International staff: 18
National staff: 90 MSF has worked in Guatemala since 1982.
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Angela (not her real name) is 35 years
old. She is an indigenous woman who lives
in extreme poverty with her six sons, the
youngest of whom is also HIV-positive.
Her children are living fatherless because
Angela's first husband died of tuberculosis
and her second husband abandoned the
family. The community where she lives
is rejecting her. She is one of the most
vulnerable of the most vulnerable: a woman,
indigenous, living in poverty, living with
AIDS, the object of discrimination.
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"I have been threatened with
death since they found out that
I was HIV-positive. My sons
were taken away while
I was in the hospital."
– Angela, Guatemala City, May 2003 |
Improving the quality of life of those with
AIDS: a worthwhile goal
Angela is one of the estimated 100,000
people in Guatemala infected with
HIV/AIDS. She is also one of only 1,800
people nationwide who are receiving
antiretroviral (ARV) treatment, which can
make AIDS patients feel better and prolong
their lives. Around 550 of these people
receive ARV treatment through MSF, at
Roosevelt Hospital (where Angela is treated)
and Yaloc clinic in Guatemala City and at
a clinic in the city of Coatepeque, in the
southwest. MSF also reaches thousands
more people through prevention programs
and through monitoring, care and treatment
of opportunistic infections, nutritional
support and home care. A key objective
of MSF's work is to provide the Ministry
of Health with a model for developing a
comprehensive public HIV/AIDS program.
To provide ARV therapy, MSF currently
imports generic medicines. The Guatemalan
government, as of July 2003, was buying
a mix of generic and brand-name drugs
(countries like Guatemala are often under
great pressure to buy brand-name drugs).
Should the Guatemalan government decide to launch a national treatment program and
use generic medicines, under today's laws
it could freely buy the affordable registered
medicines that MSF is purchasing.
Unfortunately, new, more stringent
intellectual property rules in Guatemala
mean that access to affordable medicines
will be much more difficult. "The situation
for access to medicines in Guatemala is
awful," says Luis Villa, MSF Head of Mission
in Guatemala. "If there is any compromise
on the ability to buy generics, then it
will become almost impossible to treat
HIV/AIDS patients here." Although generic
competition has begun to bring drug prices
down dramatically in some Latin American
countries (and elsewhere in the world),
this positive dynamic is now threatened
by bilateral and regional trade agreements
that are putting drug company profits
above people's health. These agreements
are creating stringent intellectual property
protection that is crushing the most
vulnerable people underneath. This is not
the spectacular, violent death of intense
conflict. It is the slowly accumulating,
officially sanctioned deprivation of one the
basic necessities of life.
Data protection: the back door to profits in
Guatemala
In April 2003, under pressure to adopt
US standards, the Guatemalan government
modified its national intellectual property bill
by passing Decree 9-2003, which stipulates
five-year data exclusivity for submitted test
data used to show that drugs are safe and
effective. Practically, this means that drug
regulatory authorities will not be able to
rely on such data to approve generics for
five years, and therefore generic competition
will be delayed despite the fact that none
of the existing ARVs is under patent in
Guatemala today – thanks to the lack of
patent protection for pharmaceuticals in the
previous patent law. Passage of the decree
makes Guatemala the only country in Central
America to give five-year data protection.
The five-year data exclusivity provision
makes this a TRIPS-plus law: it is even more
restrictive than prevailing world standards.
Data exclusivity acts as an obstacle that
denies poor people access to affordable
medicines. This means that people like Angela will be less likely to get the drugs
they need to save their lives.
