Keele University

1
Keele University

• Must We Exclude the Poor from Advanced Medical
  Treatments?
• 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 Today
 
 

• Among 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/plan/exec_summary.htm),
• 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),
• 774 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).

4
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).

5
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 Worlds
  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).

6
Death Toll of Century's Atrocitieshttp//users.er
ols.com/mwhite28/war-1900.htm
7
Millions of Deaths
8
Shares of Global Income2005 poorest households
versus richest countries
Calculated in terms of market exchange rates so
as to reflect the avoidability of poverty. Per
capita Pie chart rich/poor ratio over 2001.
(Decile inequality ratio 3201, Milanovic 2005,
pp. 111-12.)
9
Shares of Global Wealth2000 poorest versus
richest households
Calculated in terms of market exchange rates so
as to reflect the avoidability of poverty. Decile
Ineq. 28371. Quintile Ineq. 851. Year 2000,
125 trillion total. (James B Davies et al.
WIDER 2006)
10
(No Transcript)
11

• Global Institutional Order

4 privileges
Protectionism Pharmaceuticals
12
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.

13
Five Problems

• 1. Diff Cost/Price ? Excessive Marketing
• 2. Treatments gtgt Cures and Preventions
• 3. High Prices Impeding Access by the Poor
• 4. Neglected Diseases (90/10 Problem)
• 5. Last-Mile Problem

14
Solutions

• 1. Differential Pricing
• a. Status Quo before TRIPS
• b. Voluntary Tiered Pricing
• c. Compulsory Licences
• 2. Public Good Strategies
• a. Push Programs
• b. Pull Programs
• (i) FULL PULL

15
Rules Governing Medical Research 2

• One 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.