Cancun and Beyond, Access to Medicine and the FTAA

Transcript of August 28, 2003 Teleconference Hosted by MSF's Kevin Phelan

Transcript of Teleconference Hosted by MSF's Kevin Phelan



Good day, ladies and gentlemen. And welcome to the Doctors Without Borders' Cancun and Beyond, Access to Medicine and the FTAA Conference. At this time, all participants are in a listen-only mode. Later, we will conduct a question-and-answer session, and instructions will follow at that time. If anyone should require assistance during the conference please press star then zero on your touch-tone telephone. As a reminder, this conference call is being recorded.


I would now like to introduce your host for today's conference, Mr. Kevin Phelan, from Doctors Without Borders. Mr. Phelan, you may begin.



Good morning and good afternoon to everyone. It's a pleasure to have with us today ELLEN 'T HOEN, the Coordinator for Policy and Advocacy for Doctors Without Borders/Médecins Sans Frontières (MSF)' Access to Essential Medicines Campaign, calling from Paris. We also have Dr. Luis Villa calling from Guatemala City, the Head of Mission for MSF programs in Guatemala. And Carlos Correa, Lawyer and Economist from Argentina. They will be speaking today on the achievements made in Doha and the threats that the Free Trade Area of the Americas (FTAA) and other trade agreements pose to some of the promises made there, including what is at stake for people throughout Latin America.


Without further adieu, I would like to invite ELLEN 'T HOEN to give a general introduction. Ellen.



Thank you, Kevin. I will just use a few minutes to explain to you why we are concerned about the FTAA. As you may remember in November 2001 the Declaration on TRIPS and Public Health was adopted by the WTO. At the time that was regarded as real progress in the whole discussion about the problems countries faced with [obtaining] medicines [that] are under patent. The Doha Declaration clarified a number of flexibilities that exist in the present international rules on intellectual property.


For example, the Doha Declaration made it absolutely clear that countries could provide compulsory licensing, which is the overriding of patents, should a patent form a barrier to access to medicines, that countries could determine what kind of policy they wanted to follow in terms of importation of cheaper priced medicines elsewhere. Countries are also free to determine what is an emergency or an urgent situation and under which procedures would be much easier to follow. These are just a few examples of what was in the Doha Declaration. The Doha Declaration was adopted by the WTO, and since then, of course, the countries concerned are in process of trying to implement this Doha Declaration.

But what we have seen since the very optimistic Doha Conference is that this Doha spirit is actually evaporating very quickly. There have been numerous attacks on the Doha Declaration of which the present talks in the FTAA are the most serious ones, because some of the proposals in the FTAA, particularly the proposals that are being put forward by the United States, would drastically limit the space that the Doha Agreement on TRIPS and public health has created.

And I'll give you just a few examples. If these proposals were adopted and would be included in the FTAA it would dramatically limit the circumstances under which compulsory licenses may be used. It would limit the use of compulsory licensing to emergencies, while the Doha Declaration very clearly stated 'countries are free to determine when to use a compulsory license.'

Some of the FTAA proposals also indicate an extension of patent terms even beyond the 20 years required in the TRIPS agreement. The FTAA proposals also introduce new roles for drug regulatory authorities, what you in the U.S. would call the FDA, and give them a responsibility into the policing the patent status of drugs by requiring that the drug regulatory agencies consider the patent status of drugs before granting a marketing authorization from generic manufacturers.

The proposals also introduce exclusive rights on pharmaceutical test data. The practical consequences of that would be that generic versions of medicines couldn't be registered because the regulatory agency cannot use the files of the originator product to register those generic drugs. That would lead to a complete market exclusivity for which even a compulsory license cannot remedy.

And so these are just a few of the examples of what is presently happening in the FTAA, and we are very concerned because if this goes through, in fact, it would annul the entire achievement of the Doha Declaration on TRIPS and public health. It would undo in a regional trade agreement what has been established multilaterally.

I think I should leave it at this as far as the introduction goes, if that's OK with you, Kevin.



Thank you very much, Ellen, for that overview.


Our next speaker will be Doctor Luis Villa. He has been head of Mission for MSF Programs in Guatemala for the past year-and-a-half. And so, Dr. Villa, if you will.



Yes, good morning to everyone. Thank you, Kevin. I am happy to be here, and talk to you about the challenges we face in this country, and there are quite a few. As doctors, every day we have to deal with a very difficult situation: [the] large number of patients who are diagnosed every day with HIV and for whom we cannot provide treatment.


