G-8: the road to Evian

On June 1, the G8 leaders will gather in Evian, France, where access to medicines is again at the top of the their agenda. (The G8 countries are: Canada, France, Germany, Italy, Japan, Russia, UK, USA.) That same day, according to far too familiar disease statistics, 19,000 people will die from AIDS, tuberculosis, malaria, African trypanosomiasis, and visceral leishmaniasis.

These five diseases represent the failure of the pharmaceutical industry to deliver medicines for the developing world, and the non-response from governments to this market failure. The G8 has an enormous political and financial potential to curb this death toll. However, while several important commitments have been made to improve access to medicines in the past 3 years, few have been achieved, and many have been forgotten (panel).

In 2000, G8 leaders in Okinawa committed to setting up a "new" partnership with governments, international organisations, industry, academia, and nongovernmental organisations aimed at reducing disease burden for HIV, tuberculosis, and malaria—also noting the impact of pneumonia, diarrhoea, measles, and other childhood infectious diseases.

The focus was on three main themes: improving health systems, improving access in developing countries to medicines and preventive measures, and strengthening the research and development of new drugs, vaccines, and other tools for diseases common in developing countries.

The adjunct Okinawa Infectious Disease Conference led to support for a range of much-needed policies to increase drug access and research and development, including a commitment to "increasing our support . . . for the R&D of international public goods" through mechanisms such as purchase funds or bulk procurement; and to "make key drugs, vaccines, treatments and preventive measures more universally available and affordable in developing countries".

The G8 meeting the following year in Genoa took place in the context of growing international pressure on increasing access to medicines, particularly for HIV/AIDS. The South African legal case had been dropped by the pharmaceutical industry in February, 2001(South Africa wanted to import more affordable anti-AIDS drugs, and was sued by 39 pharmaceutical companies).

The TRIPS Council (Trade-related Aspects of Intellectual Property Rights) had started to discuss access to medicines. And the UN General Assembly Special Session on HIV/AIDS in June resulted in the launch of the GFATM (Global Fund to Fight Aids, Tuberculosis and Malaria). However, amid mounting evidence that patents result in high prices for drugs while doing little to stimulate research and development into the diseases of the developing world, the G8 chose to emphasise the importance of strengthening intellectual property rights.

The disease focus at Genoa had narrowed to AIDS, tuberculosis, and malaria while research and development for tropical diseases had fallen completely off the agenda.

At Kananaskis in 2002, under the shadow of terrorism and security, the G8 reached for the lowest hanging fruit. A needed commitment was made towards the elimination of poliomyelitis, but ambitions at Okinawa to increase research and development in areas that are completely failed by market forces and public policies were ignored.

On AIDS the focus was almost exclusively on preventive measures, at a time when the need to ensure treatment for the 6 million people who currently need it was gaining international acceptance.

Since Okinawa, the number of HIV-infected children has nearly tripled from 1.3 million to 3.2 million; 6 million more people have died from tuberculosis; and malaria mortality in children-under-5 has increased up to 5-fold in some parts of Africa. And yet, under the guise of doing good, the G8 in fact appears most concerned about protecting their own interests.

Strong commitments to stimulate research and development into new health tools for the diseases of the developing world as international public goods have dissolved; proposals to promote research and development by private industry have not been adequately laid down; and the crisis in research and development remains as acute as ever.

The GFATM now risks becoming bankrupt, largely because G8 countries have not contributed enough, while even the basic right of developing countries to access generic medicines for infectious diseases risks being swept away by efforts from G8 members to limit the scope of compulsory licensing.

The G8 have the financial and pharmaceutical resources to do an enormous amount of good. They should do this by: making existing medicines affordable through promoting equity pricing (fair, affordable, and equitable drug pricing achieved through such mechanisms as generic competition, global procurement and comprehensive tiered pricing) and the Doha Declaration on TRIPS and public health (which affirms the right of countries to protect public health and ensure access to medicine for all); increasing funding to help purchase existing medicines; and establishing needs-driven research and development through public funding and the enhancement of north-south and south-south collaboration and technology transfer, guaranteed through an international convention.

In other words, the G8 should move towards meeting past commitments rather than away from them, and to demonstrate to the developing world that it can put global health above the interests of industry in the developed world. No more broken promises.

Mary Moran, *Nathan Ford