Msonkhano wa 56 wa World Health Assembly-msonkhano wapachaka wa zaumoyo womwe malangizo a World Health Organisation (WHO) akhazikitsidwa chaka chino-watha sabata ino ku Geneva pambuyo pa zokambirana zazitali za saga yomwe ikupitilira SARS. Kuwulutsa kwa atolankhani a Msonkhanowo kudayang'ananso kukwaniritsidwa kwa chigamulo choletsa kusuta fodya, chomwe nthumwi yaku US idagwirizana kuti isayine posinthana ndi mapangano omwe angateteze pangano lamtsogolo pazogulitsa shuga. Koma ganizo lomwe lidalandira mkangano wautali kwambiri pakati pa nthumwi za maboma 192 omwe abwera ku Msonkhano wa WHO adalandira chidwi chochepa kunja kwa atolankhani amabizinesi (1, 2).
Mkanganowo unali pa chigamulo cholamula bungwe la WHO kulangiza maboma za malamulo a patent ndi kupeza mankhwala. Malamulo a patent m'maiko ambiri omwe akutukuka kumene tsopano akhazikitsidwa kudzera mu malangizo a World Trade Organisation (WTO), upangiri wa World Intellectual Property Organisation (WIPO), ndi kukakamizidwa kwa malonda awiri a US (3). Koma chifukwa Mgwirizano wa WTO's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement umafuna kuti mayiko omwe akutukuka kumene akhazikitse malamulo adziko lonse otsimikizira kuti ali ndi chilolezo chazaka makumi awiri pazamankhwala, mitengo yamankhwala atsopano pazochitika zomwe wamba komanso osowa ikuyembekezeka kuwirikiza kawiri Januware atangotha. 2005 (2). Mgwirizano wa TRIPS, womwe unadutsa zaka zoposa khumi zapitazo mothandizidwa ndi WTO, adafotokozedwa ngati "malonda aulere" ndi womanga wamkulu wa Pfizer CEO (ndi Ronald Reagan mlangizi wa zamalonda) Edmund Pratt (4). Mwa tanthawuzo, ndizosiyana kotheratu ndi malonda okhudzana ndi mpikisano: zimapatsa makampani opanga mankhwala kukhala olamulira pa chinthu chilichonse chatsopano chomwe apanga, motero amalola kuti mitengo yamankhwala ikhazikike pamiyezo yogulira anthu apamwamba, kuwonongera koonekeratu kwa osauka. .
Pambuyo pa mantha a anthrax chaka chapitacho ku Washington, Aphungu anali kuopseza bungwe la mankhwala la Bayer ngati kampaniyo sinabwere ndi ciprofloxacin yokwanira (Cipro, mankhwala omwe amagwiritsidwa ntchito pochiza matenda a anthrax) kuteteza thanzi la anthu onse (5). Chiwopsezo chinali chopanga mitundu ya Cipro m'malo mopangana ndi Bayer; kupanga ma generic kukadafulumizitsa ntchito yopanga mankhwala ndikulola opanga angapo kuti apikisane nawo pamakontrakitala aboma, kutsitsa mitengo yamankhwala monga momwe mpikisano umachitira nthawi zambiri.
Chodabwitsa cha chochitikacho sichinatayike kwa nduna zamalonda zamayiko omwe akutukuka kumene. Kwa zaka zambiri, nduna za zamalonda ndi ogwira nawo ntchito mu unduna wa zaumoyo akhala akuyesera kuti agwirizane ndi opanga mankhwala a Edzi molingana ndi mfundo yomweyi-kuti apange opanga kupikisana ndi kutsitsa mtengo wa ma ARV ndikukulitsa chithandizo chawo kwa omwe akufunika kwambiri. Thailand, Brazil, ndi South Africa, pakati pa ena, adakumana ndi ziwopsezo zamalonda aku US poyesa mapulogalamu otere (6). Koma dziko la United States likakumana ndi โmliriโ wa matenda a anthrax, nduna za zamalonda za mayiko omwe akutukuka kumene anali ndi chida chokambirana.
Pamsonkhano wa nduna za ku Doha mu Novembala 2001 wa WTO, nduna za mayiko omwe akutukuka (pamene adavutitsidwa kuti asaine mapangano angapo oyipa) adakwanitsa kukakamiza kudzera mu mgwirizano womwe umatchedwa Doha Declaration on TRIPS and Public Health (7). Mgwirizanowu udatsimikiziranso njira zachitetezo zomwe zilipo kale mu Mgwirizano wa TRIPS-kuphatikiza njira zomwe zidalola mayiko ngati Thailand, South Africa ndi Brazil kupanga mankhwala pamene mitengo yamankhwala ovomerezeka inali itasokonekera (kupangitsa kuti zomwe US โโโโakuchita motsutsana ndi mayikowo ziphwanya malamulo a WTO. ). Koma mu ndime 6 ya Doha Declaration, nduna zinaphatikizanso mawu ofunikira kuti maiko osauka kwambiri kuti akhale ndi mphamvu zawo zopangira mankhwala (omwe akuphatikizapo maiko osatukuka kwambiri, omwe ali ndi matenda olemetsa kwambiri) atha kuitanitsa ma generic. Malamulo a TRIPS, modabwitsa, amaletsa kutumizidwa kwa mankhwala a generic, kotero ndime iyi ya Doha Declaration ilola mayiko olemera kupanga mankhwala a generic kumayiko otukuka kumene, osati kwa iwo okha.
