses of the Existing Global Institutional Order
• Causally inert (“explanatory nationalism”)
• (Nearly) best of all possible designs with respect to human-rights fulfillment
Defenses Defeated
The Negative Case:
The fallacious argument from
differential trajectories
18
.
Global Institutional
Order
National Institutional Schemes of the Various Developing Countries
Poor and Vulnerable Citizens in the
Developing Countries
The Positive Case (3 P’s)
Protectionism against the poor
Pharmaceuticals at monopoly prices
Privileges: Borrowing, Resources, Treaties, Arms
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Global Institutional Order
Governments of the More Powerful(G-7) Countries
National Institutional Schemes of the
Various Developing Countries
Citizens of theMore Powerful(G-7) Countries
Poor and Vulnerable Citizens in the
Developing Countries
4 Privileges
ProtectionismPharmaceuticals
Rules Governing Medical Research
Under the TRIPs agreement, inventors of new drugs can get a 20-year global monopoly. This regime prices most new drugs beyond the reach of the global poor. It also skews medical research toward the affluent: Diseases accounting for 90% of the global disease burden receive only 10% of all medical research worldwide. Pneumonia, diarrhea, tuberculosis and malaria, which account for over 20% of the global disease burden, receive less than 1% of all public and private funds devoted to health research. Of the 1556 new drugs approved between 1975 and 2004, only 18 were for tropical diseases and 3 for TB.
Rules Governing Medical Research 2One obvious alternative is a regime under which inventor firms can choose to be rewarded in proportion to the impact of their invention on the global disease burden.This solution would end the morally untenable situation of the drug companies, which must now, to recover their costs, price life-saving medications out of the reach of vast numbers of poor patients. The solution would align the interests of inventor firms and the generic drug producers. The former would want their inventions to be widely copied, mass-produced, and sold as cheaply as possible, because this would magnify the health impact of their inventions. If new drugs were sold at the competitive price, near the marginal cost of production, many poor patients would gain access to drugs they now cannot afford. And affluent patients would gain as well, by paying substantially less for drugs and medical insurance.This solution would also greatly expand research into diseases that now attract very little research: dengue fever, hepatitis, meningitis, leprosy, trypanosomiasis (sleeping sickness and Chagas disease), river blindness, leishmaniasis, Buruli ulcer, lymphatic filariasis, schistosomiasis (bilharzia), malaria, tuberculosis, and many more.
In time, this one rule change alone would easily halve the number of annual poverty deaths.
23
The Consent Objection
Governments of poor countries often- lack expertise- lack bargaining power- lack democratic legitimacy
Most of those suffering are children
Human rights understood as inalienable
24
Injustice of an Institutional Order
An institutional order is unjust if all four are true:
• The institutional order is causally associated with a massive human-rights deficit.
• This causal association is foreseeable.
• This causal association is reasonably avoidable through some alternative design of this institutional order.
• This avoidability is foreseeable (we can know that the alternative institutional design would do much better in giving participants secure access to the objects of their human rights).
25
Human Rights as Moral Claims on (Global) Institutional Arrangements
“Everyone is entitled to a social and
international order in which the rights
and freedoms set forth in this
Declaration can be fully realized”
(Article 28)
Universal Declaration of Human Rights
26
Individual Moral ClaimA human right to X gives you a moral claim against all others ― and them a correlative negative duty ― that they not harm you by cooperating, without compensating reform and protection efforts, in imposing upon you an institutional order under which you lack secure access to X as part of a foreseeable and foreseeably avoidable human rights deficit.
27
Moral Responsibility When an institutional order is unjust (by
foreseeably producing massive and foreseeably
avoidable human-rights deficits), then those
who – without compensating reform and
protection efforts – are actively cooperating in
designing or imposing this order are harming
(violating the human rights of, violating a
human-rights-correlative negative duty toward)
those who suffer the avoidable human-rights
deficits.
28
Human Rights andCorrelative Duties
Negative duties toward
compatriots
Negative duties toward
foreigners
Positive duties toward
compatriots
Positive duties toward
foreigners
29
Prospect for ReformGovernments and corporations are under continuous counter-moral pressures not merely from ordinary profit motives, but also from their competitive or adversarial situation and from fairness considerations: Each party may reasonably judge that it cannot afford to forgo wrongdoing or to act well, because such unilateral self-restraint would place it at an unfair competitive disadvantage vis-à-vis its less scrupulous competitors.
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How Much
Would
It Cost?
