Econometica Milano

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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

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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

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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/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 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).

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Death Toll of Century's Atrocitieshttp//users.er
ols.com/mwhite28/war-1900.htm
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Millions of Deaths
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Income Poverty Relative to the World Banks
1/day and 2/day Poverty Lines
1/day (1.075/day PPP 1993) Amounts Per Year 2/day (2.15/day PPP 1993)
Poverty Line Poverty Gap Consumption Poverty Line Poverty 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 countrys currency 20 to 80, depending on purchasing power of poor countrys currency typically ca. 40 50 to 200, depending on purchasing power of poor countrys currency typically ca. 100 At market exchange rates, per Person 140 to 560, depending on purchasing power of poor countrys currency 60 to 240, depending on purchasing power of poor countrys currency typically ca. 120 80 to 320, depending on purchasing power of poor countrys currency typically ca. 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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Shares of World PopulationIncome Poorest
Households versus Richest Countries
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Shares of Global IncomeIncome Poorest
Households versus Richest Countries
Calculated in terms of market exchange rates so
as to reflect the avoidability of poverty.
Rich-Poor Ratio over 2001. Decile Inequality
Ratio 3201 (Milanovic 2005, pp. 111-12).
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Reported Changes in Population Below
1/DayChina and the Rest of the World (Chen
and Ravallion 2004)
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Reported Changes inPopulation Below
2/DayChina and the Rest of the World(Chen and
Ravallion 2004)
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Shares of Global WealthPoorest versus Richest
Households
Calculated in terms of market exchange rates so
as to reflect the avoidability of poverty. Decile
Ineqty 28371. Quintile Ineqty 851. 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

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Defenses Defeated

• The Negative Case
• The fallacious argument from differential
  trajectories

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Global Institutional Order National Institutional Schemes of the Various Developing Countries
Poor and Vulnerable Citizens in the Developing Countries

• .

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The Positive Case (3 Ps)

• Protectionism against the poor
• Pharmaceuticals at monopoly prices
• Privileges Borrowing, Resources, Treaties, Arms

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• Global Institutional Order

4 Privileges
Governments of the More Powerful (G-7) Countries National Institutional Schemes of the Various Developing Countries
Citizens of the More Powerful (G-7) Countries Poor and Vulnerable Citizens in the Developing Countries
Protectionism Pharmaceuticals
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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.

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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.

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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

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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).

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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

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Individual Moral Claim

• A 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.

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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-correlat
  ive negative duty toward) those who suffer the
  avoidable human-rights deficits.

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Human Rights andCorrelative Duties
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Prospect for Reform

• Governments 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?