Human Rights Council holds Panel discussion on access to medicines

AFTERNOON

GENEVA (8 March 2017) - The Human Rights Council this afternoon held a panel discussion to exchange views on good practices and key challenges relevant to access to medicines as one of the fundamental elements of the right to health.

Opening the panel discussion, Kate Gilmore, Deputy High Commissioner for Human Rights, noted that today, millions lived without access to affordable medicines; only half of those living with HIV/AIDS had access to anti-retroviral therapies, and women and girls were routinely denied their rights and access to essential medicines, with a consequence to their lives and health.  The right to health was an enabler of other rights - States must shift from a market-oriented perspective of access to medicines towards a right-to-health paradigm.  The protection of intellectual rights must not trump the right to health, concluded Ms. Gilmore.
 
Maria Nazareth Farani Azevêdo, Permanent Representative of Brazil to the United Nations Office at Geneva and panel moderator, said that States, international organizations, civil society and the private sector were engaging in different ways in a discussion on how best to address challenges affecting access to medicines, and this engagement from relevant stakeholders was reflected in the composition of the panel.
 
Ruth Dreifuss, former President of Switzerland, Chair of the Global Commission on Drug Policy and Co-Chair of the Secretary-General’s High-level Panel on Access to Medicines, said the mandate of the High-level Panel was to consider and evaluate proposals and recommend solutions to address the incoherence between, among other things, trade rules and public health.  Intellectual property rights were most often given to companies, and were not the legitimate rights of inventors.
 
Michael Kirby, former Justice of the High Court of Australia and Member of the Secretary-General’s High-level Panel on Access to Medicines, said that unless the international community acted now to achieve Sustainable Development Goal 3 on health and well-being for all by 2030, millions would be left behind to die.  The Secretary-General should initiate an independent review body on health innovation to address market weaknesses once and for all, and the international community must combine efforts to tackle the combined failures of the uncorrected market.
 
Marie-Paul Kieny, Assistant Director-General, Health Systems and Innovation, World Health Organization, spoke of recent examples of initiatives to increase access to medicines, for example in Colombia the World Health Organization had advised on the use of trade-related aspects of intellectual property rights flexibilities to make cancer treatment more affordable.  In Ethiopia, the organization had supported the design of the national strategy and plan of action for pharmaceutical manufacturing development.
 
Antony Taubman, Director of the Intellectual Property Division at the World Trade Organization, reminded that the Doha Declaration framed the legal, practical and policy context of the Agreement on Trade-Related Aspects of Intellectual Property Rights squarely within a public health setting.  It remained a benchmark for policymakers nowadays, all the more pertinent in the light of the Sustainable Development Goals, the growing complex of regional and bilateral trade agreements, and the renewed multilateral dialogue exemplified by the very resolution that had established the panel. 
 
Thomas Bombelles, Head of Global Health at the Global Issues Sector, World Intellectual Property Organization, said that in the field of global health, the central challenge was how to sustain innovation while also ensuring access for all.  Mr. Bombelles emphasized the role of technology transfer and capacity building, and catalysing more research and development for neglected diseases. 
 
Carlos Correa, Special Advisor on Trade and Intellectual Property, South Centre, stressed the obligations of States to assess public health impact of bilateral and regional trade and investment agreements, and to ensure that they did not prevent them from fulfilling the obligations related to the right to health.  Access to medicines was not just a concern of developing countries but also of developed countries due to exorbitant prices.
 
James Zhan, Director of the Division on Investment and Enterprise at the United Nations Conference on Trade and Development, said that local production could be politically and strategically important for developing countries to ensure the security of access to medicines for their populations, and in this it was important to build capacity of low-income countries to help adaptation to specific local needs and conditions, and also to build their competitive edge in the production of generic medicine.
 
