Congress report - European Health Forum Gastein

Forum II: Globalisation, World Trade and Health
current trade rules. For example, to qualify for a WTO tribunal a person must have worked at
the GATT or WTO or represented a country there, with limited exceptions.
General Agreement on Trade and Services
Since the meeting on international trade rules in Seattle in 1999 talks have begun to
strengthen one of the 28 agreements overseen by the WTO – the General Agreement on
Trade in Services, GATS. GATS covers sectors of the economy like banking, construction,
education, insurance, retail, telecommunications, tourism, health or waste disposal.
Via GATS, private companies can insist on being allowed to enter the market for publicly
funded services. In the countries of the OECD public expenditure on health services and
education accounts for 13% of GDP. Much of this goes to public or voluntary bodies but
could end going to for-profit groups. As of 1998, 59 countries had put one or more aspects
of their professional (medical, dental, veterinary, nursing, midwifery, physiotherapy) services
or health-related and social services (including hospitals) under GATS. 39 countries had
agreed to open up hospital services to foreign suppliers. 76 countries have made financial
services sector, including health insurance commitments.
“We believe we can make much progress in the [GATS] negotiations to allow the opportunity
for US businesses to expand into foreign health care markets . . . Historically, health care
services in many foreign countries have largely been the responsibility of the public sector.
This public ownership of health care has made it difficult for US private-sector health care
providers to market in foreign countries.” The US Coalition of Service Industries.
TRIPS
The WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) covers
a wide range of subjects, copyright and trademarks as well as patents. A patent on a
pharmaceutical product can cover the product or the manufacturing process if these can be
shown to be novel. The aim of the patent is to reward the inventor and enable research
costs to be recovered. Once the patent has expired, other companies can make the drug –
these “generics” are often cheaper as they do not have to cover the research element,
furthermore competition lowers the price.
TRIPS standardises the use of patents, so that all WTO members have to grant patents for
twenty years, previously some countries had shorter periods and could therefore permit the
production of generics. All countries including those which had not had patent processes will
be expected to implement the provisions of TRIPS
There is concern that the attempt to balance the interests of public health with the interest
of innovators is tilted towards the pharmaceutical industry and that without access to
generics new drugs will remain too expensive for poor countries. Furthermore the generics
manufacturers in developing countries will be adversely affected. TRIPS also allows for action
to be taken against countries with patent laws which are perceived to be inadequate.
The are some safeguards for protecting Public Health interests within TRIPS.
Governments can set justifications for compulsory licensing which could include a “national
emergency”, however this is not clearly defined. The TRIPS Agreement says products made
under compulsory licences should be “predominantly for the domestic market” however
some countries may not have the capacity and wish to use compulsory licenses for import.
Parallel imports are also allowed and this may keep process down however there is concern
that this might lead to re-export of cheaper products.
International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein
Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org
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