At the Global Health Diplomacy Symposium held in Geneva (November 23), speakers illustrated the complex relationship between public health concerns, trade and intellectual property. Traditional actors in the global health arena, including WHO alongside current leaders from other international organizations in both public and private sectors, gathered to express their determination to remain relevant and engaged in the global health governance arena. Ten years after the Doha Declaration, chiefs of WIPO, WHO and WTO remain under increasing pressure to ensure patent protection and the protection of intellectual property, to act according to the complex interrelation of their respective mandates, and to address public health concerns. To simplify this complexity, a trilateral relationship has been created to facilitate cooperation (between WIPO, WHO and WTO) on matters of public health, intellectual property and trade, and to ensure a proper balance between intellectual property and access to essential medicines and other public health concerns.

Since the 2011 Doha Declaration, one of the main challenges remains the states' lack of policy coherence when negotiating on 'trade-related aspects of intellectual property rights' (TRIPS). At the Symposium, Pascal Lamy, Director-general of WTO stated, "I sometimes see countries who in the WTO will take a very vibrant position on problems with the TRIPS Plus agreements," but who, elsewhere, "will de jure and de facto accept a TRIPS Plus agreement because they are in a negotiating context that leads to this.'' According to Lamy, international organizations have their hands tied by their limited political power and limited role in advocating the use of TRIPS flexibilities - which remain the responsibility of member states. Lamy remained cautious and diplomatic when speaking in the debates on intellectual property within his organization, including in the discussion stirred by the current implementation of the Doha Declaration Paragraph 6. The latter ensures the possibility of issuing compulsory licenses for pharmaceutical companies to produce generic medicines for countries that do not have the capacity to manufacture certain drugs. Since its inception, the paragraph 6 waiver to TRIPS has only been used for generic drug exports from Canada to Rwanda. Evoking this ongoing debate, Lamy declared ‘’It is not for me to take sides… We can only hope to have, as far as possible, an informed debate.’’ 

Despite the continuing debate on TRIPS, the discourse has shifted to the current need for incentives for innovation in global health. Director-general of the World Health Organization, Margaret Chan, is confronted by new players joining her organization's traditional role in global health governance. At the Symposium, Chan underlined that "the biggest challenge is how to find the right balance to provide incentives and at the same time to assure access."  As organizations attempt to adapt to the current dynamics of global governance, WIPO Director-general, Francis Gurry, said "we need to find a way of encouraging innovation ... new medicines will come from innovation."  WIPO's recent work in the global health governance arena includes the creation of its latest public-private partnership, WIPO Re:Search, which aims to increase collaboration between public and private actors in research on ''neglected diseases.'' 

Presently, it is not only the traditional actors who are addressing the need for innovation; other key players, including private-public partnerships, are attempting to be flexible as they face the difficulties of the financial crisis as well as increasing pressure to fulfill public health demands. Executive Director of the Global Fund, Michel Kazatchkine, whose organization is currently facing a significant financial crisis, made a clear statement about the Fund's work to remain efficient and relevant. "The Global Fund is trying to become more involved in market dynamics; that means inviting countries to join, be involved in procurement and voluntary pool procurement.’’ CEO of GAVI, Seth Berkeley, also stressed the need to consider innovation in global health governance, "the future is not going to be Big Pharma alone in the world of innovation …personalized medicine is going to come in.  Innovation occurring in much smaller companies, such as academia…We are going to see new and innovative models…The engagement of the developing world is going to increase from generics manufacturers to R&D, innovation, open-source; serving markets from their innovation, focusing on the needs of the developing countries… Again, this requires innovative partnership but not only big companies or UN alone….it is going to be innovative market creation, we heard about the large purchasing fund GAVI, Global Fund, and how these morph over time.  We are going to see markets affected by these funding mechanisms, including the transition.’’  Berkeley also stressed the need to create appropriate pricing in developing countries though innovative means, including the creation of purchasing co-ops.

Ten years after the 2001 Doha Declaration, the quest to lead in the global health governance arena is still on. This has clearly created new forms of authority and new relations of power. Since the 2001 Doha Declaration, the discourse on TRIPS has been reconsidered and reframed by shedding a light on the existing relationship between trade, innovation and public health, and the need to ensure the right balance. As the implementation of TRIPS flexibilities is considered by some to be unsuccessful, due to political and economic pressures from both public and private interests, the discourse has evolved and no longer revolves solely around the confrontation between intellectual property and access to medicines. It has embraced the need to consider the importance of innovation in health, with regard to product development and financing mechanisms.

(Photo ©World Trade Organization)