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Unveiling the WTO August 30 Decision: The Canadian Experience
Rachel Kiddell-MonroePresident, Universities Allied for Essential Medicines; Former Coordinator for MSF’s Access to Essential Medicines Campaign in Canada
Canada’s Pledge to Africa May 2004: Canada implemented the WTO’s August
30 Decision to allow: “…the use of patents for international humanitarian
purposes to address public health problems” Canadian government refers to “Canadian Access
to Medicines Regime” (CAMR) After Stephen Lewis’ call to action in Canada,
Canadian NGOs embarked on making legislation meaningful for patients.
Drugs to Rwanda
25 September is long-awaited moment forRwandans living with AIDS: up to 21,000 can
receive treatment with AZT/3TC/NVP for 1 year (2 pills per day)
Canadian GovernmentApotex http://www.apotex.com/apotriavir/Canadians
But what does it actually mean for global access to medicines ?
Chronicle of a CAMR Drug Order (1) Sept 2003 to May 2005: extensive advocacy
involvement in process of enacting legislation (May 2004) and regulations (May 2005).
May 2004: MSF committed to making an order under the legislation.
August 2004: MSF invited to propose drugs for production under the under legislation. Proposed 3-in-1 antiretroviral (AZT/3TC/NVP).
December 2004: Canadian generic drug producer agreed. Health Canada approval process begins.
Chronicle of a CAMR Drug Order (2) April 2005: Active prototype formulated and clinical
trials begin. May 2005: MSF agrees to purchase if compulsory
licence obtained in Canada and importing country found who willing to import drug.
July 2006: drug passes Health Canada review. Sent to WHO PQP.
August 2006: WHO PQ received, coinciding with Toronto International AIDS Conference.
MSF decides not to continue with the order 20 September 2007: compulsory licence issued
(first in the world under WTO Aug 30, 2003 Decision)
Chronicle of a CAMR Drug Order (3) Late 2007: Rwanda announces competitive tender
process for the 3FDC 7 May 2008: Apotex announces contract with Rwanda to
provide 15.6 million tablets of 3FDC (1 year treatment for around 21,000 patients).
Cheaper than price offered by Indian generic companies with same product (according to the11th edition of MSF “Untangling the Web”, as of July 2008 - pages 64-65)Apotex: US$0.195 cents per tablet (US$0.39/day)
US$143/year per patientAurobindo/Cipla:
US$176/year per patient 25 September 2008: first shipment due to arrive in
Rwanda
CAMR Provisions Required by WTO August 30th Decision Drug by drug, country by country, case by case decision
making ignores- economies of scale - need for stockpiling
Voluntary licence negotiations at discretion of companies Anti-diversionary measures (pill colours, labelling, website
tracking by generic manufacturer) Notification in writing to TRIPS Council Two compulsory licences Resources to administer complex legislation in developing
countries
CAMR Advantages
Clear royalty formula (sliding scale based on country ranking on UN Development Index to max of 4%)
30 day limit on voluntary licence negotiations (but only starting from the date that all of the information is provided to the patent-holder, including the quantity, name of the country, etc).
CAMR Provisions Not Required by WTO August 30th Decision
Limited list of medicines: In practice taken 3-5 months and discretionary process to add drugs to list
Health Canada approval: required extra-ordinary involvement of MSF and others
Two year limit on compulsory licence List of eligible countries Sections limiting price and profit margin of
generic manufacturer and providing basis for patent-holder to litigate to vary or rescind compulsory licence
Regular Drug Order
MSF Faxes order to company
Company confirmsorder and
estimated date ofarrival in project
Project receivesdrugs
Process Chart: JCPA
WTOMember
Yes No
Schedule1
No
30d 15d 15d 15dSeekVoluntaryLicense
Apply toCIPO &
Pay Fees
CIPOProcess
ComplusoryLicenseIssued
CopyContractto CIPO
NotifyHC
of Startof MfrLots M
anuf
actu
re
PostWeb-site
ExportNotice
Ship Royalty
Complieswith Act& Regs
Enters C-9Queue,
StandardReview and
DistinguishingFeatures
(A)NDS for Schedule 1 DrugStatement of Intent forCompulsory LicenseDistinguishing Features
HCNotifiesCIPO
(A)NDSPatentHold inCanada
Manufacturer mayapply for Health
Canada remissionof fees w/in 45
days ofCompulsory
License issue
Gov’t to Gov’tRequest
orAdvisory
Committee
DiplomaticChannels
(Non-TRIPSMember)
PostInfo
(TRIPSMember)
StartProcess
Renewal
Conclusion of Canadian Experience
August 30 Decision is not an expeditious solution to the access to medicines crisis
The outcome…
Up to 21,000 Rwandan patients have access to treatment they need
Another affordable treatment option available One developed country generic company shown to
have capacity and will to provide low cost, high quality medicines
Extra competition on this drug which brought price down
…does not solve the problem7 years after Doha declared access for all
5 years after August 30 Decision promised a mechanism to allow generic drug production for developing countries
And more than 4 years after Canadian legislation enacted 70% of patients needing ART still do not have access to
treatment Limited coverage No other country or company tried to use legislation
either in Canada or in the other countries which have also adopted legislation.
Historically easy access to Indian drugs clearly demonstrates limitations of WTO process.
From Apotex
‘If other critical medicines are to go to Africa in a reasonable timeframe, the Federal Government must change the CAMR Legislation. CAMR is unworkable as it now stands’ Jack Kay, Apotex President and COO
The AIDS crisis has not gone away
People on antiretroviral treatment develop intolerable side effects or start to develop resistance to the first line drugs (MSF in South Africa: 1 in 5 after 5 years)
Switching to second line is 10 to 20 times more expensive
Switching to less-toxic first-line is 5 times more expensive
Need an effective international solution to bring prices down
Next Steps
WTO members must reconsider ratifying the August 30 Decision recognising the conclusions of the Canadian experience
WTO should consider Article 30 alternative once more
WTO members should ask the Canadian government to take a lead and amend its legislation along the lines of Article 30.
On-going work Canadian NGOs, activists, students and Canadian
media. Notable role of Richard Elliott of Canadian HIV/AIDS Legal Network, Stephen Lewis and the Global Treatment Action Group
New network of Grandmothers-for-Africa groups across Canada raising this issue in international fora, in meetings with parliamentarians, keeping it in the media, gathering thousands of signatures on a petition to Parliament
Legal Network have presented Canadian Parliament with detailed proposals for legislative reform.
For more resources go to www.aidslaw.ca/gtag.