The WTO under Okonjo-Iweala: Challenges of Access to Medicine for Africa

In the 1990s, millions of HIV/AIDS patients in Africa died as a result of patents placed on the manufacturing of medications by pharmaceutical companies in the Global North. Since the past two decades, however, the WTO has worked with representatives of developing countries, advocacy groups and regional organizations to ensure that pharmaceuticals prioritize public interest over profit-making. Progress has been made, but the final destination of that conversation is still an appreciable distance away. South Africa and India are currently pushing for a waiver of patents on COVID vaccines to enable them to produce cheaper, generic versions for distribution to less financially viable economies. While it took heavy global convergence to extract compliance from pharmaceuticals in the case of HIV/AIDS, it appears a consensus will be more easily reached this time. A WTO chief who is not afraid to speak out in favour of Africa and other developing countries does make a lot of difference. Hopefully, African countries will be spared the worst effects of the pandemic, if access to vaccines and other medications ceases to prize capitalist accumulation over human life and suffering.

Although the WTO Trade-Related Intellectual Property Rights (TRIPs) is referred to as an agreement, it is everything short of that term, especially where Africa is concerned. The final draft of TRIPs was adopted in 1995 with minimum input from African countries that could not afford the highly skilled and expensive representation needed during the negotiation of trade issues at the WTO. Under the TRIPs agreement, it became possible to place international patents on medicines for the first time. What this means is that once a pharmaceutical company in any WTO member state has patented a pharmaceutical process or product, it can no longer be produced by any other pharmaceutical company in any member state. The WTO TRIPs agreement prevents member countries from producing medicines patented in another member country even if half of a country’s citizens are being wiped out by a plague. Once the country cannot afford to buy medication from a pharmaceutical production company in the West, it is usually allowed to perish.

Following the adoption of TRIPs, there was an astronomical increase in the cost of life-saving medications originating from Europe and the United States. Countries with little or no research and development base were losing sick citizens by the hundreds of thousands; African countries were the worst hit. Countries like India that could manufacture generic versions of these medications were barred from doing so.

With an emphasis on pharmaceuticals, American doctors have taught for centuries that medical knowledge should be shared freely for the benefit of patients and never for private commercials’ benefits. Anyone who can muster technological know-how to help the suffering of humanity should not be discouraged from doing so. The American Medical Association made it the basis of its earliest Code of Medical Ethics in 1847, with a declaration that considered it “derogatory to professional character” for a physician “to hold a patent for any surgical instrument or medicine.” This was a matter of licensing for practice, with serious professional consequences if violated.

Having built a strong foundation in medicine and pharmaceuticals as a result of this humane approach, the ultra-capitalist pharmaceutical companies in the 1995 TRIPs agreement, muscled the rest of the world out to insist that patients who could not afford expensive versions of life-saving medications should be allowed to die.

American pharmaceuticals’ embargo on access to the production of affordable, generic versions of life-saving medications is in stark contrast to the intellectual property history of the United States, a country well documented for state-sponsored production of other nations’ technology. In the 18th and 19th centuries, the American government actively encouraged citizens to pirate technology from other countries and patent and commercialize it in the United States. In his book, Hot Property: The Stealing of Ideas in an Age of Globalization, author Pat Choate notes that “any American could bring a foreign innovation to the United States and commercialize the idea, all with total legal immunity.” This made the United States, “by national policy and legislative act, the world’s premier legal sanctuary for industrial pirates.” Today, through borrowing ideas and learning from other nations, the United States has been transformed into a global industrial power. In the words of respected trade historian, Doron Ben-Atar, writing in his book, Trade Secrets, “the United States emerged as the world’s industrial leader by illicitly appropriating mechanical and scientific innovations from Europe.

When the world gathered in Durban, South Africa, for the very first International AIDS Conference to be held on the continent, only one in 1,000 people living with HIV in Africa had access to AIDS treatment. That was because only Euro-American companies were allowed to produce Antiretrovirals (ARV) and their cost was US$10,000 to $15,000 per patient per year

The global outcry against the injustice of the TRIPs agreement led to some changes in 2001 during the Doha Round of Trade Talks. It was at that meeting that low- and middle-income countries were given the go ahead to produce cheaper, generic versions of life saving medications.  

Upon her resumption of office as the DG of the World Bank, Okonjo-Iweala met at her table a proposal from South Africa (co-sponsored by India), requesting a waiver of Intellectual Property Rights from COVID vaccine for 3 years, which is enough time to produce and distribute generic versions of the presently expensive vaccine in order to make it more accessible to a wider global population. Other African countries (as well as other non-African countries) have since joined South Africa and India in making the demands.

Western pharmaceutical companies are fighting this proposal, insisting on being allowed to make as much profit as possible from life-saving medicines. In this conversation, the most important point is that Dr. Okonjo-Iweala, through her utterances, has shown great courage in standing up for equal access to life-saving medications for all. In an interview she granted to CNBC, Dr. Okonjo Iweala stated that “the level of inequity is quite high,” since access to vaccines is tied to the rate of economic recovery in the wake of the pandemic. “I am very concerned that if we continue with the inequity… [it] will have a dampening effect on the recovery in those countries,” said the Director-General of the WTO. Dr. Okonjo Iweala’s courage has inspired many leaders to stand up and join hands with her, South Africa, India and other countries in demanding a waiver.  Indeed, in a surprising turn of events, the President of the United States, Dr. Joe Biden, is standing up to his own pharmaceutical companies by speaking out in support of the call for a waiver.

It is hoped that under Dr. Okonjo Iweala’s courageous leadership, the necessary waiver for COVID drugs will be secured, and beyond that, other questions of inequality being faced by African countries will be addressed during her tenure.

First published by the Pan African Review Magazine.