29/44 Report of the 2015 Social Forum (Geneva, 18–20 February 2015)
Document Type: Final Report
Date: 2015 Apr
Session: 29th Regular Session (2015 Jun)
Agenda Item: Item5: Human rights bodies and mechanisms
GE.15-07704 (E)
Human Rights Council Twenty-ninth session
Agenda item 5
Human rights bodies and mechanisms
Report of the 2015 Social Forum (Geneva, 18–20 February 2015)*
Chairperson-Rapporteur: Faisal bin Abdulla al-Henzab (Qatar)
Summary
The present report contains a summary of discussions and recommendations of the
2015 Social Forum. In accordance with Human Rights Council resolution 26/28, the Forum
was held in Geneva from 18 to 20 February 2015, and focused on access to medicines in
the context of the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health, including best practices in that regard.
* The annexes to the present report are circulated as received.
United Nations A/HRC/29/44
General Assembly
Contents
Paragraphs Page
I. Introduction ............................................................................................................. 1–3 3
II. Opening of the Social Forum .................................................................................. 4–6 3
III. Summary of proceedings ......................................................................................... 7–58 4
A. Keynote speakers and general statements ....................................................... 7–10 4
B. Overview of access to medicines in the context of the right to health ............ 11–15 5
C. Improving health delivery systems in challenging contexts ........................... 16–20 6
D. Access to medicines for women and children ................................................. 21–25 8
E. Intellectual property rights and access to medicines ....................................... 26–30 9
F. Lessons learned and emerging challenges in the global response to AIDS .... 31–35 10
G. Patient-centred approaches to access to medicines ......................................... 36–41 11
H. Breakout discussion groups and plenary discussion ....................................... 42–43 13
I. Innovative approaches to promoting access to medicines .............................. 44–49 13
J. Good practices in promoting access to medicines (round table) ..................... 50–58 15
IV. Conclusions and recommendations ......................................................................... 59–74 18
A. Conclusions .................................................................................................... 60–66 18
B. Recommendations ........................................................................................... 67–74 19
Annexes
I. Provisional agenda ........................................................................................................................... 21
II. List of participants ............................................................................................................................ 22
I. Introduction
1. The Human Rights Council, in its resolution 6/13, preserved the Social Forum as a
unique space for interactive dialogue between the United Nations human rights machinery
and a variety of relevant stakeholders, underlining the importance of coordinated efforts at
the national, regional and international levels for the promotion of social cohesion based on
the principles of social justice, equity and solidarity; to address the social dimension and
challenges of globalization; and issues linked with the national and international
environment required for the promotion of the enjoyment of all human rights by all. 1
2. In accordance with Human Rights Council resolution 26/28, the Social Forum was
held in Geneva from 18 to 20 February 2015 and considered access to medicines in the
context of the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health, including best practices in that regard. The President of the
Council appointed Faisal bin Abdulla al-Henzab, Ambassador and Permanent
Representative of Qatar to the United Nations Office at Geneva, as the Chairperson-
Rapporteur of the Forum.
3. The programme of work2 was prepared under the guidance of the Chairperson, with
inputs from relevant stakeholders. Pursuant to Human Rights Council resolution 26/28,
paragraph 8, background reports made available by the Office of the United Nations High
Commissioner for Human Rights (OHCHR) informed the discussions (A/HRC/23/42,
A/HRC/17/43 and A/HRC/11/12). The present report contains a summary of the
proceedings as well as conclusions and recommendations.
II. Opening of the Social Forum
4. In his opening remarks, the Chairperson-Rapporteur of the Social Forum called on
participants to identify and promote concrete, progressive and action-oriented approaches to
improve access to medicines. Noting the particular significance of that issue to the State
and people of Qatar, he advocated greater international cooperation to guarantee access to
medicines, which was critical for health, well-being and development for all and a matter of
social justice. Therefore inequities, including high costs borne by patients in many low and
middle-income countries, must be eliminated. To that end, the international community
should support innovation and local production, use of flexibilities under the Agreement on
Trade-Related Aspects of Intellectual Property Rights (TRIPS), policy coherence among
human rights obligations and international trade and investment regimes, and active
engagement of all stakeholders, including the private sector, to save the lives of millions
who do not have access to medicines.
5. Jane Connors, Director of the Research and Right to Development Division,
OHCHR, described access to medicines as a critical and timely issue, particularly in the
light of the emerging post-2015 development agenda. OHCHR had consistently advocated
that the agenda be underpinned by human rights law, which obliged States to respect,
protect and fulfil the right to health. The International Covenant on Economic, Social and
Cultural Rights required States to take steps, to the maximum of their available resources,
towards realization of the right to health, prohibited retrogressive measures, and required
immediate fulfilment of minimum core obligations. According to the Committee on
1 For further details on the Social Forum, see
www.ohchr.org/EN/issues/poverty/sforum/pages/sforumindex.aspx.
2 Available from www.ohchr.org/Documents/Issues/SForum/SForum2015/PoW.pdf.
Economic, Social and Cultural Rights, access to medicines was a core obligation.
Medicines must be affordable, acceptable, accessible, of good quality, and made available
without discrimination. Yet, 2 billion men, women and children had no access to essential
medicines. Ms. Connors called on the international community to take immediate steps to
rectify that tragedy, including by building production capacity in developing countries,
allowing access to generic drugs and enhancing research and development relating to
treatment for neglected diseases.
6. Joachim Rücker, President of the Human Rights Council, affirmed his support for
the Social Forum as a subsidiary body of the Council, bringing together multiple
stakeholders including Member States, civil society and others. The Forum provided a
unique space enabling constructive engagement to discuss practical solutions to real life
problems including at the grass-roots level. He called for immediate action to strengthen
health systems, establish universal health coverage and ensure access to safe and
efficacious medicines. Recent tragedies, like the Ebola outbreak in West Africa, illustrated
the need for immediate measures to strengthen health systems with rights-based solutions
that affirmed peoples’ dignity and ensured their well-being. In moving forward, including
on access to medicines in the post-2015 development agenda, respect for human rights must
be the ultimate foundation upon which rested the legitimacy of the actions of governments,
international institutions and corporations.
III. Summary of proceedings3
A. Keynote speakers and general statements
7. Deqo Mohamed, Chief Executive Officer of the Dr. Hawa Abdi Foundation in
Somalia, described its work. With limited resources, it had provided health care to over a
million people in a war-torn, rural setting. She advocated a holistic approach to health-care
delivery by improving access to clinics (roads and infrastructure), training medical
personnel and building health facilities. The Foundation also developed the skills of grass-
roots communities. The Hawa Abdi Village that had grown around the clinic represented a
bastion of security and community. While international non-governmental organizations
contributed to programmes, their roles were often temporary, leaving a vacuum following
their departure. Support was required to establish a functioning public health system,
including through training community health workers and improved use of technology.
Mobile phones, for example, could facilitate communication between patients and health
personnel, where physical access was difficult. A renewed focus on sustaining access to
medicines was needed, including by empowering people through education designed to
promote their independence.
8. Jorge Bermudez, Vice-President of Health Production and Innovation, Fundação
Oswaldo Cruz, Ministry of Health, Brazil, discussed the impact of international trade
agreements on access to medicines and the need to integrate right to health considerations
in negotiations. The TRIPS Agreement should not impede the realization of the right to
health. In its negotiations, Brazil advocated measures to uphold the right to health. It had
explicitly embraced that right in its domestic laws and policies, including by guaranteeing
universal access to health care and linking health and development. Brazil had used public-
private partnerships to reduce medicine costs and develop local expertise. It had also
employed price regulation, essential medicines lists and other domestic policies. Those
3 Statements and presentations made available to the Secretariat are available from
www.ohchr.org/EN/Issues/Poverty/SForum/Pages/StatementSForum2015.aspx.
efforts had resulted in substantially lower prices for antiretroviral therapies. Nevertheless,
affordability remained a major problem. He called for national, regional and global action
to address the human rights implications of the intellectual property regime, including
expansion of TRIPS flexibilities, increased use of voluntary licensing mechanisms and
international support to promote progress towards trade agreements that improved access.