Free Trade Agreement of the Americas
Unfortunately, intellectual property
provisions such as those in Guatemala's
Decree are a foretaste of what is planned
for the new trade agreement currently
under negotiation in the region, the Free
Trade Agreement of the Americas (FTAA). If
formally implemented, the FTAA will create
the largest free trade zone in the world:
a US $13 trillion market covering more
than 800 million people in 34 countries in
North, Central and South America and the
Caribbean (except Cuba). The draft FTAA
contains provisions on intellectual property
rights which could reinforce monopolies and
put essential medicines out of reach of those
who need them most. If the FTAA strengthens
patent and data protection, it will destroy the
dynamic of competition that has caused ARV
prices to plummet in some low- and middleincome
countries in the Americas.
The US is already putting bilateral pressure
on countries in the hopes of wearing down
resistance to the restrictive provisions
planned for the FTAA. Guatemala's Decree is
one example of how this is being done.
MSF continues to work with NGOs and
governments to advocate for a public health
interpretation of intellectual property law.
In August 2003, MSF formally launched
a campaign and petition designed to
raise awareness of the potential harmful
consequences of certain parts of the FTAA.
And, at the time of going to press, MSF and
other organizations were still urging the
Guatemalan government to repeal Decree
9-2003.
The big picture
In 2001, in Doha, Qatar, World Trade
Organization (WTO) member states adopted
the groundbreaking Doha Declaration,
which unequivocally recognizes that access
to medicines should have primacy over
commercial interests. However, since that
time, the spirit and intent of the Doha
Declaration has come under attack. In
negotiations in August 2003 aimed at finding
a solution for countries with insufficient
manufacturing capacity to import medicines,
WTO members adopted cumbersome and economically risky provisions which may
actually hamper access to medicines. Hailed
as a "success" by many countries, the
provisions are instead a sign of the WTO's
failure to safeguard the spirit of Doha. In
addition, the negotiating process itself
revealed to what extent many negotiators
were acting in bad faith vis-Ã -vis the Doha
Declaration.
MSF, along with other NGOs, pointed out
that the WTO's August deal on medicines was
a "gift" bound tightly in red tape, and that, as
a measure of trade policy, it contradicts the
basic principles of the WTO and free trade.
Nonetheless, MSF is urging countries to
make use of these provisions in order to test
them and see what can be improved before
they are reviewed and used to amend the
TRIPS agreement in 2004.
The failure to safeguard Doha in the recent
multilateral talks has made the outcome of
regional and bilateral negotiations, such
as those underway for the FTAA, all the
more important. In a multilateral context,
developing countries have more clout. They can vote in blocks and use their numbers as
leverage. In a bilateral or regional setting,
it is much more difficult for developing
countries to stick up for pro-public health
positions, when faced with the enormous
pressures exerted by wealthier countries.
It is also harder for NGOs to influence the
process on these countries' behalf.
MSF firmly believes that there should be
no "TRIPS-Plus" – and no "DOHA-Minus"
– intellectual property agreements. The
Doha Declaration should be the guideline
for providing access to generic drugs. MSF
is therefore calling for intellectual property
provisions to be dropped from FTAA, to
date the most far-reaching and extreme
attempt to weaken the Doha Declaration.
There is already a multilateral agreement on
intellectual property that most countries are
happy with. Why negotiate another?
Other programs
In addition to its HIV/AIDS care and
advocacy work in Guatemala, MSF continues
to address the medical and psychological needs of children living on the streets
in Guatemala City. MSF teams at the Tzitze clinic
provide 200 medical and 220 psychological
consultations each month. In the therapeutic
crèche "Casa del Patojo" in Lomas de Santa
Faz, a slum area on the outskirts of the
capital, MSF provides medical assistance
and psychological and social support to
young mothers and their at-risk children.
Recently two new programs opened on the
Atlantic Coast: in Puerto Barrios, focusing
on HIV/AIDS; and in Olopa, focusing on
treatment of Chagas disease (read more about Chagas disease here).
MSF also responds to natural disasters.
In slum areas of Guatemala City, MSF
provides structural and logistical support
to help mitigate the effects of potential
natural disasters and supports a local
health center. Community training focuses
on developing the capacity to respond to
emergencies.
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