In the discussion that followed, speakers expressed concern that one third of the global population still lacked access to essential medicines, even though access to safe and affordable medicines had long been recognized as critical to the achievement of the right to health.  Delegations spoke of challenges to address in the realization of this right, including the current high cost of innovative medicines and their implications for the accessibility of treatments, the sustainability of the health systems in all regions, and the challenges attached to market failures in addressing specific public health needs.  Achieving universal health coverage required the re-assessment of existing bilateral trade agreements, public-private partnerships and how they related to the World Trade Organization policies, and more attention needed to be given to engaging pharmaceutical companies in the effort to ensure greater access to medicines.
 
Speaking in the discussion were Brazil on behalf of the Community of Portuguese Speaking Countries, El Salvador on behalf of the Community of Latin American and Caribbean States, Tunisia on behalf of the African Group, European Union, Indonesia on behalf of a group of countries, Pakistan on behalf of the Organization of Islamic Cooperation, Togo, Cuba, Portugal, Qatar, Mexico, El Salvador, Kuwait, Russia, United States, Malaysia, Sierra Leone, Fiji, Republic of Korea, Pakistan, Brazil, Iran, Sudan and Libya.
 
The civil society organizations that took the floor included the International Confederation of Catholic Charities, Conectas Direitos Humanos, Swedish Association for Sexuality Education, Reseau International des Droits Humains, American Association of Jurists, and Iraqi Development Organization.
 
The Council will meet at 9 a.m. on Thursday, 9 March to hold an interactive dialogue with the High Commissioner for Human Rights on his annual report.
 
Introductory Remarks
 
MOUAYED SALEH, Vice-President and Rapporteur of the Human Rights Council, said that this panel discussion aimed to enable the exchange of views on good practices and key challenges relevant to access to medicines and one of the fundamental elements of the right to health.  Mr. Saleh welcomed Kate Gilmore, Deputy High Commissioner for Human Rights, and introduced the panellists.
 
Opening Statement
 
KATE GILMORE, United Nations Deputy High Commissioner for Human Rights, said that the right to health and its associated obligations called on all States to ensure access to good quality health care, including medicines, on the basis of equality and non-discrimination.  In this, the protection of those who were marginalized and routinely left behind was essential.  The enjoyment of the benefits of scientific progress was a right in and of itself; among its key elements was the affirmation that innovation essential for life in dignity should be accessible to everyone without any discrimination. 
 
And yet, millions lived without access to affordable medicines.  As of June 2016, 18.2 million people – only half of the 36.7 million living with HIV - were accessing antiretroviral therapy.  While this represented progress compared to the previous period, it was not enough.  Furthermore, there was a denial of women’s and girls’ rights and access to essential medicines, with a consequence to their lives and health.  Today, it was unconscionable that young women were old enough to catch a sexually transmitted disease and were still deemed too young to access health services, contraception, information and education, said the Deputy High Commissioner for Human Rights.  It was unconscionable that some States condemned girls for getting pregnant, expelled them from school, and refused to provide them with the medicines and services they needed to be in control of their own fertility.
 
The right to health was an enabler of other rights and it needed concrete steps and course correction where it was required; States must shift from a market-oriented perspective of access to medicines towards a right-to-health paradigm.  The protection of intellectual rights must not trump the right to health.  Further, trade and investment agreements must be negotiated with human rights in mind and concluded with human rights input.  Ms. Gilmore also stressed the issue of accountability and empowerment of stakeholders to claim their rights and holding policy-makers accountable for delivery on their obligation.  Political will was the most important obstacle to ensuring access to medicines, but access was also hampered by health economics and the values prevailing in the pharmaceutical industry.
 
Statements by the Panel Moderator and the Panellists
 
MARIA NAZARETH FARANI AZEVÊDO, Permanent Representative of Brazil to the United Nations Office at Geneva and moderator of the panel, said the panel would examine contributions from the Human Rights Council together with the High Commissioner for Human Rights and other United Nations entities.  States were obliged to respect, protect and fulfil the right to the highest attainable standard of health.  Nevertheless, one third of the global population had no access to medication.  States, international organizations, civil society and the private sector had been engaging in different ways for a discussion on how best to address challenges.  The composition of the panel showed the continued engagement from relevant stakeholders.  She then introduced the first panellist, Ruth Dreifuss.
 