9. Stephen Lewis, Co-Director of AIDS-Free World, discussed affordability and the
responsibilities of pharmaceutical companies. He decried a system that allowed companies
to charge tens of thousands of dollars for treatment with a production cost of only around
100 dollars, wherein companies intensively lobbied governments to protect the status quo.
Emphatic that balance sheets must not be prioritized over human lives, Mr. Lewis recalled
the recommendation of the Global Commission on HIV and the Law to convene a neutral
high-level body to develop a new intellectual property regime for pharmaceutical products,
and to place a moratorium on patent protection of medicines in future free-trade
agreements. He proposed five steps to increase access to medicines: (a) use the proposed
sustainable development goals, especially goal 3.8, to put pressure on governments;
(b) litigate against pharmaceutical companies; (c) integrate right to health considerations in
trade negotiations; (d) form alliances to raise awareness of cost and accessibility issues;
(e) support OHCHR in its efforts to encourage governments to fund health care.
10. In the general statements segment, representatives of Brazil, Chile, China,
Colombia, Cuba, India, Pakistan, South Africa, Sri Lanka, Thailand, the Bolivarian
Republic of Venezuela, the Holy See, the Ariel Foundation International and Autistic
Minority International intervened. States highlighted measures at the national level for
ensuring access to medicines. They emphasized that health concerns must prevail over
intellectual property rights and commercial interests and called for flexibility in the TRIPS
Agreement. Other issues raised included: quality of medicines; production of generics;
supporting local capacity; inequality between States and the resulting impact on access;
mental health; overprescription; international cooperation; public-private partnerships;
benefits of healthy populations to development; links between health costs and poverty;
investment and innovation; mobilizing resources to combat disease in developing countries;
medication for children; youth participation in relevant discussions; black markets; health-
care laws and policies.
B. Overview of access to medicines in the context of the right to health
11. Martin Khor, Executive Director of the South Centre, described access to medicines
as a cornerstone of the enjoyment of the rights to health and life. Key barriers included
investment treaties and regional agreements limiting TRIPS flexibilities, reduced
government revenues owing to economic situations, and conditions that prevented the
establishment and continued functioning of generic companies. To address those
challenges, he suggested: (a) promoting the use of TRIPS flexibilities; (b) renewing TRIPS
exceptions for least developed countries for as long as they retained that status;
(c) permitting TRIPS exceptions for middle-income countries; (d) amending investment
treaties that threatened the right to health; (e) eliminating TRIPS-plus provisions and other
clauses in free-trade agreements that might jeopardize access to medicines and the right to
health; (f) protecting public health services even in times of economic crisis; (g) building
capacity to produce generic medicines; (h) promoting universal access to newly developed
medicines; (i) prioritizing development of medicines for drug-resistant diseases;
(j) promoting publicly funded and shared research and development; (k) providing financial
and technological assistance to developing countries.
12. Zafar Mirza, Coordinator, Public Health, Innovation and Intellectual Property,
Department of Essential Medicines and Health Products, World Health Organization
(WHO), presented an overview of the WHO work on access to medicines which was one of
its six leadership priorities. Access to medicines could be rendered sustainable in the
context of universal health coverage and functioning health systems. It was an unequivocal
part of the human right to health and a complex issue involving multiple stakeholders,
determinants and perspectives. WHO strived to promote universal access to safe, effective
and high quality medicines that were prescribed and used rationally, and monitored by
appropriate regulatory mechanisms. Access to existing medicines (generic and patent)
should be improved and research and development for new essential medicines should
focus on improving health outcomes, not only returns on investment. The medical needs of
the most vulnerable must be met. Litigation on the right to health promoted access to
medicines.
13. Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the
highest attainable standard of health, denounced widespread and crippling inequalities in
access to health services and medicines that had left 2 billion people without access to the
health products they needed. Ill health was both a cause and consequence of poverty and
access to medicines was a particularly pertinent problem in the developing world. States
must ensure that medicines were affordable and accessible on a non-discriminatory basis.
That required improved procurement and distribution globally, especially in developing
countries. Research and development in medicines for neglected diseases must be
improved. Although States had the primary responsibility for ensuring access to medicines,
including through domestic health policies, intellectual property laws and donor country
policies could also have major impacts. He discussed problems of medicine overuse and
misuse especially in relation to mental illness. Prescription of medicines, particularly
psychotropic medicines, should be part of a holistic approach to treatment.
14. During the interactive dialogue, representatives of India, the Indian Council of South
America, the International Association for Hospice and Palliative Care and Rencontre
africaine pour la défense des droits de l’homme took the floor. The speakers highlighted
issues such as lack of access to effective pain relief medicines, the slow response to the
Ebola crisis, the failure of the intellectual property regime to protect traditional knowledge
from exploitation by pharmaceutical companies, and differences between challenges
relating to access to patented and generic drugs.
15. In response, the Special Rapporteur on the right of everyone to the enjoyment of the
highest attainable standard of health observed that there were many lessons to learn from
the Ebola crisis. He called for improved response systems, mobilization of additional
resources, and improved health systems and infrastructure to prevent crises. Dr. Mirza
clarified the fact that the challenges in access to patented and generic drugs were the same,
but that the high prices of patented drugs posed an additional challenge. He suggested a
broader approach going beyond a focus on patented drugs and market failures, to also
recognize failures in public policy. Speaking on behalf of Mr. Khor, Germán Velásquez,
Special Adviser for Health and Development at the South Centre, suggested that WHO
employ article 19 of its Constitution to make binding decisions and deliver justice in access
to medicines.
C. Improving health delivery systems in challenging contexts
16. Abdul Majeed Siddiqi, Head of Mission, HealthNet TPO, Afghanistan, discussed
mental health treatment in fragile States. In Afghanistan, the work of HealthNet TPO since
2000 had included efforts to integrate mental health services in the health systems of
15 provinces on the basis of fact-finding, education and training, and policy advocacy.
However, approximately half the Afghan population suffered from mental health problems,
compared with 20 per cent in other developing countries, and only 2 per cent sought
treatment. Additional challenges in Afghanistan included: stigmatization of mental health
patients; unequal integration of mental health services in primary and secondary health
care; lack of quality referral health care, funding and prioritization by the Government and
donors; staff capacity, supply of medicines in health facilities, quality of medicines and
compliance.
17. Msgr. Robert J. Vitillo, Head, Caritas Internationalis, Geneva, while acknowledging
the role of States, pointed to the complementary role in health crises of various stakeholders
including faith-based organizations. Following the Ebola outbreak, while governments and
international organizations struggled to respond, organizations like Caritas had acted
immediately at the local, national, regional and international levels. They strengthened and
maintained support provided by local Catholic health services and mobilized international
volunteers, working with local communities. Faith-based organizations were particularly
well placed to ensure that human dignity was upheld in all circumstances, and to provide
local communities with material, pastoral and spiritual support that complemented medical
support from health-service providers.