Now in Guatemala we have 67,000 people with HIV, and we are only able to provide treatment for 1,500 of them. This really tells the story, but just let me give you an example of the situation that we had just last week. This is the story of one person, but it could be the story of many others here in Guatemala and throughout Central America.

This was a woman whose husband died of AIDS, and she was also quite sick. She was so desperate trying to seek treatment for herself. During a year out of the public system, she tried to go to a private practice and had to pay close to $1,000 U.S. dollars per month.

So she had to sell everything she had, and had to take her kids out of school, because she couldn't [afford to] send them anymore. And after that, well, she needed money. After two months she was again without any treatment, no opportunity whatsoever. She entered the MSF hospital, and now she is receiving treatments, and the kids are back to school.

This is the story of so many people that they don't even but it's not only the consequences for the patients themselves, but also for their families. Here in Guatemala we face all these issues we hear about in the negotiations of (ALCA) and in the Central America (CAFTA) agreement between Central America and the US which is due [to start] by the end of this year.

In Guatemala last year, sorry this year, 2003, a law was approved that practically eliminates the facilitation of generic drugs, eliminating the generic competency in the Guatemalan market. This will take us to the situation we had two years ago, when the prices of treatment for patients was up to $10,000 per patient per year. Now we are treating patients with the same medicines, with the same quality medicines, for between $300 and $500 per patient per treatment. So we know that [these issues] are already real in Guatemala. We are probably going backwards at least a couple of years. And the situation for the future is not one that we can look to with hope of thing getting better.

Our experiences in the field with our various dealings with our colleagues in the hospitals and with the population here, we are calling for all intellectual property [IP] protection to be removed from bilateral agreements like FTAA, and that we just remain with the Doha agreement. It has been proven in different parts of the world and especially here in Latin America that generic competition can help countries access the drugs and provide treatments for our patients at the cost that poor countries can afford.

That will be it for me now. I have plenty of data and plenty of things to tell you, but I will wait for the questions. Thank you very much.



Thank you very much, Dr. Villa.


Professor Carlos Correa teaches at the University of Buenos Aires and has served as a consultant to the U.N., WHO, World Bank, and other regional and international organizations. He has written extensively on IP protection, and will discuss who it benefits, who it hurts, and why more and higher standards are not necessary.

Without further adieu, Professor Correa.



Thanks, Kevin. And it's also pleasure for me to participate in this conference. While I think Ellen has already covered a lot about these inflexibilities that the FTAA agreement will eliminate, let me just tell you that when the Trips agreement was negotiated, in fact, developing countries made a very significant concession to developed countries to the extent that they accepted that the intellectual property standards that were in force in developed countries could be implemented in poor countries.


And this was on the basis of, I would say three elements. The first one was the idea that developing countries would get other advantages in agriculture and textiles. As we all know these advantages did not materialize as expected. Secondly, developing countries expected that the Trips agreement would set a ceiling, would set the highest standard, and then developing countries would not be requested or pressured anymore to provide further protection or higher levels of protection. And finally, the Trips agreement, as Ellen has mentioned, contains a number of flexibilities that may be clear that any member can apply some measures in order to mitigate the monopolies that patent - concern.

Well, the problem is that developing countries face significant troubles, significant obstacles in order to effectively use those flexibilities as illustrated, for instance, by the case of South Africa, and many other countries. And these obstacles and the problems that patent in pharmaceuticals pose to the - mentioned that they significantly increased prices and then limit access was a main issue that led to the declaration on Trips and public health by the conference in Doha in 2001.

And so the problem now is that the United States is completely ignoring the fact that this declaration has been adopted. It's ignoring the flexibilities allowed by the Trips agreement. And that these flexibilities are needed as was mentioned, in order to facilitate the adoption of measures that are crucial for some societies, especially for poor societies, in order to allow among other things access to many things.

And so this is really very troubling because clearly the United States is responding to pressures from industry, and they are undermining an international agreement to which they have agreed upon, because the U.S. Government has also signed the [Doha] Declaration. They have admitted they have accepted these flexibilities, and especially they have accepted that these flexibilities are important in order to ensure public health and access to medicines to all.

And this is the awkward situation in which the FTAA and other bilateral agreements the U.S. Government is completely trying to not only ignore this but to set very high standards of protection, as Ellen mentioned. This means limiting the use of compulsory licensing, extending the term for patents beyond 20 years, and other measures that further restrict the fusion of innovations and access to many things.