RUTH DREIFUSS, former President of Switzerland, Chair of the Global Commission on Drug Policy and Co-Chair of the Secretary-General’s High-level Panel on Access to Medicines, said the mandate given by Ban Ki-moon was to consider and evaluate proposals and recommend solutions to address the incoherence between, among other things, trade rules and public health.  The mandate was not confined to medicines, she said, noting that prevention, treatment and social reintegration required access to vaccines and diagnostic tools.  The group’s mandate also addressed shortcomings in biomedical research, she said, mentioning the importance of intellectual property rules.  Inventors were physical persons, and they were entitled to remuneration for their contribution to science.  But intellectual property rights were most often given to companies.  Those intellectual property rights were not the legitimate rights of inventors, which came under the rules of international trade.  In doing its work, the panel had built on the work of the World Trade Organization and the World Health Organization.  Trade rules and international property rights were developed to promote economic growth.  Governments sought the benefits of international trade.  The international community must welcome the Doha negotiations introducing flexibility for States, she said, adding that there was continuing incoherence because subsequent negotiations had reduced Doha flexibility.  While the Panel had focused on that tension, it had also made a whole range of proposals on the duties of States.  It was a matter of State sovereignty to lay down criteria for granting patents.  Transparency was an important precondition for ensuring coherence.
 
MARIA NAZARETH FARANI AZEVÊDO, Permanent Representative of Brazil to the United Nations Office at Geneva and panel moderator, introduced the next panellist and said he would discuss the right to access to medicines as a fundamental element of the right to health, his view on the primacy of human rights norms, and the findings and recommendations of the high level panel in that regard.  
 
MICHAEL KIRBY, former Justice of the High Court of Australia and Member of the Secretary-General’s High-level Panel on Access to Medicines, said from the outset that he aligned himself with those celebrating the International Day of Women.  The right to health was not just a matter of ethics, it was a matter of law.  The high-level panel had conducted high-level hearings to listen to States, industry and civil society and individuals denied access to essential medicines.  The high-level panel would not forget the voices of those left behind and those who came before the hearings representing families forced to beg for the supply of patented drugs that would save lives.  Moreover, it would not forget the people of Africa and Asia who had contracted tuberculosis and could not afford the therapies available.  Unless the world and the United Nations and the Human Rights Council acted now, there was no way the international community would achieve Sustainable Development Goal 3 by 2030, he warned, adding that millions would be left behind to die.  In the high-level panel, some would have taken a different path and gone further in the report, but all agreed on the core conclusions.  Chief among them was with respect to human rights protections in the Doha declaration, countries must not be forced to surrender their health rights.  The international community should enforce a treaty concerning essential medicines for all and that the Secretary-General should initiate an independent review body on health innovation to address market weaknesses once and for all.  The international community must combine efforts to tackle the combined failures of the uncorrected market, he said. 
 
MARIE-PAUL KIENY, Assistant Director-General, Health Systems and Innovation, World Health Organization, said the World Health Organization had a long tradition of activities supporting access to medicines as one of the fundamental elements on the right of all to the enjoyment of the highest attainable standard of physical and mental health.   She concentrated on recent examples of initiatives to increase access to medicines.   In May 2016, at the request of the Ministry of the Health of Colombia, the World Health Organization had provided advice on the Government’s plan to use trade-related aspects of intellectual property rights flexibilities to make cancer treatment more affordable.  In addition, the World Health Organization supported the Government of Ethiopia in developing and implementing their national strategy and plan of action for pharmaceutical manufacturing development.  Moreover, at the request of the South African Government, the World Health Organization, World Trade Organization, World Intellectual Property Organization and the United Nations Conference on Trade and Development in September 2016 jointly provided advice on the reform of the South African intellectual property regime.  During the past year, the World Trade Organization had participated in the United Nations Secretary-General high-level panel discussions through membership in the Expert Advisory Group, and made two submissions to the panel.  She welcomed the call of the panel for more transparency on prices.   One of the high-level panel recommendations to the World Trade Organization was to set up a global pricing database, she noted.  Another one of the main themes of the high-level panel was the call for more policy coherence.  She also highlighted the high-level panel’s call for governments to review the situation of access in their countries in light of human rights principles and States’ obligations to fulfil them. 
 
ANTONY TAUBMAN, Director of the Intellectual Property Division at the World Trade Organization, reminded that the Doha Declaration framed the legal, practical and policy context of the Agreement on Trade-Related Aspects of Intellectual Property Rights squarely within a public health setting.  It remained a benchmark for policymakers nowadays, all the more pertinent in the light of the Sustainable Development Goals, the growing complex of regional and bilateral trade agreements, and the renewed multilateral dialogue exemplified by the very resolution that had established the panel.  The coherent, health-centred view that Doha promoted had also guided a great deal of practical action.  Trilateral (the World Health Organization, the World Intellectual Property Organization, and the World Trade Organization) cooperation manifested that holistic, inclusive approach towards policy and practical coherence for public health, including recognition of the human rights dimension.  Since Doha, the international community had a much greater wealth of experience and data that could set the multilateral policy framework in a practical, operational light.  Doha had clarified the parameters of the available policy space, but it had left open the practical question of how best to navigate through that policy space, and how best to flex flexibilities.  Multilateral collaboration for technical assistance and policy support would benefit from a more systematic empirical foundation: distilling lessons from the full range of practical experience in financing, procuring and developing medicines and other medical technologies at international, national and programme levels, and guided by globally inclusive data on patent coverage, regulatory measures, prices, actual access to medicines and the future epidemiological outlook.  No single set of policy prescriptions could apply identically for all United Nations Member States and World Trade Organization members.  But, building an information platform would support all Governments as they confronted the daunting health challenges that lay ahead, assisting them to make effective use of their rights and the flexibilities within the system, and to fulfil their related human rights responsibilities.   
 
THOMAS BOMBELLES, Head of Global Health at the Global Issues Sector, World Intellectual Property Organization, said the promotion of intellectual property as a tool to support creativity and economic development was central to the World Intellectual Property Organization.  In the field of global health, the question of how to sustain innovation while also ensuring access for all was a central challenge.  In its contributions to the High-Level Panel process, the World Intellectual Property Organization had focused its activities on technology transfer and capacity building.  He went on to detail the activities of the World Intellectual Property Organization that were directly relevant to the High-Level Panel’s work.  In the policy sphere, cross-cutting issues of innovation and access in global health were the focus.  Another division had as its purpose to catalyse more research and development for neglected diseases.  One forum was for Member States to discuss issues, set priorities and drive policy coherence when it came to patents.  The World Intellectual Property Organization provided legislative and policy assistance within the framework of the multilateral system, and the World Intellectual Property Organization’s databases provided access to information about many forms of intellectual property fights, including patents, trademarks and copyrights.  The World Intellectual Property Organization’s Chief Economist prepared a range of reports based on statistics regarding the creation and use of intellectual property.
 
CARLOS CORREA, Special Advisor on Trade and Intellectual Property, South Centre, said he would focus on the recommendation in the report that Governments engaged in bilateral and regional trade and investment treaties should ensure those agreements did not include provisions that interfered with their obligations to fulfil the right to health.  As a first step, they must undertake public health impact assessments.  Such assessments should inform negotiations and be conducted transparently.  Following the recommendation, it would be important for the Human Rights Council to develop guidelines for the realization of impact assessment studies.  In terms of access to medicines, it was not just a concern of developing countries but also of developed countries due to exorbitant prices, he stressed.  As a result of the ex-ante approach, there was a lack of methodologies to address the adoption of intellectual property rights protection.  Developing countries that accepted those provisions did so in asymmetrical power relationships and could not resist protectionist provisions in intellectual property.  It was important to look at the Trade-Related Aspects of Intellectual Property Rights Agreement and other agreements in which trade-related aspects of intellectual property rights plus had been adopted, in other words higher intellectual property standards.  The report was crucial because the recommendations were sound, cautious and the South Centre was committed to working with countries in the implementation of its recommendations.
 
JAMES ZHAN, Director of the Division on Investment and Enterprise at the United Nations Conference on Trade and Development (UNCTAD), reminded that UNCTAD had been working on access to medicines since 2005 from the point of view of intellectual property rights and investment in local pharmaceutical production.  Local production could be politically and strategically important for developing countries to ensure the security of access to medicines for their populations.   Mr. Zhan noted that it was important to build capacity in low-income countries to help adaptation to specific local needs and conditions.  It was important for countries to develop through economic diversification and industrialization.  In 2005 UNCTAD started a programme to help low-income countries to build their pharmaceutical production capacity.  It encountered lack of financing due to poor investment return and lack of a policy framework.  There was also ineffective investment facilitation, as well as weak local productive capacity and distribution network.  The lack of a private insurance network was another challenge.   There was a need for more effective international support investment in low-income countries to produce affordable medicines.  Social impact investment, in addition to traditional investment, would be welcome to boost the productive capacity of developing countries.  For the least developed countries, it was important to build a competitive edge in the production of generic medicine.  Regional cooperation for production and distribution of medicines was necessary to achieve economy of scale and a market for consumption.  In recent years, UNCTAD had been able to cooperate with the World Trade Organization and the World Intellectual Property Organization towards that goal.  
 
Discussion:
 
Brazil, speaking on behalf of the Community of Portuguese Speaking Countries, noted that the commitment to universal health coverage and to ensuring access to medicines was part of the 2030 Agenda, and highlighted efforts in combatting HIV/AIDS and ensuring universal access to treatment for all.  El Salvador, speaking on behalf of the Community of Latin American and Caribbean States, recognized that access to health was a foundation for all human rights and stressed the obligation of States to ensure the realization of this right.  The Community was striving to provide universal health coverage, and ensure access to medicines and vaccination, particularly for youth, women and in rural areas.  Tunisia, speaking on behalf of the African Group, said that although access to safe and affordable medicines had long been recognized as critical to the achievement of the right to health, the picture on the ground was very dire: hundreds of millions of people – especially women and children - were still without this access, particularly in Africa. 
 
European Union recognized challenges that must be addressed, including the current high cost of innovative medicines and their implications for the accessibility of treatments and the sustainability of the health systems in all regions, as well as the challenges attached to market failures in addressing specific public health needs.  Indonesia, speaking on behalf of a group of countries, said that at least one third of the world’s population had no regular access to medicines and that recent developments, such as outbreaks of highly infectious diseases, epidemics, antibiotic resistance, and cost of drugs shed light on systemic challenges faced by the current regime of access to medicines.
 
Pakistan, speaking on behalf of the Organization of Islamic Cooperation, said it was important for developing countries without manufacturing capacity to explore all possible means to increase affordable access to medicines for their people, especially as the number of essential medicines under patent protection was expected to increase.  Togo said that unequal access to medicine depending on where one lived was concerning.  International partners should understand that Sustainable Development Goal 3 on health was closely linked to Goal 17 on international partnerships.  Access to medicines was a benefit that States must ensure for their citizens, especially the most vulnerable ones.  Cuba said health was a public good and was a right to all, it was non-negotiable and its enjoyment was in a class of its own.  Cuba was a global leader in south-south technology transfer and had provided basic technology training to developing countries.  
 
Portugal said all regions of the world faced insufficient access to medical products and the prices of new medicines were shocking.  Access to medicines was both a human right and a public health issue, and the international community needed to work together to ensure policy consistency.  Qatar said that access to medication and medical technology without discrimination was an integral right.  The Government had drafted a framework for universal health coverage and had published a guidebook on medicines available in the country.  At the same time, Governments needed to make best use of the Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights.  Mexico said that while the right to health included access to quality, affordable medicine, economic and social challenges in many countries prevented universal health coverage.  For its part, the Mexican Government supported investment in medical technology and promoted access to generic medicines.  El Salvador reminded that in 2008 States had assumed an obligation to better ensure accessibility of medicines and medical equipment.  How could the international community ensure that international commitments become more effective and to ensure a real access to affordable and quality medicines?
 
Caritas Internationalis (International Confederation of Catholic Charities), on behalf of severals NGOs1, drew attention to the serious challenges faced by children and families living with HIV.  Medication distribution and delivery systems remained complicated and medicines continued to require cold chain storage, even in countries with a reliable electrical supply.   Conectas Direitos Humanos noted that in Latin America, due to abusive drug prices, the HIV mortality rates had soared back to the rates during the early times of the epidemic.  Countries should apply rigorous health-sensitive standards of invention and patentability to curtail the evergreening of patents.   Swedish Association for Sexuality Education warned that access to information, medicines and services on sexual and reproductive health was still limited or denied to many, mainly women and adolescent girls.  It urged States to ensure access to contraception, medicines for abortion, and prevention and treatment of sexually transmitted diseases. 
 
Kuwait noted the obstacles to accessing medicines and said that poverty was the main cause and it was incumbent on States to ensure access for the poor, with the support of the international community.  Russia said that people throughout the world still did not have adequate access to medicines, and informed the Council that, as a part of its social policies, 50 million citizens received low-cost or free of charge medicines.  United States reiterated its commitment to supporting policies that drove the development of new medicines, including promoting robust intellectual property rights protection, and expressed regret that the panel discussion had focused solely and inappropriately on advancing the recommendations of the report by the High-Level Panel on Access to Medicines, and thus neglected to consider critical barriers.
 
Malaysia listed accomplishments made in access to medicines, but noted that there were challenges, like the increased cost of health expenditure: total expenditure on drugs had increased by 89 per cent between 2008 and 2013.  Malaysia asked about the global solutions, from a human rights perspective, to the problem of drug pricing and accessibility of life saving medicines and orphan drugs?  Sierra Leone said that access to essential medicines remained a challenge to two billion people globally and that achieving universal health coverage required re-assessment of existing bilateral trade agreements, public-private partnerships and how it related to the World Trade Organization policies.  More attention needed to be given to engaging pharmaceutical companies in the effort to ensure greater access to medicines.  Fiji said it was one of the few countries in the world where the right to health was constitutionally guaranteed, and it had in place the free medicine programme which targeted vulnerable and low-income families.
 
Republic of Korea said it was regrettable that both in developing and developed countries many people suffered from the lack of access to medicine.  No one country could achieve a balance in the right to health, sustainable development and the right of inventors.  Republic of Korea was working to make vaccines more available and accessible in developing countries.  Pakistan said the Government had addressed the issue through national procurement policies that ensured the availability of medicines in public sector hospitals.  Appropriate regulations were also in place and being implemented for the provision of medicines, devices and diagnostics.  Brazil said the world was far from achieving the goal to ensure access to medicines for all.  Efforts needed to be re-doubled in order to reach the targets set out in the 2030 Agenda.  The Brazilian AIDS programme was recognized worldwide due to its integrated approach.  Iran said there were hurdles to affordable access to medicines and these consequently violated the rights of all to the enjoyment of the highest attainable standard of physical and mental health.  In particular, the imposition of unilateral measures and sanctions had deprived people of vital medicines in targeted countries, including Iran.  Sudan said the world had witnessed the emergence of new pathogens that constituted a health threat, especially in developing countries.  The responsibility of providing access to medicines was a great burden to Governments and they needed assistance from the international community in that regard.  Libya said access to medicines was a critical issue in all countries and was closely linked to the right to health.  Libya faced many challenges in its healthcare sector and asked the international community to help promote its medical infrastructure and provide vaccinations to children.
 
