SEVERAL times over the past three years, governments of rich countries have publicly committed themselves to helping poor countries overcome poverty and disease. At summit after summit, they have promised greater access to desperately needed medicines and technologies. Given the publicity surrounding these commitments, you might think that the problems of developing countries must be halfway to being solved. But the reality is far grimmer. Rich countries have still to deliver on their promises, while the problems of many poor countries continue to deepen.
Some nations have made significant progress in tackling poverty, hunger and disease. But others – particularly in sub-Saharan Africa – have only slipped back. Fifty-four countries are poorer now than they were in 1990. In 21 countries a greater proportion of the population goes hungry. In 14 countries more children are dying before age 5. And in 34 countries, mainly because of HIV/AIDS, average life expectancy has dropped, in some cases dramatically. In Zimbabwe, for example, if you were born in the early 1970s you could expect to live to nearly 50; people born there today will be lucky to see 33.
This reversal in human development in the poorest countries is unprecedented. Urgent action is needed to stop things getting worse. Aid has to be a two-way street, and it is important that governments in developing countries implement reforms that benefit the poor. But rich nations must now do what they have often promised: in particular they must make AIDS drugs and other essential medicines cheap enough for people in countries such as Botswana and Zimbabwe, where the disease affects 1 in 3.
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The most significant international development targets are those agreed by more than 150 governments at the UN Assembly in September 2000. These Millennium Development Goals include targets not only for clean water, hunger, disease and other key dimensions of poverty, but also for rich countries to increase aid, expand debt relief, reform trade policy and widen access to essential medicines and technologies. Governments restated their commitment to these targets at two global meetings in 2002, Monterrey and Johannesburg, and again last month at the G8 summit in Evian.
Access to medicines and other technologies is crucial for combating the spread and impact of HIV/AIDS and poverty more generally. Developing countries cannot depend solely on voluntary price cuts by pharmaceutical companies. While this is a valuable tool, it leaves the poor dependent on the goodwill of the drugs sector. It would be far more effective for countries to produce their own generic drugs, which introduces competition and allows the open market to drive prices down.
The most prominent voluntary price-cutting scheme, the UN-sponsored Accelerating Access Initiative, has supplied about 30,000 people with drugs in 3 years of operating. Compare that with Brazil’s generic HIV/AIDS treatment scheme, through which more than 115,000 patients received affordable antiviral treatments in 2001 alone. This programme has cut deaths by half and reduced common opportunistic infections by 60 to 80 per cent.
So what should the rich world do to make such successes more frequent? At the World Trade Organization (WTO) meeting in Doha in November 2001, trade ministers declared that intellectual property rights should not stand in the way of public health. This was a milestone, but rich governments should now make the WTO’s TRIPS agreement – which sets minimum standards of protection for intellectual property – more explicit and more effective in protecting public health. Since Doha, negotiations on TRIPS have broken down. Restarting them is crucial.
Governments should also explore the provisions in TRIPS that allow technology transfer. They should take steps to recognise and reward indigenous knowledge, which is not yet part of the agreement. They should promote technological development, including the pharmaceutical sector, in developing countries. They should invest in a whole range of areas critical to tackling problems stemming from poverty, such as research into cures for sleeping sickness and other diseases particular to the developing world. For decades, the World Health Organization has been drawing attention to the gross underinvestment in health research for the poor. Some 90 per cent of global health funding is spent on diseases that affect just 10 per cent of the world’s population – mostly the rich.
Many expert groups, including the UK’s Commission on Intellectual Property which reported last September, have shown that tight intellectual property regimes are not in the interests of poor countries. It is time for governments to act on that advice. Sharing the fruits of scientific and technological progress is one of the most important ways rich countries can help poor countries fight poverty.