Public Health Ethics - Advance Access

Race Against Time: The Export of Essential Medicines to Rwanda

Rimmer, M. — 2008-01-01

This article considers the significance of the first export of essential medicines under the WTO General Council Decision 2003. In July 2007, Rwanda became the first country to provide a notification under the WTO General Council Decision 2003 of its intent to import a fixed-dose, triple combination HIV/AIDS drug manufactured by the Canadian generic pharmaceutical manufacturer Apotex, Inc. In September 2007, Apotex was granted the first compulsory licence application under Canada's Access to Medicines Regime. This article considers the convoluted and protracted negotiations between the Government of Rwanda, Apotex and three patent holders, GlaxoSmithKline, Boehringer Ingleheim Canada and Shire BioChemical, Inc. It questions the efficiency of this process. This article considers the review of the Jean Chrétien Pledge to Africa Act 2004 (Canada). It is critical of the refusal of the Conservative Government of Canada to make any amendments to the legislation to improve the cost-effective delivery of essential medicines. This article queries the proposed Hong Kong Amendment to the TRIPS Agreement 1994, given the concerns of the Africa Group. It is submitted that it is undesirable to codify the WTO General Council Decision 2003, given its failure to provide a speedy, efficient and cost-effective delivery of essential medicines.

Transnational Medical Aid and the Wrongdoing of Others

Horton, K. — 2008-01-01

One of the ways in which transnational medical agencies (TMAs) such as Medicins Sans Frontieres aim to increase the access of the global poor to health services is by supplying medical aid to people who need it in developing countries. The moral imperative supporting such work is clear enough, but a variety of factors can make such work difficult. One of those factors is the wrongdoing of other agents and agencies. For as a result of such wrongdoing, the attempt to supply medical aid can sometimes lead to significant negative effects. What should TMAs do in such situations? On one view, TMAs should take account of any negative effects arising from the wrongdoing of others in just the same way in which they take account of negative effects arising more directly from their own actions, or from natural forces. To many people, this view seems wrong. In this paper, I articulate and discuss several different reasons why one might think this. In doing so, I hope to contribute to a debate about the more general question of how TMAs should respond to the wrongdoing of others.

The Health Impact Fund: A Useful Supplement to the Patent System?

Hollis, A. — 2008-01-01

The Health Impact Fund has been proposed as an optional, comprehensive advance market commitment system offering financial payments or ‘prizes’ to patentees of new drugs, which are sold globally at an administered low price. The Fund is designed to offer payments based on the therapeutic impact of the drugs or vaccines, so that innovators will have efficient incentives to develop drugs that maximize health gains. Consumers would have improved access to such drugs because of low prices.

Ethical Implications of Active Surveillance Cultures and Contact Precautions for Controlling Multidrug Resistant Organisms in the Hospital Setting

Edmond, M., Lyckholm, L., Diekema, D. — 2008-01-01

Healthcare-associated infections due to multidrug-resistant organisms continue to increase in incidence. To control the transmission of these pathogens, such as methicillin-resistant Staphylococcus aureus, some have advocated active surveillance cultures of all hospitalized patients, followed by institution of contact precautions. While there has been extensive debate about the effectiveness of this approach in reducing infections, little attention has been given to the ethical issues raised by the intervention. Active surveillance for multidrug-resistant organisms is a quality improvement measure and ethical implications arise through the potential to inadvertently cause harm. Unintended adverse effects may include decreased contact with healthcare workers, increased depression and anxiety, and increased rates of noninfectious adverse events among patients placed in contact precautions. The potential risks and benefits are not distributed fairly; patients placed in contact precautions are exposed to the risks, while those not isolated experience the benefit. Ethical challenges involve a conflict between the interests of the individual patient and the patient population not already colonized with the organism. For healthcare systems, active surveillance increases the complexity of bed management, exacerbating problems with patient placement, patient throughput, emergency department overcrowding and ambulance diversion for some hospitals. It also poses ethical dilemmas regarding societal resource allocation. Investing in an unproven or marginally beneficial quality improvement activity such as this must be balanced against other public health priorities competing for scarce resources.

Three Proposals for Rewarding Novel Health Technologies Benefiting People Living in Poverty. A Comparative Analysis of Prize Funds, Health Impact Funds and a Cost-Effectiveness/Competitive Tender Treaty

Faunce, T. A., Nasu, H. — 2008-01-01

This paper sets out to analyse three different academic proposals for addressing the needs of the poor in relation to new, rather than ‘essential’ medicines. It focuses particularly on (1) research and development prize funds, (2) a health impact fund (HIF) system and (3) a multilateral treaty on health technology cost-effectiveness evaluation and competitive tender. It compares the extent to which each responds to the ‘market fundamentalist’ philosophy (that we maintain forms a loose theoretical background for the patent-driven approach to pharmaceutical R&D) and begins to analyse their respective strengths and weaknesses.

Improving Access to Essential Medicines: How Health Concerns Can Be Prioritised in the Global Governance System

Sridhar, D. — 2008-01-01

This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration.