Towards a world convention for R&D?
14 February 2007
Interview with Mrs Nicoletta Dentico, DNDi - (Drug for neglected diseases -
Member of the Group of Experts on the Intergovernmental Working Group on Public health, Innovation and Intellectual Property (IGWG)
Interview conducted during the 120th meeting of the WHO Executive Board (Jan 22-26) to which N. Dentico and this author participated as civil society observers.
Interview by Garance Upham, Safe Observer International, NGO Forum for Health, PHM Disability and Economics Circle)
Q: A large group of developing countries, joined by Non-Governmental Organizations (NGOs) - such as DNDi - are demanding that WHO take the initiative of drafting a Convention on Public Research and Development (R&D). This was clear in the IGWG meeting on the issue last December. Could you explain?
N. Dentico: The idea of a Convention has been debated for about four years – the basic drive is the need for a new juridical and legal instrument looking at health from a health perspective and not from a trade based juridical standpoint – an instrument which can deliver public goods.
The Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement looks at knowledge management from a proprietary point of view, it is favoring monopolies and is basically anti-market since it does not truly allows for competition. Now is the time to look at novel ideas. After all, TRIPS is not sculptured in marble - to last for ever. The width and power of monopolies must be challenged. One new way to look at TRIPS globally is to put it into competition.
Q: How should we go about it?
N. Dentico: There are a variety of options. The pillars of a new R&D convention are, first the commitment of States to work with the WHO to look at needs, and so define an R&D agenda for the first time. Then, find the mechanisms to so so. WHO has that mandate.
Then, as concerns innovative ways to promote innovations all governments must get involved in the exercise, not just the private sector.
To reestablish governments in the driver's seat, this comes first. Who is governing and making the rules The public or the private sector? The main cause of the problems of today is that basically governments have abdicated their mandate in this regard!
There is talk of 'market failure', but where is the market when there is no competition, just a profit logic ?
Let's face it: governments have allowed today's situation to happen.
The call for a convention is saying the following: State governments ought to regain their freedom of decision on health and look at the best ways to spend dollars on R&D.
Q: In the international meetings such as the December meeting of the IGWG, the United States delegations oppose anything which comes close to reinstauring public State directives.. Yet, when you look at their domestic policies...
N. Dentico: Indeed. US domestic practice is an example to follow in terms of public funding of research, if you look at the NIH (National Institute of Health) they even fund research on neglected diseases. It is a pity that US delegations policies for international practice bear no resemblance to what they do at home, and this not just in terms of the importance of public funding and support for R&D, but also in terms of respect for TRIPS. The US imposes TRIPS plus and even TRIPS ++ in bilateral trade agreement, while freely resorting to compulsory licensing at every opportunity for their own domestic needs, as for example, in the anthrax crisis.
Q: So, what kind of initiative are you recommending instead of TRIPS?
N. Dentico: For type 2 and type 3 diseases (and even for type 1) the patent system is not the best mechanism. This was clearly stated in the report of the Commission on IP, Innovation and Public Health.
Another way is possible, there is the need to frame it. We should have a GLOBAL approach, not a North-South approach. DnDi is one such example. The idea is definitively not for the North to fund Northern research to apply to the helpless poor South.
Science in Africa may have brilliant ideas but scientists there are isolated.
We need to open up public science, all science libraries and data banks, so all can tape into it.
Q: What you want to do, in fact, is to put the inventor at the heart of the system, this reminds me of Thorstein Veblen..
N. Dentico: I like to remember what Abraham Lincoln said: “Knowledge is like a candle, when the candle lights another candle, it increases its own light.”
Governments need to create new types of incentives to make it happen and allow all to participate in this public pool for R&D. However, this will not be the task of the sole government, the issue here is not to nationalize R&D, as I presented the project in « The Courage to change the rules” (available on line)
Rather, the task is to find a way for a mechanism for public use. It exists in other UN organizations, such as in the FAO, not in the WHO however. Governments have to take the lead. Over 30 governments participating in the IGWG- Intergovernmental Working Group on Public health, innovation and Intellectual property rights- which first met on December 4-9 here in Geneva, have picked up and adopted this idea.
Q: Funding is not, in a sense, a crucial issue, rather what is needed is the commitment?
N. Dentico: There are many recommendations that countries should devote a certain percentage – 0.7% - of their GDP to R&D. There is a conference coming up in Oslo also looking at global levies such as taxations on speculations, transactions or fiscal heavens- the Tobin tax promoted by ATTAC and more. UNITAIDS, the new body for essential drugs to face HIV is partly funded by the airline tax.
But if we look at the basics, the reason for the absence of a public driven R&D has never been lack of funding or resources, but, rather, lack of political will and commitments on the part of governments. Look at Avian flue, it is a political issue, and as such it has received billions in funding.
Q: Would you say the Convention on Tobacco control is an example?
N. Dentico: The proposals are on the table. It will be a long process but hopefully it can be born. It is important to sit down with governments and to establish a procedure to make it happen.
There must be a binding enforcement mechanism, not a voluntary one. It is important to start work on these. The International Court of Justice is an example. The Framework of Tobacco control also, as it created a precedent that can be duplicated.
Health cannot depend upon a philanthropic venture, as suggested in Davos. Bill Gates has been filling a gap because governments left it empty. Governments must take the initiative, and then civil society should play a big role.
Q: From the December debates, there is the impression that if, as an NGO, you play the role of a vanguard, your audience is not just among developing nations, for there are several European countries, among which Norway, Switzerland, France, and others still, who go in the same direction on many issues...
N. Dentico: In the debate on ideas that is now open, support for a public R&D convention is on the discussion table.
"Thirty years ago modern health technology had just awakened and was full of promise. Since then, its expansion has surpassed all dreams, only to become a nightmare. For it has become over-sophisticated and over-costly. It is directing our health policies unwisely; and what is useful is applied to too few- Based on these technologies, a huge medical industry has grown up with powerful vested interests of its own. Like the sorcerer's apprentice, we have lost control -social control-over health technologies. The slave of our imagination has become the master of our creativity. We must learn to control it again and use it wisely, in the struggle for health freedom. This struggle is important for all countries: for developing countries, it is crucial."
Dr Halfdan Mahler, Director General of WHO (in Muller M. The Health of Nations, Faber and Faber, London 1982, p 158 – opt cit by Nicoletta, The Courage to Change the Rules)