18. Mahmoud Daher, Head, WHO Gaza sub-office for the occupied Palestinian
territories, explained how since 1967 military occupation had impeded development in the
region, weakening all aspects of development for 4.2 million Palestinians and adversely
affecting health systems. In Gaza, multiple external and internal factors had caused chronic
shortages in essential medicines averaging 30 per cent over the past five years, and,
averaging 50 per cent in disposable medical supplies. Unreliable fuel supplies and
inadequate equipment and financial resources also posed obstacles to health services
delivery, especially in Gaza. He noted that the Palestinian health sector would continue to
suffer until the structural causes of those deficiencies were addressed and barriers were
removed to control over resources and planning, to economic and educational opportunities
and to self-determination.
19. During the interactive dialogue, interventions were made by representatives of the
Congo, Associazione Comunità Papa Giovanni XXIII, the China Medical Association,
Health Innovation in Practice, New Generation Ishaka, the People’s Health Movement, and
by Dr. Bermudez and Raffaela Schiavon, General Director, Ipas Mexico. Suggestions
included: (a) the international community must guarantee access to essential drugs and
protect and support health-care professionals even in challenging contexts and people in
vulnerable situations including women, must have access to medicines; (b) renew the focus
on direct actions to improve health systems, including in rural areas, and to train medical
personnel and support staff; (c) build trust between communities and health workers; (d)
effectively coordinate international responses to health challenges; (e) base long-term,
sustainable approaches to improve access to medicines, on data and not politics.
20. In his concluding remarks, Msgr. Vitillo observed that maternal health care was
often neglected in challenging contexts, for example, Ebola treatment units had no facilities
designed for childbirth. However, increased cooperation between governments,
international medical teams and non-governmental organizations working with local
communities could support better health outcomes. Mr. Daher noted that many health-care
professionals in Gaza had not received their salaries for over a year, causing serious strains
on the system. Dr. Siddiqi stated that donors adopted different approaches, but that there
had been some recent success in streamlining and improving the effectiveness of
international assistance to improve access to essential medicines in challenging contexts.
Panellists agreed on the need for pharmaceutical companies, governments and the
international community to improve responsiveness to crises and ensure the realization of
human rights.
D. Access to medicines for women and children
21. Dr. Schiavon stated that ensuring access to, and consistent procurement of,
reproductive and neonatal health commodities was essential to ensuring human rights
including the rights to health and life. Although maternal mortality rates had dropped
significantly since 1990, 289,000 women had still died from causes relating to maternity in
2013, and there were significant disparities in mortality rates between regions. Worldwide
41 per cent of pregnancies were unwanted, and most of them were due to non-use or
underuse of contraceptives. Lower contraceptive use correlated with higher rates of
abortion. Reducing unintended pregnancies could avert 60 per cent of maternal deaths and
57 per cent of child deaths. Although access to contraceptives had increased, inequities
remained both within and between States. Diverse challenges and barriers prevented equal
access to potentially life-saving drugs for women, including ideological opposition to
certain medications, such as emergency contraception and misoprostol (oral oxytocic)
recommended for a variety of obstetric uses. She advocated evidence-based guidelines and
policies to promote access to medicines for sexual and reproductive health.
22. Tarek Meguid, Associate Professor, State University of Zanzibar, asserted that lack
of access to medicines constituted a grave human rights violation, particularly in maternal
and child health. Quoting Mahmoud Fathalla, he said that women were not dying from a
lack of technical capacity. They were dying because they were poor, powerless and
pregnant, and the international community had yet to make the decision that their lives were
worth saving. He described inadequate facilities which had an air of veterinary medicine
about them, and stressed that the lives and dignity of poor women and children must be
protected. Women must be given the space to empower themselves so that they can take
control of their own lives. Dr. Meguid called for the creation of physical, economic and
social spaces for women to give them agency and enable them to be the drivers of change.
That required immediate action.
23. Lingli Zhang, Professor and Director of Pharmacy, West China Second University
Hospital, Sichuan University, described efforts to improve children’s access to medicines in
the BRICS countries (Brazil, China, India, the Russian Federation and South Africa),
noting their efforts to reach reduction targets in child mortality. While many affordable and
accessible medicines had been developed, effective intervention was often inadequate
owing to the lack of paediatric formulations and other factors. Despite positive steps, only
4.1 per cent of medicines in China were reserved for children, according to a survey of
medicines used in paediatrics in 15 hospitals. Dr. Zhang suggested that an appeal be
launched to raise global awareness of the need for all States to have an essential medicine
list for children. She called for States to learn from each other’s good practices, including
advances by BRICS countries, like the essential medicine list for children in China, India
and South Africa.
24. In the ensuing discussion, the speakers were Dr. Mohamed and representatives of
OHCHR, Associazione Comunità Papa Giovanni XXIII, Autistic Minority International,
the Center for Reproductive Rights and the People’s Health Movement. They discussed
governmental duties to ensure access to information on contraceptive services on a non-
discriminatory basis; access to medicines for pregnant women living with food insecurity,
and for autistic women and children; and the potential of education in reducing infant
mortality. War and migration disproportionately affected women, mothers and children. In
such cases, special health policies should be implemented and drugs made available in
durable forms that did not require refrigeration.
25. Dr. Meguid stated that poor conditions were the standard for people who lived with
inadequate medical facilities. Since they had no agency in relation to their health needs that
would enable accountability, they did not complain. Health facilities were understaffed and
their personnel worked in unacceptable conditions. Health workers became both victims
and perpetrators of human rights abuses. Consequently, they would continue to deliver
inferior health services until they and their patients were empowered. Dr. Schiavon
concluded that inequity in access to contraceptives and some other medicines was global,
and often an ideological issue. Dr. Zhang called for change in mindsets on access to
medicines and stressed the importance of an effective health policy.
E. Intellectual property rights and access to medicines
26. Lisa Forman, Assistant Professor, Dalla Lana School of Public Health, University of
Toronto, described access to medicines as one of the most explicit examples of how
economics and trade rules conflicted with human rights, including the rights to life, health
and development. She focused on how intellectual property rights had an impact on drugs,
illustrated by the increase in drug prices in Malaysia of 28 per cent per year between 1996
and 2005 following the implementation of TRIPS. Over 2 billion people still lacked access
to essential medicines, with drug pricing remaining a key obstacle to access. She called on
the United Nations to support the use of compulsory licensing as a proven means of
reducing prices and realizing State duties under the right to health. States should be held to
account in the universal periodic review process for imposing TRIPS-plus provisions in
free trade agreements as a violation of the right to health. Ms. Forman suggested that
TRIPS flexibilities were an insufficient solution to pricing concerns, referring to the Global
Commission on HIV and the Law’s recommendation that the Secretary-General create a
new body to recommend a new intellectual property rights regime for drugs.
27. Thamara Romero, Legal Officer, Intellectual Property Unit, United Nations
Conference on Trade and Development (UNCTAD) discussed UNCTAD work on access to
medicines. The UNCTAD mandate in that area was based on the 2012 Doha Mandate
(TD/500/Add.1, para. 65 (j)), and its assurance of the supply of essential medicines.
UNCTAD had observed an increased need to diversify and expand pharmaceutical
production. In the future India might no longer be considered the “pharmacy of the world”.
Expanding local production could result in improved access. She referred to a high court
case in Peru in which an individual’s right to health had been upheld, regardless of whether
the Government had assigned adequate financial resources to the health sector. She called
for increased use of TRIPS flexibilities. She argued that, if properly implemented, human
rights and intellectual property were not necessarily contradictory. However, it was
necessary to create awareness among policymakers and judges on the application of TRIPs
flexibilities to enhance access to medicines.