Reseau International des Droits Humains said all members of society had a responsibility when it came to the realization of the right to health, but noted that medicine was the only profession which was punished with prison for malpractice.  Negative consequences stemming from that included, among other things, that doctors delayed decisions.  Ecuador should amend its laws so medical personnel did not end up in prison.  American Association of Jurists said more than 2 billion people did not have access to essential medicines, but after more than 10 years of discussions, the situation was still of deep concern, and the recommendations in the report did not constitute a paradigm shift; the attention of Member States was drawn to the need to recognize the primacy of human rights over trade rules.  Iraqi Development Organization said that in the Arab Gulf region, some groups were denied access to healthcare because they were not recognized as groups, and in many countries, dissidents were deprived of health care in prison, which was the case in Bahrain.
 
Concluding Remarks
 
MARIA NAZARETH FARANI AZEVÊDO, Permanent Representative of Brazil to the United Nations Office at Geneva and moderator of the panel, said that the panel had attracted attention from a range of stakeholders and that many interesting issues had been raised in the discussion.
 
RUTH DREIFUSS, former President of Switzerland, Chair of the Global Commission on Drug Policy and Co-Chair of the Secretary-General’s High-level Panel on Access to Medicines, welcomed the interest in the report by the High-level Panel on Access to Medicines to which all stakeholders had contributed: patients, governments, health providers, pharmaceutical companies, and others.  One of the most important issues was that of governance and the issue of responsibilities that everyone had in this sphere, stressed Ms. Dreifuss.  Governments had problems of consistency and harmonizing their priorities and policies; they had to achieve balance between different rights and for this to happen, governments must create environments in which each ministry had an equal right to access the decision-making process.  However, the priority was often given to economic needs over and above human rights, so it was ministries of economy that usually had a greater voice in decision-making.  So this was an appeal to involve everyone, including civil society organizations.  As for the multilateral organizations, the creation of an inter-agency working group was a welcome step and it should ensure that all agencies were consistent in their decision-making.  As for private companies that worked in the area of health technology and health care, they should include in their annual reports information on their activities in this regard and how they contributed to the realization of the right to health.

MICHAEL KIRBY, former Justice of the High Court of Australia and Member of the Secretary-General’s High-level Panel on Access to Medicines, said that in order for generic medicines to become more readily available, it was necessary for countries to learn from the lessons of the HIV epidemic.  Everyone had to address the issue of readily available medicines.  Around the world in developed countries there was a concern about their own budgetary issues.  More transparency could be achieved through initiatives of local law makers, namely by requiring pharmaceutical companies to publish in their annual reports their actual investments in research and development.   Referring to the United States’ call for a robust intellectual property system, Mr. Kirby explained that nothing in the report of the High-level Panel on Access to Medicines was opposed to having a robust intellectual property system.  It was not true that that the panel had not considered non-intellectual property barriers to access to medicines.  Mr. Kirby pleaded with delegations to read the report before making recommendations or criticism.  He urged the delegates to judge the report based on what was actually said in the report rather than on suppositions.
 
MARIE-PAUL KIENY, Assistant Director-General, Health Systems and Innovation, World Health Organization, said there needed to be openness of the pharmaceutical industry to disclose costs.  On the cost of production, the World Health Organization could get a good grasp through a fair pricing forum.  Regarding transparency of prices, she said governments had a big role to play.  Many countries had what she called mystery advantages, urging governments to make public what they paid for medicines.  With regard to “delinkages” it had been advocated that the price of medicine should be for the cost of research and development, but the international community saw that the cost of medicine had nothing to do with research and development, instead it was subject to social value based pricing.  Because of that, the cost of hepatitis medicine was not indexed on the cost of research and development, but the cost of a liver transplant.  The international community had to oppose social value based pricing in cooperation with the industry.
 