There have been many studies about the extent to which it is logical at all for developing countries to apply standards of protection on intellectual property which are similar to those applied in developed countries. And even the World Bank has indicated that there is no logic, no reason for this. And that one size does not fit all, and quite clearly different levels of intellectual property [protection] should apply when different economic and technological levels exist.

And this is in relation to access to many things. It is quite clear, for instance, that in the case of United States and Canada, the rich partners in the FTAA, the problem of access is to a large extent covered by Social Security and Government. This is particularly case of the universal [healthcare] coverage in Canada. And so in these cases, its prices are increased because of higher protection of invention through the patent system and other titles, while there is a State that will provide assistance to the people.

But can you imagine what the impact may be in countries where people have to pay 80 percent or more of the prices of medicines. Can you imagine the impact of these higher levels of protections when you have millions of poor people that have no Social Security, no State help for access to medicines? Therefore the impact of these standards of protection, quite clearly, is very, very different in a developed country, a rich country, than in a poor country.

The United States completely ignores this, and because their business community and pharmaceutical sector is pushing for this, they are just trying to force Latin American countries to apply these high levels of protection, and quite clearly this is unacceptable from a public health perspective. This is, I would say, even unethical because the life and health of millions of people is affected. It is not only a commercial or a trade issue. Fundamentally it has more to do with human rights and the right of people to life.

And so I'll finish now.



Thank you very much, Professor Correa.


I think now we will open up the conference call to any questions.



Thank you. Ladies and gentlemen, if you have a question at this time please press the one key on your touch-tone telephone. If your question has been answered or you wish to remove yourself from the queue please press the pound key.


Our first question comes from Laurie Garrett of NewsDay.



Good morning, and thanks for putting this together. Ellen or someone there, could you just walk us through the timetable and the sort of logistics of what's coming up and what are the key datelines of when things are happening in the near future?




Yes. Thank you. I think that that's also a question Luis or Carlos can respond to. An important date for the FTAA is the FTAA meeting that will take place in Miami in November [16-21]. There has been talk about concluding the FTAA negotiations and the agreement by that date, but considering the fact that Brazil has objected to many of the proposals that have been made, people close to negotiations say that that would not be very likely. But I would like to so invite others at this point to respond to this question, who are closer to the negotiations.




Dr. Villa, Professor Correa?




Well, I think this is correct. The deadline is 2005, and so discussions on intellectual property and other issues have been going on for some time, and they will continue. And these will probably become one of the main issues at the very end of negotiations.


I think it's important to stress that there is a major risk, really major risk, that at the end of the negotiations perhaps many Latin American countries will accept the proposal by the United States that will lead to this increase in intellectual property protection. We can imagine a situation in which these countries will be faced with the option of either accepting these levels of protection or losing concessions that eventually the U.S. and Canada will make in other areas.

In other words, I think at the very end of negotiations, trade ministers will be facing these very hard options. And in this context they may prefer some trade concessions in this area rather than in some areas that are critical perhaps for some economies. And then they will be forced to have these higher standards of intellectual property protection.

A similar scenario, as I mentioned, existed when the Trips agreements was adopted. Developing countries were offered theoretical advantages in other sectors. And that was one of the main factors for the approval of the agreement. And as you know, in this case then public health may be the big loser of such a deal.



Well, I'd like to say something because regarding Central America, as I mentioned before, the agreement between the countries in Central America and the States [will be implemented] by the end of this year.


This agreement is really important, because we know that the same issues are being proposed and are being discussed for the FTAA. I think it will set -will be like a benchmark for the negotiations next year for the whole region.



Our next question comes from Corey Henry of U.S. Trade.




It appears that at the WTO today or perhaps tomorrow members will come to an agreement on the Trips declaration with respect to the outstanding agreement from December of last year. But I understand that Doctors Without Borders is one of the NGOs that's objecting to language, would see, you know, developing countries not be able to use compulsory licenses as an instrument to pursue industrial and commercial policy objectives. I am just wondering if you might comment on why you would be opposed to such language, and in general, what your feelings are on the proposed deal that looks likely to be agreed this week?




I think we can go to Ellen for an answer to this question. Ellen.




Yes, thank you for this question. We're following what is going on in Geneva at this very moment, actually in three minutes the Trips Council will meet again. The text that is being discussed this week at the WTO in preparation for Cancun will be a statement by the Chair of the Trips Council that will accompany the so-called Motta text.


And the Motta text is the text that was supposed to be the solution to a problem that was left unresolved in Doha, namely how to assure the production and exportation of generic versions of medicines in the future once the Trips agreement is fully implemented [in 2005, in 2016 for least developed countries].