28. Antony Taubman, Director, Intellectual Property Division, World Trade
Organization (WTO), highlighted the intersection of health, trade and intellectual property
rights. The Doha Declaration on the TRIPS Agreement and Public Health was a major
milestone in understanding those intersections, recognizing the importance of intellectual
property in the development of new medicines while acknowledging possible effects on
pricing — a basis for international policy discussions seeking to implement practically an
appropriate balance between promoting access and innovation. He recommended greater
international cooperation to fulfil the right to health, required for sustainable development.
He outlined three broad areas for future work: (a) elucidation of rules, data and industry
developments; (b) coordination of operations and system-wide coherence;
(c) implementation and action. Drawing on the study by WTO, the World Intellectual
Property Organization and WHO, Promoting Access to Medical Technologies and
Innovation, he noted widespread recognition of the need to strengthen national health
systems and to develop innovative procurement solutions within existing legal and policy
frameworks.
29. During the interactive dialogue, comments were made by representatives of
Colombia, India, Mexico, the Colombian Commission of Jurists, Knowledge Ecology
International, the People’s Health Movement-Safe Observer International, Third World
Network, Universities Allied for Essential Medicines, as well as by Dr. Bermudez, Dr.
Schiavon and Regina Kamoga, Executive Director, Community Health and Information
Network, Uganda. They discussed the following: South-South cooperation; patent
monopolies; TRIPs-plus provisions in free trade agreements; the fundamental unfairness of
intellectual property regimes, particularly for middle income countries; definition of
“essential medicines”; alternatives to TRIPS; the role of WTO; contribution of universities
to innovation and development of medicines; barriers to research and development;
antibiotic resistance and the challenge from intellectual property regimes that hampered the
supply of effective antibiotics; the positive role of TRIPs in spurring innovation; the need
for more compulsory licensing in developing countries.
30. In her closing remarks, Ms. Forman referred to the responsibilities of States in
ensuring access to all medicines, not only essential medicines, and asserted that the current
system of TRIPs exceptions and flexibilities was inequitable. The Optional Protocol to the
Convention on Economic, Social and Cultural Rights, which had entered into force on
5 May 2013, established a legally binding petitions procedure, an important mechanism for
interpretation and enforcement of the right to health. Mr. Taubman reiterated the
importance of policy coherence across legal and policy regimes. He called for intellectual
property experts to develop a stronger understanding of public health issues, and for health
practitioners and policymakers to gain a practical understanding of TRIPS flexibilities.
Ms. Romero noted that different countries had different needs, but that analyses of national
legal strategies were helpful in implementing the TRIPS agreement and its flexibilities.
Improved local production capacity facilitated access to medicines.
F. Lessons learned and emerging challenges in the global response
to AIDS
31. Martin Choo, Asia Pacific Network of People Living with HIV/AIDS (APN+),
stressed the importance of equitable access and effective treatment. He asserted that access
to treatment was a human right, treatment made patients feel human, and effective
treatment was a public good. However, patients were being left behind, and many of those
so left behind were from vulnerable social groups including the poor, sex workers, drug
users and lesbian, gay, transgender, transsexual and intersex persons. He argued that
patients should not be mere statistics. In the Asia Pacific region, almost 40 per cent of
people infected with HIV/AIDS were not receiving treatment. Depression and mental
illness were highly prevalent amongst people with HIV but they often went untreated as
well. In national legislatures APN+ had strongly advocated that people living with HIV had
the right to have access to treatment. APN+ also worked to extend treatment and
community support to the most vulnerable.
32. Alma de Leon, Regional Director, International Treatment Preparedness Coalition,
Latin America and the Caribbean, explained that many medicines available in the
developed world were not available in Latin America. Children often had little access to
treatment, which might, however, be reduced or eliminated when they became adults for
lack of the third line of drugs, which were inaccessible in some countries because of their
high price. The new development goals must accelerate universal coverage and eliminate
gaps in access to medicines. Universal health care would only become a reality if the
people’s demands were met and if human rights prevailed over intellectual property rights.
She called on the international community to break down barriers to access and pursue
international trade and investment laws that permitted access to affordable medicines. The
commendable efforts of community movements in exerting pressure to reduce prices must
be redoubled to enhance progress towards access to affordable medicines for all.
33. Tenu Avafia, Policy Adviser, HIV, Health and Development Practice, Bureau for
Development Policy, United Nations Development Programme, cited the report of the
Global Commission on HIV and the Law which called for changes in legal systems. That
could prevent up to 900,000 new HIV infections by 2030. The Joint United Nations
Programme on HIV/AIDS had set several targets in that regard including: halving the
number of countries with punitive laws and practices around HIV transmission; creating an
environment which safeguarded dignity, health and justice; and developing action-oriented,
evidence-based recommendations for effective AIDS responses that promoted and
protected the human rights of people living with and most vulnerable to HIV. The report
emphasized that application of the current patent regime to medicines was a recent
development. Furthermore, States had historically had the right to license patented
inventions compulsorily when needed. The TRIPS Agreement posed a barrier to access to
medicines. It benefited patent-holders at the expense of people living with HIV. The report
recommended that the Secretary-General examine proposals for a new multilateral regime
to promote innovation and increase access, that developed countries stop pushing TRIPS-
plus agreements, that developing countries use TRIPS flexibilities, and that least developed
countries be indefinitely exempted from TRIPS.
34. During the dialogue, there were interventions from representatives of the Bolivarian
Republic of Venezuela, the China Medical Association, Health Innovation in Practice and
Zomi Community USA, as well as from Amit Sengupta, Associate Coordinator, People’s
Health Movement, India, and Dr. Bermudez. They called for urgent action to change an
intellectual property regime that continued to be a barrier to access to medicines. The
achievements of the AIDS movement had not been adequately translated into improved
access to all medicines for all. Continued activism would support access to medicines for
HIV/AIDS treatment and States must act to improve their local production of drugs,
eradicate stigmatization of persons living with HIV/AIDS and ensure that domestic laws
and policies promoted, protected and fulfilled people’s right to health.
35. In conclusion, panellists emphasized the need to eliminate stigma and discrimination
against persons living with HIV/AIDS. Mr. Choo called for increased support from
international organizations, improved mental health care and strategic, interlinked,
community-based partnerships to support and care for persons living with HIV/AIDS.
Ms. de Leon advocated increased attention to key populations and an end to senseless
deaths caused by stigmatization of persons living with HIV/AIDS. Mr. Avafia stressed the
importance of strong legal systems in protecting patient confidentiality and reducing
stigma. He observed that current drug prices were not sustainable even in developed
countries and that they affected persons suffering from all diseases. He argued for policy
coherence to reconcile human rights obligations and international trade and investment
laws.
G. Patient-centred approaches to access to medicines
36. Ms. Kamoga called for a people-centred approach to access to medicines that took
into account cultural and demographic differences to extend appropriate and effective
health care to rural and urban populations alike. Rural populations faced particular
difficulties in reaching medical centres and were more likely to experience lack of access to
medicines owing to shortages. She explained that Uganda had both formal and informal
medical systems. People who lacked access to formal systems must rely on private health
care and pay three to five times more for medicines than those with formal coverage.
Innovative approaches were essential to ensure access to medicines and save lives. Civil
society organizations had led the way by extending medical services to rural areas,
promoting community drug distribution programmes that pooled transportation costs and
providing social support and education for patients. Unfortunately, many national
governments in developing countries lacked the political will to take action to protect their
citizens. They must act immediately to ensure access to affordable, high quality and safe
medicines and promote further investment in research and development.