ANTONY TAUBMAN, Director of the Intellectual Property Division, World Trade Organization, said coherence began at home.  Concerns had been heard about mainstreaming of human rights concerns, but that did not mean letting the multilateral system off the hook.  That was something the international community had sought to do by normalizing cooperation between different agencies.  That would take the international community beyond a zero sum approach that typified governance when it was not working well.  Intellectual property should function to mutual advantage to a balance of rights and obligations.  The international community had common goals, and in answer to delegations who asked for ideas and models, he said he was struck by many which had reported on their own initiatives, that had been the role of a trilateral study to create a feedback loop to learn from experience.  The focus had been on measures on the Agreement on Trade-Related Aspects of Intellectual Property Rights and TRIPS-Plus, but they did not function in isolation from other policy settings.  Trade was for most countries the way they got access to medicines, and the obstacles disproportionately fell on poor countries.  Trade was often the most vital way to get access to medicines.
 
THOMAS BOMBELLES, Head of Global Health at the Global Issues Sector, World Intellectual Property Organization, urged the delegates to read the information on the website of the World Intellectual Property Organization, particularly in relation to flexibility in the context of the Agreement on Trade-Related Aspects of Intellectual Property Rights.  Mr. Bombelles encouraged States to contact the World Intellectual Property Organization with their requests for technical assistance.
 
CARLOS CORREA, Special Advisor on Trade and Intellectual Property, South Centre, called for a self-reflection and the examination of the role of international organizations in the matters of intellectual property in relation to the right to health.  Had they fulfilled their role properly and used the flexibility in the Agreement on Trade-Related Aspects of Intellectual Property Rights, many countries would not be in the dire situation they were in today.  It would have been right and fitting for agencies to deal with those issues, to be self-critical in assessing the balance achieved between intellectual property and human rights.  Some States were truly committed to ensuring access to medicines, but the European Union for example requested States partners in trade agreements to adopt intellectual property laws which directly hindered the realization of the right to medicines.  Mexico had referred to the need to promote the regime of economy of scale so it was legitimate to ask whether the resolution on the amendment of the Agreement on Trade-Related Aspects of Intellectual Property Rights had adopted this stance.  Hopefully, this panel would be the first step to building consistency between the right to intellectual property and human rights.
 
JAMES ZHAN, Director of the Division on Investment and Enterprise, United Nations Conference on Trade and Development, reminded that the General Assembly was supposed to convene a conference on medical innovation and technology no later than 2018.  Between now and that event, four issues needed to be clarified: views of Governments and pharmaceutical industries regarding research and development, areas of agreement between Governments and businesses on issues, such as, for example, anti-microbes resistance, modalities for the use of public funding for medical research and development, and the role of private sector investment. 
 
MARIA NAZARETH FARANI AZEVEDO, Permanent Representative of Brazil to the United Nations Office at Geneva and panel moderator, urged Governments, businesses, civil society and all other relevant stakeholders to include the human rights perspective in their discussions on access to medicines and investment into medical research and development.

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1. Joint statement: Caritas Internationalis (International Confederation of Catholic Charities), Associazione Comunita Papa Giovanni XXIII; International Catholic Child Bureau; Catholic Medical Mission Board; International Volunteerism Organization for Women, Education and Development – VIDES; Community of Sant'Egidio; Elizabeth Glaser Pediatric AIDS Foundation; Edmund Rice International Limited; Istituto Internazionale Maria Ausiliatrice delle Salesiane di Don Bosco; Mouvement International d'Apostolate des Milieux Sociaux Independants; and Association Points-Cœur. 

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