You can, on the one hand, say countries are free to issue compulsory licenses, but if you cannot produce the drugs yourself you have to be able to find it somewhere else. Technically, legally, countries are allowed to import. But if in practice there are no generic producers around anymore, well that becomes an empty meaningless provision.

So the objective is to make the production and exports of those medicines easier. But what we've seen in the proposals that have been made both in the Motta text and now with the declaration of the Chair of the Trips Council is that these procedures are being made extremely complicated, complex, local procedural requirements that requires two compulsory licenses in two different countries. Two countries have to report to the Trips Council and other countries can immediately question it. It introduces new role for the Trips Council in terms of being able to take action, although it is unclear what kind of action the Trips Council could take.

And then there is this language about the commercial activity, which is new language introduced in the statement of the Chair that says that it is understood that this provision should be used for public health, and not to pursue commercial or industrial objectives. And that is very strange language, because in fact what it says is that pursuing public health and pursuing commercial objectives are contradictory objectives.

Well, of course, in the real world we live in, pharmaceutical provisioning and the availability of pharmaceuticals largely depends on commercial and industrial activity. We need more commercial and industrial activity in the pharmaceutical area and not less. Higher intellectual property protection is aimed at having less activity and more monopolistic situations.

What we see in our reality and what we see in the field, we buy the drugs cheaper when there are more active producers. And so we feel that there should be an emphasis on having more production of these pharmaceuticals in multiple places. Because as soon as more producers are active, the prices go down. And so if you narrow the production of pharmaceuticals to a kind of not-for-profit type activities you take away what should be, in fact, the normal business. And we feel that over time, we'll completely dry up the availability of generic medicines, particularly the newer medicines after 2005.



Thank you very much, Ellen.




Our next question comes from Paul Magnusson of Business Week Magazine.




I'd like to just close and thank everyone for joining the call today. We do know that there's a lot going on, and we are very appreciative of your attention and hope that you will be able to write on World TB Day. It's marked on March 24, next Monday. If anyone has any further questions on the Alliance or the work here, please feel free to give me a ring, and we'll be in touch shortly. Thank you, operator, as well.




Professor Correa.




Yes, I would like to address these. Well, you know, there is no evidence at all to support that kind of statement. In fact, if you look at recent history then the U.S. pharmaceutical industry was the most profitable industry in the United States before the adoption of these international rules or before the implementation of the Doha agreement, if you look at the profits of the industry in the 1980s and 1990s in the United States.


And so the contribution developing countries can actually make for the research and development enterprise of these companies is quite limited. Between 80 and 90 percent of sales, by these companies, are in developed countries. And so they get most of the resources for recovering certain development costs from the developed countries themselves. And it is not credible that any action taken by developing countries, particularly increasing competition in developing countries, will hurt this capability.

The other problem I'd like to mention is that there is some real exaggeration about the limitations or the losses that compulsory licensing may create. And in fact, compulsory licensing is not in use every day. And as experience can show, it is used when it is needed.

On the other hand, the practice by the pharmaceutical companies with the use of the patent system has been that they apply for and in many cases are able to obtain patent rights not on major innovations or new molecules, which are very few, in fact rare. But they get a large number of patents on a line of treatment development, and in some cases, developments that are patented just to block generic competition.

So the problem that the patent system poses is a significant one because these legal titles are used in order to delay or block the entry of generic competition that would mean lower prices for patients and greater access to drugs.

And so I will certainly, just to conclude, say that this argument by companies cannot be sustained. There is no solid evidence to argue that the measure that are, or may be adopted by developing countries to protect to public health will in many manner, and I stress in many manner, hurt the research and development capacity of these companies.



Ellen, is there anything you would like to add to Professor Correa's remarks on intellectual property protection and research and development?




Yes, thank you Kevin. I would, because I think the issue of research and development is an extremely important one. Because we need more research and development in the health area, and we need more health oriented research and development. The research and development in the pharmaceutical field for diseases that are rampant in the developing world and for the so-called tropical diseases and the neglected diseases have almost come to a standstill. There is almost no activity in that area whatsoever.


And I think that the discussions that are taking place on the protection of intellectual properties should also include how can we assure that we're actually designing a system that encourages research and development that meets real health needs. Of the 1,300 new chemical entities of the last 25 years, about 13 were for tropical diseases and that includes tuberculosis. So we're dealing at the moment with a real research and development crisis that needs to have a solution. Under the present system, it will not come from the larger pharmaceutical companies because they're mostly investing in where profit opportunities are in North America or in Europe.