37. Dimitry Borisov, Executive Director, Equal Right to Life, Russian Federation,
asserted that all persons had an equal right to life. Therefore, access to medical care for all
categories of patients must be ensured. Unfortunately, in the Russian Federation, there were
plans to reduce spending on health care from 3.6 per cent to 2.8 per cent of gross domestic
product, placing a direct threat to access to medicines. Beyond resources, there were
structural barriers to access including inadequate transparency in decision-making
processes, insufficient collection of data, and a gap between legislative policies and their
financing and execution. Those problems were clearly evident in cancer treatment. The
inadequate treatment of cancer patients substantially affected mortality rates and those
problems were reflective of the health system of the Russian Federation as a whole. Equal
Right to Life promoted a patient-centred approach and advocated fulfilment of State health-
care commitments and intersectoral collaboration.
38. Noel Hayman, Clinical Director, Inala Indigenous Health Service, Australia,
described his efforts to extend health care to aboriginal communities, in which life
expectancy was 17 years less than for other Australians. He emphasized the importance of
quality research and good data to ascertain the origins of health outcome disparities.
Research revealed that few indigenous peoples had access to and used primary health-care
systems. Results of a focus group demonstrated that many aboriginal Australians were not
accessing available health services because of cultural differences making them feel
unwelcome. By actions to bridge those cultural differences, including employment of
aboriginals in health systems, cultural awareness strategies and educational outreach, the
health service had greatly expanded its reach. The key was to understand and acknowledge
the culture and community. To further close the health coverage gap for indigenous
peoples, the private sector, national and local governments, medical practitioners and
communities must continue to collaborate to address their specific medical needs
effectively. By so doing, the health service had improved access to affordable medicines.
39. Dr. Sengupta stated that people working together had the power to change health
systems by demanding fulfilment of their rights. In India, there was a history of common
people uniting to bring about transformative change. Access to medicines had always been
an issue for popular mobilization by the masses. Civil society organizations in India
campaigned against large pharmaceutical companies and put pressure on the Government to
introduce measures that would allow generic pharmaceutical and local production to thrive.
Consequently, drug prices in India were 10 per cent or less than global prices, and Indian
generics helped reduce the cost of antiretrovirals by more than 40 times. However, the
implementation of TRIPS in India posed a threat both for India and importing States. He
called for global solidarity and collective action to address that threat, preserve the generic
industry of India, resist pressure to adopt TRIPS-plus agreements and improve access to
medicines for all.
40. During the interactive dialogue, there were interventions from Dr. Mohamed and
Dr. Schiavon, representatives of Panama, the United States of America, WHO, the
International Association for Hospice and Palliative Care, Maloca Internationale, Third
World Network and the Union for International Cancer Control. Issues included the
following: access to opioids and palliative care; patenting and criminalization of traditional
medicines; cancer treatment; use and standardization of essential medicine lists; acquisition,
receipt, distribution and storage of medicines; impact of changing political regimes on
health systems; procurement of medicines and treatment of patients in resource-constrained
settings; balancing between ensuring drug quality and safety and preventing overregulation
and regulatory capture.
41. In his concluding remarks, Dr. Sengupta stated that, although safety was a valid and
important concern, the current debate around it had political elements that could not be
ignored. Decisions and policies affecting health care must not lose sight of the ultimate
objective of fulfilling the people’s right to health. Dr. Hayman agreed that safety,
particularly for use of opiates, was an important concern. He emphasized the
responsibilities of all governments in guaranteeing access to medicines. Mr. Borisov
described how the transition from the Soviet public health system to the current
public/private health system had had a negative impact on access to health care in the
Russian Federation. Currently, thousands lacked adequate cancer care because of coverage
gaps and insufficient financing for legislative mandates, exacerbated by lack of
transparency in decision-making. Ms. Kamoga stated that substandard drugs posed a real
challenge, particularly in Uganda which lacked appropriate regulatory and enforcement
mechanisms. She advocated a rights-based approach to access to medicines that empowered
communities and individuals and employed effective, evidence-based policies.
H. Breakout discussion groups and plenary discussion
42. All participants were invited to join one of three breakout discussion groups. Each
focused on a key issue relating to access to medicines in the context of the right to health.
Group one, facilitated by Dr. Velásquez, addressed intellectual property regimes and access
to medicines. Group two, facilitated by Nhan T. Tran, Manager, Implementation Research
Platform, Alliance for Health Policy and Systems Research, WHO, focused on health
systems strengthening, capacity-building, community engagement and empowerment.
Group three, facilitated by Dr. Sengupta, discussed financing access to medicines and
universal health coverage. In those groups, participants focused on identifying concrete
solutions and good practices for overcoming barriers to access to medicines.
43. During the plenary discussion which followed, the main findings of the groups were
presented by a rapporteur nominated by each group. All participants were given an
opportunity to respond and present proposals for the conclusions and recommendations of
the Social Forum. Those who took the floor were representatives of Ecuador, Panama, Ariel
Foundation International, Knowledge Ecology International, Third World Network and
Universities Allied for Essential Medicines, as well as Ms. Forman, Dr. Meguid,
Dr. Sengupta and Damiano de Felice, Strategic Adviser to the Chief Executive Officer,
Access to Medicine Foundation. A synthesis of the proposals emerging from the breakout
and plenary discussions is reflected in the conclusions and recommendations of the present
report.
I. Innovative approaches to promoting access to medicines
44. Geoff Adlide, Director of Advocacy and Public Policy at Gavi, the Vaccine
Alliance, explained the innovative efforts of Gavi to shape vaccine markets with a view to
promoting access. Gavi was a public-private partnership focused on saving children’s lives
and promoting human health through improved access to immunization in poor countries. It
sought to address inequities in access to vaccines through innovative approaches to access,
governance, monitoring and vaccine markets. It supported vaccine purchases by low-
income countries through pooling domestic and regional purchasing power and donor
contributions to minimize costs. Gavi also promoted competition and sought to balance
supply and demand to ensure continuous supplies of the vaccines required. It tried to
improve vaccination delivery including with regard to thermostability, presentation and
packaging, combinations, safety and efficiency. Timely, transparent and accurate market
information for manufacturers and States was essential to its work to promote sustainable
access to vaccines for all.
45. Nana Boohene, Procurement and Supply Specialist, Global Fund to Fight AIDS,
Tuberculosis and Malaria, and Hye-Young Lim, Human Rights Adviser at the Global Fund,
presented the Fund’s work to promote access to medicines. A rapidly evolving global
health landscape required innovative approaches to increasing access to essential health
commodities. The Global Fund operated in 140 countries and adaptability was integral to
maximizing its impact. When States reached middle-income status, they lost access to
certain benefits in international assistance and delayed implementation of TRIPs which had
an impact on their ability to procure medicines. The Fund sought to improve access by
underserved populations worldwide by reducing market fragmentation to capitalize on
collective negotiating power including through the use of electronic marketplaces and
exchanges. Its strategies directly integrated human rights considerations, focused on
procurement for impact, leveraged new technologies for innovation and supply chain
management, and promoted market access and continuity of supply. The Fund sought to
increase investment in programmes that addressed human rights barriers to accessing health
services and withdraw support from programmes that infringed upon human rights.
46. Rohit Malpani, Access to Medicines Campaign Director of Policy and Analysis,
Médecins Sans Frontières, described the Access Campaign, which responded to doctors’
frustration regarding the availability, affordability and suitability of medicines. It sought to
address basic market failures of the patent system, under which research and development
costs were to be recouped through monopolies leading to high-priced products. There was
no incentive for research and development for the poor nor for expanding their access. The
Campaign called for delinking product prices from research and development costs. Its 3P
project, “push, pull, pool”, aimed to combine push funding, pull funding and the pooling of
intellectual property rights to promote innovative research and development for new,
effective tuberculosis drug regimens and affordable access to quality medicines for all. In
multidrug-resistant tuberculosis, the 3P project incentivized collaborative, early-stage
research through patent pooling and pull and push funding. By securing public funding for
prizes and clinical trials, ensuring an open and collaborative model, it promoted the
collaborative development of drug regimens through patent pooling. The Campaign was
seeking to promote a model of research and development that delinked its cost from the
final product price and ensured that research and development for tuberculosis was carried
out in a manner that delivered effective, short-course, affordable tuberculosis regimens
for all.
