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Global health poison pill for poor wrapped in Obama’s trade bacon

A summit with leaders of the member states of the Trans-Pacific Strategic Economic Partnership Agreement (TPP) in 2010. Wikipedia

News analysis

The latest battle between the Obama Administration and Congress is a confusing one focused, nominally at least, on improving international trade.

Much of the coverage has been on the horse race, on warnings by US policy makers of how Obama’s trade agenda could hurt American workers and on the bizarre debate in Congress about whether or not Congress should even have a say in drafting the world’s biggest ever trade deal.

As a result, the actual issues at stake often get short shrift. That goes doubly for how this deal could affect the world’s poorest – especially when it comes to their health. Some of the latest headlines:

How Asia trade deal could make or break Obama’s foreign policy vision

Obama, GOP allies, try to revive trade deal but hurdles remain

House votes to buy time for Obama’s trade agenda

Now, nearly everyone wants to improve trade, including many of those in the anti-poverty business or sector. Most agree that a healthy marketplace can sustainably contribute more to reducing poverty than even the most well-intentioned charitable program (since charity is only sustained as long as the giver feels like giving).

The countries involved in the TransPacific Partnership trade talks.

The countries involved in the TransPacific Partnership trade talks.

But how? Do you best improve trade by making life easier for mega-corporations to operate globally or by measuring success solely on large-scale economic productivity gains? Do you improve trade by incorporating into the profit-making schemes better protections for individual workers, by requiring ventures be environmentally sound or by otherwise constraining some of the less desirable by-products of the so-called free market? (I like to tweak my laissez-faire friends by suggesting eastern Congo is perhaps the closest thing to a pure free market.)

Is the best way to improve trade to negotiate all these questions behind closed doors and give the President ‘fast track authority’ to approve the deal, effectively eliminating Congress’ ability to modify it? That may be best if legislative efficiency and service to the business interests are your higher priorities. It may not be best if democracy and public accountability are important when setting up global trade rules.

So, yeah, how you improve trade is the real question. The weird thing about Obama’s trade agenda, other than that he is allied mostly with Republicans and fighting mostly with progressive Democrats, is that we don’t really know what’s on the agenda.

The centerpiece is something called the TransPacific Partnership (TPP), a trade deal that would encompass some 40 percent of the world economy, which so far has not been revealed to the public. The Obama ‘trade agenda’ lately has been a proxy term for first trying to get Congress to give the President the power to approve the TPP and only give Congress a ‘yes-or-no’ vote.

Many progressives and conservatives alike, such as Sen. Elizabeth Warren (D-MA) in the former and Iain Murray at the Competitive Enterprise Institute in the latter camp, oppose giving the President fast-track authority to pass the TPP, though sometimes for quite different reasons.

The humanitarian community, focused on fighting poverty, appears split  as well on whether or not to support the Obama Administration’s push to pass the TPP, as we reported in early May.

Any piece of legislation this big and geopolitical can be pretty overwhelming to get a grip on. So let’s focus on just one piece of it that the public – thanks to Wikileaks – has been told about and which may indicate the general strategy of this semi-secret trade proposal.

Drug prices. As the AIDS pandemic in the year 2000 showed the world, lack of access to affordable medications can be murder on the poor. When new life-saving anti-HIV drugs came on line in 1996, it felt like a miracle. People with HIV who had been expected to die were saved, sometimes from the brink of death. Much of the despair that attended an HIV-positive diagnosis disappeared. AIDS became rare as HIV became a chronic, manageable illness like diabetes.

In rich countries anyway. Patent protection on these life-saving drugs meant the poorest of the poor – including those experiencing the lion’s share of the pandemic in sub-Saharan Africa – were still dying. To make a long story short, AIDS activists, bold government officials in Brazil and South Africa, health advocates and others pushed to demand that the pharmaceutical industry allow poor countries to produce these drugs as generics, cheaply.

Arguably, that’s what turned around the world’s AIDS pandemic. That’s what led to funding major initiatives like the Global Fund or Pepfar; cheap drugs made wide distribution to the neediest possible. That’s what led to seeing fewer photos of AIDS patients looking like concentration-camp prisoners and many more photos of HIV-positive people in poor African communities living relatively normal lives.

A number of humanitarian organizations, most notably Medicins Sans Frontieres (aka Doctors without Borders), contend the TPP would make that kind of a success story (success for those who think public health should trump profit concerns, that is) much more difficult. Even as the drug industry is now churning out new life-saving drugs that can easily cost something like $100,000 or more for a year’s treatment or to achieve cure, many in the industry appear determined to make patent protections ensuring those profits even more rigorous and long-lasting.

James Love

James Love

As Jamie Love, director of the consumer protection advocacy organization Knowledge Ecology International, wrote recently for The Hill, passing the TPP will only serve to increase drug prices by virtue of its approach to patent protections:

The result is to lock the United States into the spiral of increasing prices and increased rationing for expensive drugs – putting patients are risk.

The trend in drug pricing allowed by our approach to protecting industrial intellectual property, Love warns, is already harming Americans’ access to critical medications and threatening to undermine whatever gains in cost control may be achieved by recent health reforms.

But as MSF says, the situation for the poor around the world will be orders of magnitude worse if the leaked language of the TPP governing drug patent protection is passed without challenge or debate:

“(L)eaked drafts of the United States government’s proposals for some sections of the agreement reveal the inclusion of dangerous provisions that would dismantle public health safeguards enshrined in international law and restrict access to affordable generic medicines for millions of people in developing countries…. MSF urges the U.S. government to withdraw—and all other TPP negotiating governments to reject—provisions that will harm access to medicines.”

There are many concerns raised about the TPP, including further endorsing the trend of allowing corporations to sue governments for denying them ‘potential profits’ if they pass laws that hurt business ventures. Here’s a story we did about one of those kind of disputes already playing out in El Salvador – thanks to previous ‘free trade’ bills that set up this extra-ordinary global judicial process known as investor-state dispute settlement.

But these arguments can get very wonky, euphemistic and incomprehensible pretty fast. Focusing solely on what the TPP may mean for drug pricing (since it’s one of the few portions leaked to the public) should be enough to show where the negotiations are finding the balance point between making the world safer for business and making this trade deal best serve the interests of the public, here and abroad.

So far, based on what little we know, the humanitarian community could do a lot more to make sure this is a trade deal that isn’t trading away what’s needed to continue making progress against poverty and inequity. The TPP looks to many to contain a big poison bill for global health. Where’s the global health community stand?


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.