This is also a reason why we're saying we need more industrial development and more industrial activity in developing countries because there, where you have pharmaceutical and industrial activity you will also see research and development activities emerge. And hopefully, those will then start addressing health needs in developing countries themselves over time.



Thank you.




Our next question comes from Harold Neuber. Sir, please state your media affiliation.




Yes, it's the Daily Newspaper (in Germany). And my question goes to the folks, and I would like to know what you think of public-private partnerships? Can this kind of corporation really be helpful for you, or is it just a kind of PR for pharmaceutical companies? Thank you.




And would anybody like to field this question?




Yes, I think I could give a few comments. It is a difficult question because there are many so-called public-private partnerships. And there are quite a number that are, indeed, more like public relations activities than initiatives that are really anchored in doing something.


There are public-private partnerships in the research and development area that could perhaps bring results because they are based on the fact that there is a profitable market to be tapped in the north. And so if you develop a drug for which there is a market in America or in Europe then you could sort of segment those markets, sell it at a higher price, and then sell the new drug at a much lower price in developing countries.

But for those diseases for which there's no market opportunity, those diseases that do not occur in richer countries, public-private partnerships will not deliver at all. And there you need an entirely different approach to research and development. That's also one of the reasons why MSF Doctors Without Borders is involved in an initiative called DNDi, the Drugs For Neglected Diseases Initiative. It aims to develop drugs for the most neglected diseases on a not-for-profit basis. That means those diseases that only occur in countries where there are huge needs but no market opportunity.



Thank you very much.




Our next question comes from Corey Henry of Inside U.S. Trade.




I'm just curious, with the WTO members likely to agree to this new Chairman's statement, you know, do you have a sense of what it is exactly that has satisfied the, you know, that developing countries have seen in there that they could find acceptable?




Would anybody care to field this?




I could try to answer that. To be honest I think it's very difficult to see the positive elements of this solution. And privately those involved in the negotiations will also say so.


One of the reasons why countries may agree to a text today or at the latest tomorrow morning is that countries do fear that if this issue goes to Cancun that they may have to pay a second time, that they may have to give in on other issues to get the medicines' issue resolved. So it's more of a negotiating practice. They'd love to get this thing out of the way so that we won't have to pay in terms of having to give in on other subjects in Cancun.



Our next question comes from Paul Magnuson of Business Week Magazine.




I wonder if you could address the question of price control? My understanding is that the United States is the only industrialized nation without price controls on pharmaceuticals. Obviously, there's Medicare, there's the Veterans Hospitals, and so forth that can negotiate, and the Managed Care companies can do some of that. But it's more a free market in the United States.


Is what your organization ultimately interested in, is your goal more of a price control structure for the world, maybe a two-tiered price control system where the developed nations pay more and the developing nations pay less? Is that the larger point?



Yes, well, what we're saying is that, obviously, rich countries should pay more for their medicines than poor countries. That does not mean that we're saying rich countries should pay as much as possible for their medicines. That is a different issue. We are not working on issues related to medicines, and medicine prices in the United States.


We do pursue strategies that will ultimately lead to tiered pricing, different pricing in different markets. And we feel that one of the, well, feel is not the word - we know from our experience that competition is the most effective way to bring prices down.

And so we want to make sure that the generic manufacturers, generic competition continues to be alive. Most of the medicines we use in our projects, and particularly in the project where we're using newer medicines, such as in our AIDS Projects, come from those companies. We get the best prices. In general, we get the best prices from the generic companies and we get the prices if there are a number of - three, four, and an ideal number is five - manufacturers active.

And you could imagine a world where you have in a way different intellectual property regimes, where you have the United States that may want to keep its very strong intellectual property regime but could allow a much more flexible implementation of the Trips agreement in the developing world that would allow this type of generic competition to be maintained and even to be strengthened.

Another strategy is that it will encourage companies, also the multi-national companies, to price their drugs lower in those markets. Clearly, when companies need to compete with other companies you also see that, for example, the Glaxo or the Pfizer medicines, they have to compete with generic manufacturers with much lower prices than in countries where they have a monopoly situation.



And perhaps Dr. Villa can talk about the specific examples of these issues in Guatemala, and what it means for the patients there?




Yes. Well, thank you. I will give you an example of a drug that we used to treat opportunistic infections. This is fluconazole. Fluconazole sells here in Guatemala at more or less around $12 versus $23 in Spain. Through generic suppliers, each pill only costs MSF 30 cents.