47. Lena Kähler, Researcher, Human Rights and Development, Danish Institute for
Human Rights, a national human rights institution mandated to promote and protect human
rights in Denmark and abroad, introduced the Institute’s efforts to develop indicators for
accessibility, availability, acceptability and quality in the context of the right to health. The
lack of consensus on the interpretation of economic, social and cultural rights constituted an
obstacle to its work. By developing a generally applicable toolbox on right to health
indicators, it hoped to promote realization of the right to health locally and globally. The
Institute had identified as core obligations the availability of essential medicines,
prevention, treatment and control of epidemic and endemic diseases, immunization against
major infectious diseases, and reproductive, maternal and child health care.
48. During the discussion, there were interventions from representatives of Brazil, Chile,
the China Medical Association, the Colombian Commission of Jurists, Third World
Network, Universities Allied for Essential Medicines, as well as from Dr. Sengupta,
Dr. Mohamed and Dr. Meguid. Some speakers described efforts to impede production of
low-cost generic pharmaceuticals as crimes against humanity. Others called on the Human
Rights Council and special procedures mandate holders to focus on access to medicines.
They supported a holistic, people-centred and community-driven approach to health. That
would include innovative efforts to address neglected diseases, like multiple drug-resistant
tuberculosis, that disproportionately impacted on the poorest and most vulnerable, and to
promote improved governance mechanisms, particularly for regulatory oversight and
accountability of multinational corporations. The question was raised as to whether or not
efforts to promote access had gone far enough to seek alternatives to market-based
approaches.
49. In their concluding remarks, the panellists supported further integration of human
rights considerations in access to medicines. Ms. Lim stressed the need to integrate human
rights principles throughout procurement processes. She noted that the concept of middle-
income countries was an artificial one and that access to medicines should not be dictated
by the economic status of a country but by the needs of people, and that the Global Fund to
Fight AIDS, Tuberculosis and Malaria was supporting the strengthening of health systems
in a number of countries. Citing the work of the Committee on Economic, Social and
Cultural Rights, Ms. Kähler asserted that the right to health required access to all medicines
not only essential medicines. Mr. Adlide clarified that Gavi only supplied vaccinations
through governments; responded to requests from governments; worked to reduce prices
and emphasized transparency in its operations. Mr. Malpani decried continued mispricing
of vaccines, called for rendering access to medicines sustainable and reiterated that middle-
income countries faced substantial challenges in improving access.
J. Good practices in promoting access to medicines (round table)
50. Mr. de Felice described the Access to Medicine Index, a ranking of the world’s
20 largest research-based pharmaceutical companies on the basis of what they did to
facilitate access to medicine in developing countries. He noted that there was hope, that
there were good practices, and that the Index, by drawing attention to corporate behaviour,
could influence businesses to exercise greater responsibility. The Index compared
corporations on the basis of their performance over time with regard to multiple factors,
including but not confined to governance, pricing, patents, local stakeholder engagement,
capacity-building and donations. Although progress was uneven, the Index indicated that
the pharmaceutical industry had stepped up its efforts to improve access to medicine in
developing countries. A competitive environment that not only held pharmaceutical
companies accountable when required, but also recognized their efforts and
accomplishments, would help advance access to medicines.
51. Sathyanarayanan Doraiswamy, Senior Reproductive Health/HIV Coordinator,
Office of the United Nations High Commissioner for Refugees (UNHCR), described
UNHCR work to ensure access for refugees and other persons of concern. When people
were forcibly displaced across national borders, they became refugees, often with limited
access to health care in countries of asylum. UNHCR efforts to promote health care for
refugees were guided by its global strategy for public health and its guidelines on essential
medicines and medical supplies. Those addressed the needs of persons in differing phases
and contexts including acute emergencies, protracted displacement and in their pursuit for
durable solutions. The two main models for providing health care were direct integration in
national systems of host States and integration to the maximum extent possible combined
with support from UNHCR and non-governmental organizations. UNHCR pursued various
methods to promote access, including: provision of emergency health kits, collaboration
with national AIDS programmes to support antiretroviral treatment, research programmes
and partnerships with the private sector. While those provided short-term solutions, the
only long-term sustainable solution was total integration into national health systems.
52. Soraya Ramoul, Director, Access to Health, Novo Nordisk, described the company’s
efforts to promote access to medicines for the treatment of diabetes. Many people with
diabetes resided in low and middle-income countries. Novo Nordisk provided half of the
insulin worldwide. It employed differential pricing policies so that patients in developing
countries paid one quarter of the price paid in developed countries. However, access was
not simply a matter of affordability. It also required strong health delivery systems
including sufficient and adequately trained medical personnel. Local prices might differ
from initial purchasing prices because of supply chain problems, price mark-ups, import
duties and taxes. Further efforts were needed to ensure that prices offered to patients were
affordable and also sustainable from a business perspective. Better implementation of the
right to health in the private sector context required translation of technical human rights
language into business language.
53. James Love, Director, Knowledge Ecology International, recommended drastic
changes to existing models of research and development and intellectual property rights.
The prevailing system had failed to promote access and was fundamentally unfair. It
created patent monopolies, vesting power and profits in private hands. Corporate lobbying
to protect those interests contributed to regulatory arbitrage and perpetuation of the status
quo. That system valued profits over human well-being and failed to achieve its stated
objective of promoting innovation, particularly in research and development for treatment
of diseases that disproportionately impacted the poor and the vulnerable. He argued for
changes to the intellectual property regime, improved incentives for underfunded areas of
research and development, mobilization of innovative sources of finance, increased scrutiny
by the Human Rights Council, particularly in applying the right to development in relation
to intellectual property rights, and innovative approaches to research and development.
Mr. Love advocated deep, radical and transformative reforms that would delink research
and development costs from product prices along with the elimination of product
monopolies, in favour of other financing mechanisms, including combination of research
grants, contracts and other subsidies and delinked financial incentives, including robust
funding of large innovation inducement prizes for HIV/AIDS and cancer as well.
54. Esteban Burrone, Head of Policy, Medicines Patent Pool, described the evolution
and work of that initiative. WHO first proposed the idea of a patent pool in 2008 as part of
its global strategy on public health and innovation. After a feasibility study by the
International Drug Purchase Facility (UNITAID) (“Innovative financing to shape markets
for HIV/AIDS, malaria and tuberculosis”), which was welcomed by the Human Rights
Council at its fifteenth session, the Medicines Patent Pool was set up to promote access to
medicines for HIV treatment through resource pooling and voluntary licensing. Since 2010,
that entity had negotiated licences for 11 antiretrovirals with five patent-holders. It worked
with 10 generic manufacturers through 53 sublicensing agreements to improve access to
antiretrovirals in low and middle-income countries where up to 94 per cent of people living
with HIV resided. Patent pool licences had been recognized for their public health
orientation, transparency and flexibility. Within four and a half years, the Pool had
contributed to opening up the market for first and second line antiretrovirals. It was
exploring expansion to cover tuberculosis and hepatitis C.