So the difference is huge. I mean with the very restricted health budget here, they are only able to a certain amount of drugs every year. And so the difference - not only for MSF but for the public health system - is huge. Being able to buy a treatment is the difference of having to pay $23 per pill or paying 30 cents per pill.

Another good example is the HIV treatments. As I mentioned before, I mean from 2000 until now, we came down from $10,000 per patient per year to $500 per patient per year. Even the originator companies, with generics in the market, have to lower the price of their drugs, because there was no way that they could compete with generics.

So the price came down from $10,000 per patient per year to $1,000 per patient per year. Now, that's more expensive than the generics but quite cheaper than they were just two years before. And this was only because they have to compete with the generic drugs.

Even so, the Government here in Guatemala is buying a combination of generic and originator medicines, and for one month of treatment, they are paying the amount of money that MSF pays for a whole year of treatment. This means that we can treat 12 patients a year with the same amount of money the Government spends to treat only one patient.

I want to explain that the difference is huge not only for organizations like us but also for the public health systems in poor countries.



And Dr. Villa perhaps you can follow that up with discussing some of the grassroots activity that is going on in Guatemala. Today MSF is launching an international campaign to speak out against proposals put forth for the Free Trade Area of the Americas (FTAA). And so perhaps you can talk about how that fits in with some of the other grassroots activity.




All right. Thanks, Kevin. Yes, we are launching this campaign here in the Americas, in Brazil, for South America and in Guatemala for Central America. Our main request is that all intellectual property protection issues are left out of the bilateral agreements between Central and South American countries and the United States.


And we are continuously asking the governments here in Central America and South America why they are willing to negotiate all these intellectual property issues while they already have an agreement they could use to buy medicines in an easier way and at a cheaper price.

We are wondering why, if they already have an advantage, why they want to lose the advantage, and why they just want to go backward and constrain the health systems with a lot of regulations that will seriously hinder the access to health especially for certain diseases. This also has a profound impact on the ability of a country to get out of an impoverished situation. We are talking about diseases that mainly affect people between 15 and 45 years old, people who are part of the work force of these countries, and other persons the system will have to take care of.

And so we have two main objectives with this campaign: one, to provide clinical support to our colleagues here in Central America and South America. The second one is trying to put some pressure on the politicians here, and just make them answer this simple question: why are you willing to discuss something that will eliminate an advantage if you have something that you could already use and will be good for your people?



And Professor Correa, would you like to add something to that?




Well, yes. I think that this last statement is very important. There is no reason whatsoever why developing countries in the Americas should now expect to include a set of new rules on intellectual property in a trade agreement with the United States and Canada. Certainly these countries are just starting to implement the Trips Agreement, which as we mentioned, establish high standards of implementation. And so they are experimenting with these new rules. And they are facing the kind of obstacles we are talking about. And it's quite clear that in particular with pharmaceuticals, the introduction of patents is creating high costs for societies and it's control.


And so from the point of view of rational policy for these countries in Latin America there is no reason at all to increase protection. When the Trips Agreement was negotiated for instance there were promises that it would bring about more investment, more transfer of technology, and more innovation related to the diseases prevalent in developing companies. As we know, these higher standards of implementation for patents are not bringing more foreign investment in these areas.

For instance, in many Latin American countries after implementation was introduced for pharmaceuticals, a large number of production plants were closed down by multinational companies. This is the case in Chile, Peru, Columbia, and other countries. There is less transfer of technology, and less competition.

In many cases, legitimate generic competition is stifled on the basis of patents that do not really cover actual innovations but rather treatment developments. Sometimes they are used to delay generic competition.

And finally, as Ellen has mentioned, there is no indication at all that increased intellectual property protection in a country has led to any increase in research and development related to the diseases which are prevalent in these areas. For instance, Chagas disease, which affects millions of people, and many others with tropical diseases are not part of the research agenda of these companies.

And so, there is no argument for the governments in Latin America and the developing countries in the Americas to go for higher standards of protection in this area. As we know, this is just because the United States is putting pressure for this, and they want to exchange these increased levels of protection against other possible concessions in other sectors. And as I mentioned before, this is unacceptable from the point of view of public health. It is not a trade issue, it's an issue that has very significant implications on health and life of the people.



Thank you, Professor Correa. I want to thank both our participants and those who called in, for joining us today, and wish everybody a lovely afternoon and evening.




Ladies and gentlemen, thank you for participating in today's conference. This concludes the program. You may all disconnect. Everyone have a great day.