55. Smiljka de Lussigny, HIV Programme Manager, UNITAID, discussed that
initiative’s focus on innovative access to medicines. UNITAID used innovative financing, a
major portion of which came from a levy on air tickets, for greater access to treatments and
diagnostics for HIV, malaria and tuberculosis in low-income countries. It focused on
maximizing available resources for the promotion of access by mobilizing resources and
promoting their effective use. Affordability posed a substantial barrier to access,
particularly when States lacked appropriate national policies, access to affordable and
quality generic medicines and/or financial resources. New, effective treatment for
hepatitis C was largely inaccessible to many patients owing to prohibitive costs. UNITAID
intervened by providing funding to organizations working to demonstrate the impact, cost-
effectiveness and utility of new treatment and diagnostic tools and to develop the evidence
needed to inform health policy and normative guidance. It also helped to improve the
affordability of new commodities, often by leveraging its purchasing power to negotiate
with manufacturers for the supply of quality-assured health products at lower prices or by
enabling generic, low-cost production of medicines.
56. Hans Rietveld, Director, Market Access and Capacity-Building, Malaria Initiative,
Novartis Pharma AG, introduced the Novartis Malaria Initiative. The latter had been
involved in providing low-cost, life-saving treatment for malaria patients, a disease which
had been taking the life of one child every 60 seconds for the past 15 years. It pursued
multiple strategies to combat malaria including research and development of new treatment
options, capacity-building, improving access and provision of treatment. Since 2001, the
Initiative had delivered more than 700 million treatments without profit to 65 malaria
endemic countries. It had developed paediatric tablets that were dissolvable in liquid for
babies and children and an improved formulation for adults. The Power of One campaign
treated one child for every dollar raised. Its partnership with the fund-raising organization
Malaria No More had rallied public support and funds for 3 million malaria treatments in
Zambia. The Initiative sought simple and innovative solutions to complex problems. For
example, it had utilized mobile phones to monitor drug supplies in Africa and head off
stock-outs, and published and distributed education materials on malaria prevention and
treatment. However, much remained to be done including on development of new treatment
for drug-resistant malaria and on strengthening health systems.
57. During the interactive dialogue, the following took the floor: representatives of
Brazil, Indonesia, the International Association for Hospice and Palliative Care, New
Generation Ishaka, Safe Observer International, Rencontre Africaine pour la défense des
droits de l’homme, Third World Network, Universities Allied for Essential Medicines;
Drs. Sengupta, Bermudez, Schiavon and Zhang; Ms. Forman. Many speakers called for a
rights-based health paradigm to replace market-oriented solutions, and related actions from
the Human Rights Council. They recommended increasing attention to the medical needs of
children, corporate responsibility, equitable access to medicines, and reduction of
regulatory barriers to access, including TRIPs and TRIPs-plus provisions, research and
development of treatments for neglected tropical diseases, access to pain medication, and
the use of tariffs to safeguard local manufacturing capacity. Several speakers called on
States to promote access without discrimination, to put people first, and to refrain from
exerting political pressure to increase patent protections at the expense of access to
medicines. They called on the Secretariat to issue strong recommendations on intellectual
property rights, regulatory measures, and equal access to health care and sexual and
reproductive health. Reiterating that access to medicines was a matter of life and death,
they demanded that States and the private sector take immediate action to remove barriers
to access to medicines.
58. In response, Mr. Rietveld clarified that he spoke for the Novartis Malaria Initiative,
and not Novartis as a whole. The Initiative worked because the non-profit business model
and the scale of the problem had allowed Novartis and partners to combine their approaches
into a sustainable effort to promote access to life-saving medicines. Ms. Ramoul urged
governments, health-care professionals, activists and industry to avoid finger-pointing and
instead collaborate to promote access to medicines. Mr. de Felice explained the
methodology of the Access to Medicine Index and suggested additional research into
neglected tropical diseases. He supported initiatives to promote sharing and enhanced
access to intellectual property like the Medicines Patent Pool. Citing positive impacts of the
Patent Pool, Mr. Burrone appealed for greater risk-taking and policy experimentation. He
highlighted the need to maintain drug quality while regulatory barriers were rationalized to
promote access. Mr. Love lamented a system which excluded the majority, and the lack of
access to cancer medication. He proposed fundamental changes to promote innovation in
the least harmful manner, and to delink drug prices from research and development costs.
Ms. de Lussigny referred to the obligation to promote access and use limited resources to
benefit as many people as possible. She recommended addressing the issue of regulatory
barriers to the importation of life-saving medicines and emphasized the important role of
generic competition in reducing prices. Dr. Doraiswamy supported a greater focus on
neglected populations and their rights.
IV. Conclusions and recommendations
59. In closing the Social Forum, the Chairperson assured all the participants of the
continued commitment of Qatar to global health. He informed them of the World
Innovation Summit for Health which had held its annual session in Qatar in February
2015. The Summit had brought together health leaders from over 80 countries to
share the latest research, ideas and health innovations that had the potential to
revolutionize the future of global health care.
A. Conclusions
60. Several common themes emerged from the 2015 Social Forum. Not only is
access to medicines a matter of life and death; it also enhances the quality of life; and
it is key to a life with dignity. Yet, 2 billion men, women and children have no access
to essential medicines. Intellectual property laws, lack of finances, weak health
systems, poverty, inequality and discrimination, among other factors, contribute to
lack of access to medicines.
61. Access to medicines involves public health, social justice and international
human rights obligations. The International Covenant on Economic, Social and
Cultural Rights requires States to take steps, to the maximum of their available
resources, to progressively realize the right to health, prohibit retrogressive measures
and requires them to immediately fulfil their minimum core obligations. It also calls
for international cooperation. Access to medicines is a core obligation. Medicines must
be affordable, acceptable, accessible, of good quality, and made available without
discrimination.
62. Access to medicines is a complex and multidimensional issue calling for holistic
solutions. Measures must be put in place to improve supply chains, address the
underlying social determinants of health, promote policy coherence premised on the
primacy of human rights over international trade, investment and intellectual
property regimes and to ensure that health delivery systems are appropriate to those
they serve. Inequities must be eliminated, including high costs borne by patients in
many low and middle-income countries.
63. People’s agency and empowerment should be improved to enhance access to
medicines especially for the poor. Procedural safeguards like participation and access
to information must be upheld. Evidence-based guidelines and policies to promote
access to appropriate health-care services for women would help realize their right to
health, and an increase in paediatric formulations would strengthen access for
children. Addressing stigma and discrimination and ensuring equitable access and
effective treatment would help realize the rights of people living with HIV.
64. Resource constraints cannot be an excuse for failing to meet health needs.
Reasons for disparities in health outcomes across States of similar socioeconomic
status must be understood and addressed. Experience shows that publicly funded
health systems are the best way to ensure equitable access to health care. Access can
be improved through innovative financing mechanisms; enabling public policies;
more health workers; technical support; better health data, administrators, transport
and delivery; improved supply chains, local production and health education; and
other means. Holistic, people-centred and community-driven policies and active local
involvement help strengthen health systems.
65. Access to medicines is one of the most explicit examples of how economics and
trade rules conflict with human rights, including the rights to life, health and
development. All are entitled to enjoy the benefits of scientific progress and
traditional knowledge must be protected. Pharmaceutical companies must comply
with their human rights responsibilities and ethical obligations. Several initiatives and
good practices, including by those companies, point to steps in that direction. New
models of research and development must address needs, not simply manage markets
and profits.
66. Effective health policies, including the development of essential medicines lists,
could improve access. States must live up to their individual and collective
commitments and adopt a human rights-based approach to access to all medicines,
not only essential medicines. International solidarity and collective action could
support access for all.
B. Recommendations
67. Participants recommended urgent and immediate action, at the local, national,
regional and international levels. Health systems needed to be strengthened, universal
health coverage established and access to medicines ensured. That included building
production capacity in developing countries, allowing access to generic drugs,
enhancing research and development into treatment for neglected diseases and
implementing effective procurement, distribution, price and quality control systems.
Urgent steps to improve access to maternal and child health would help prevent
maternal and infant mortality. The international community must aim for universal
access in the post-2015 development agenda, which should also include mental health.
68. All stakeholders should explore ways of mobilizing new and innovative means
of financing development and increasing resources available for health. Possibilities
included imposition of a financial transaction tax, debt cancellation, resource pooling
and tax reforms. International financial institutions must allow States sufficient policy
space to pursue health objectives and States should make efforts to utilize existing
resources more effectively including by leveraging their political and purchasing
power to negotiate reduced prices and voluntary licensing.
69. TRIPS flexibilities and compulsory licensing should be used to their fullest and
resort to political pressure to undermine those tools or impose TRIPS-plus provisions
in trade agreements must be regarded as a violation of human rights obligations,
calling for accountability in the universal periodic review. The legally binding
petitions procedure under the Optional Protocol to the Convention on Economic,
Social and Cultural Rights provided a means for interpretation and enforcement of
the right to health.
70. Intellectual property laws required transformative changes to ensure that the
benefits of scientific progress were enjoyed by all. Recommendations included
alternatives to market-based approaches and reforms to delink research and
development costs from product prices. The recommendations of the report of the
Global Commission on HIV and the Law, particularly the call for the United Nations
to establish a commission to examine and propose alternatives to TRIPS, needed
follow-up action. In the meantime, implementing TRIPS must be suspended, where it
impeded access to medicines for the poor.
71. Participants called for a new and legally binding treaty on research and
development of medicines that would promote innovation and equitable access.
University research should be perceived as public research for everyone’s benefit and
not patented without proper safeguards to ensure access to resulting medicines. The
Committee on Economic, Social and Cultural Rights should consider adopting a
general comment on the right to enjoy the benefits of scientific progress.
72. All stakeholders should collaborate to enhance health systems. Participants
proposed a holistic approach to health systems that enhanced equitable access,
improved training of health and administrative personnel, employed culturally
appropriate delivery systems, involved engagement with local communities and
provided health and education outreach.
73. Participants recommended improved governance mechanisms, particularly for
the regulatory oversight and accountability of multinational corporations.
Pharmaceutical companies had responsibilities as articulated in the 2008 report of the
Special Rapporteur on the right of everyone to the enjoyment of the highest attainable
standard of health (A/63/263) containing the Human Rights Guidelines for
Pharmaceutical Companies in relation to Access to Medicines. States, pharmaceutical
companies, the Working Group on the issue of human rights and transnational
corporations and other business enterprises, and the Human Rights Council should
act to ensure their implementation.
74. The Human Rights Council and the international human rights machinery
must remain seized of the issue. Participants recommended integration of a universal
periodic review of the right to health and access to medicines that is evidence-based
and promotes transparency and accountability. They called on the Council to
commission a compilation of good practices in promoting access to medicines. The
recommendations of the Social Forum must be taken up by the Council and
acted upon.
Annexes
[English only]
Annex I
Provisional agenda
1. Opening of the session.
2. Implementation of Human Rights Council resolution 26/28 entitled “The Social
Forum” on the theme “Access to medicines in the context of the right of everyone to
the enjoyment of the highest standard of physical and mental health, including best
practices in this regard”.
3. Closure of the session.
Annex II
List of participants
States Members of the Human Rights Council
Argentina, Bolivia (Plurinational State of), Botswana, Brazil, China, Congo, Cuba,
El Salvador, Ethiopia, France, Germany, India, Indonesia, Ireland, Japan, Kenya, Mexico,
Morocco, Pakistan, Qatar, South Africa, United Kingdom of Great Britain and Northern
Ireland, United States of America, Venezuela (Bolivarian Republic of).
States Members of the United Nations represented by observers
Angola, Australia, Austria, Bahrain, Belarus, Belgium, Chile, Colombia, Ecuador, Greece,
Honduras, Iran, Italy, Kuwait, Lao People’s Democratic Republic, Lebanon, Lithuania,
Luxembourg, Mozambique, Myanmar, Nicaragua, Panama, Peru, Philippines, Senegal,
Slovenia, Spain, Sri Lanka, Switzerland, Syrian Arab Republic, Tajikistan, Tanzania,
Thailand, Togo, Tunisia, Ukraine, Zambia.
Non-Member States represented by observers
Holy See.
Intergovernmental organizations
Commonwealth Secretariat, Council of Europe, Global Fund to Fight AIDS, Tuberculosis
and Malaria, Medicines Patent Pool, Organisation International de la Francophonie, South
Centre, UNITAID (Innovative Financing to Shape Markets for HIV/AIDS, Malaria and
Tuberculosis), World Trade Organization.
United Nations
United Nations Conference on Trade and Development, United Nations Educational,
Scientific and Cultural Organization, United Nations Development Programme.
Specialized agencies and related organizations
Joint United Nations Programme on HIV/AIDS, United Nations High Commissioner for
Refugees, World Health Organization.
Non-governmental organizations
Access Our Medicine Initiative, AIDS Free World, Alliance Defending Freedom
International, American Association of Jurists, Ariel Foundation International, Asian-
Eurasian Human Rights Forum, Asia Pacific Network of People Living with HIV/AIDS,
Association of World Citizens, Associazione Comunita Papa Giovanni XXIII, Autistic
Minority International, Caritas Internationalis, Center for Reproductive Rights, Centre du
Commerce International pour le Développement, China Medical Association, Civicus,
Commission Africaine des Promoteurs de la Santé et des Droits de l’Homme, Community
Health and Information Network Uganda, Comision Colombiana de Juristas, Déclaration de
Berne, Dominicans for Justice and Peace, Dr. Hawa Abdi Foundation, Equal Right to Life,
Gavi, The Vaccine Alliance, Geneva for Human Rights, Health Innovation in Practice,
HealthNet TPO, Hope International, Indian Council of South America, International
Association for Hospice and Palliative Care, International Investment Center, International
Longevity Centre/NGO Committee on Ageing, International Network for the Prevention of
Elder Abuse, Intellectual Property Watch, Ipas Mexico, International Treatment
Preparedness Coalition, International Youth and Student Movement for the United Nations,
Jingguo Law Firm, Knowledge Ecology International, La Compagnie des Filles de la
Charité de Saint Vincent de Paul, LDS Charities, Médecins Sans Frontières, Maloca
Internationale, Mylan, India, New Generation Ishaka Belgium, Organisation of Islamic
Cooperation, People’s Health Movement, Press Trust of India, Rencontre Africaine pour la
défense des droits de l’homme, Safe Observer International, Salud Por Derecho, Save the
Children International, Sparkwater India, Third World Network, Union for International
Cancer Control, Universities Allied for Essential Medicines, World Federation of the
Society of Anaesthesiologists, Zomi Community USA.
National human rights institutions
The Danish Institute for Human Rights.
National Ministries and Departments
Department of Health, South Africa; Inala Indigenous Health Service, Australia; Ministry
of Health, Brazil.
Academic institutions
Peking University, State University of Zanzibar, University of Strasbourg, University of
Toronto, Vilnius University, Sichuan University.
Private sector
Access to Medicine Foundation, Malaria Initiative, Novartis Pharma AG, Novo Nordisk.
Independent experts
Dainius Pūras, United Nations Special Rapporteur on the Right to Health.