Njira yosavutayi inkawoneka ngati yolunjika panthawiyo-koma panthawi yolemba zolemba zake zomwe zikugwiritsidwa ntchito mu December 2002, Woimira Zamalonda ku US (USTR) Bambo Robert Zoellick anakhala membala yekhayo wa WTO (ananena mokakamizidwa mwachindunji ndi White House). kuletsa kuchitidwa kwa mgwirizano mu mawonekedwe ake (8). Ngakhale kuti adasaina kale dzina lake ku Doha Declaration, USTR ingavomereze kulola kukhazikitsidwa ngati mayiko ambiri omwe akutukuka kumene omwe ali ndi mphamvu zopanga kupanga saloledwa kugulitsa kunja komanso ngati njira zovuta zalamulo zidapangidwa zomwe zingalepheretse dziko lililonse losatukuka kuti lisakhalepo. kutha kuitanitsa mankhwala a generic kuchokera kunja; Zingachepetsenso kutumizidwa kwamtundu uliwonse ku mndandanda wachidule wa matenda omwe kulibe mankhwala kapena mankhwala akale okha omwe alibe patent (9). Mgwirizano womwe wawunikiridwawo upangitsa kuti msika waku US ukhale wokhazikika pamitengo yamankhwala padziko lonse lapansi. Kugwirizana kwamakampani sikunabisike - pa World Economic Forum ku Davos, Pfizer Corporation idalengeza kwa atolankhani kuti yatenga mpando wokambirana kuchokera ku USTR ndipo ikukambirana mwachindunji ndi bungwe la WTO (10). Zokambirana pakukhazikitsa zidatha pomwe Pfizer ndi makampani ena adalowererapo-ndipo zokambirana zitha kupitilirabe mpaka (ndipo mwina kupitilira) msonkhano waunduna wa Cancun wa WTO mu Seputembala uno.
Pamsonkhano wa WHO sabata yathayi, mayiko omwe akutukuka akufuna kuthana ndi vutoli ndikulola bungwe la zaumoyo padziko lonse lapansi kuti likambirane zotsatira za thanzi la "kusinthidwa" kwa USTR. Pamwamba pa mndandanda wautali wa matenda ndi mfundo yakuti mndandanda wa matenda a USTR omwe mankhwala opangidwa ndi generic angapangidwire, osaphatikizapo matenda aakulu a kupuma movutikira (SARS) - omwe, ndithudi, analibe poyera mpaka USTR itayambitsa. adatulutsa mndandanda wake. Izi zikuwonetsa kufunikira kosunga Chidziwitso cha Doha ngati momwe chidaliri - momwe maunduna azaumoyo atha kuthana ndi mliri momwe ukuchitika m'malo modikirira kuti anthu awo afe ndikufalitsa matendawa kumayiko olemera omwe ali ndi mphamvu yopanga mankhwala osokoneza bongo. (ndipo izi ndizofunikira makamaka pankhani ya SARS, yomwe zigawo za ma genome ndi othandizira omwe atha kukhala achire ali kale ovomerezeka, 11, 12). Lingaliro lokonzedwanso la USTR lipanganso njira zomwe zingalepheretse mayiko ngati Korea ndi Philippines kupanga mankhwala (osapatula Canada ndi China, omwe akhudzidwa ndi SARS) - kulepheretsa kuti mafakitale awo azitha kudzimanga okha mpaka pamlingo womwe ungapatse mpikisano makampani aku US-chifukwa akuyenera kuti ali ndi mphamvu zopangira. Vuto ndiloti akuluakulu azaumoyo amafunikira luso lopanga mankhwala otsika mtengo komanso mwachangu; Palibe malo opangirako ku Korea kapena ku Pilipino omwe ndi okwanira kupanga mankhwala a ma syndromes ambiri, ndipo chifukwa chake mazana a odwala matenda a myeloid leukemia ku South Korea akutsutsa kuti apeze mankhwala a Glivec (opangidwa ndi Novartis ndikugulitsidwa pamitengo ya OECD m'dzikolo). kungouzidwa kuti upite kunyumba ukafe (13). Pakali pano, USTR ikuzembera bungwe la WTO popereka malingaliro a mgwirizano wamalonda pakati pa mayiko awiriwa ndi mayiko angapo omwe akuvutitsidwa kuti apange malamulo amphamvu a patent kuposa omwe adagwirizana nawo pa mgwirizano wa TRIPS, posinthanitsa ndi ndalama za msonkho ku mabungwe olemera a mayikowa. ndi mapangano otumiza kunja (onani, mwachitsanzo, mkangano waposachedwa ku Uganda, 14; mndandanda wamapangano amalonda apakati pa mayiko awiri ndi mayiko ambiri omwe US โโikuthandizira, komanso kukhudzika kwawo pakupeza mankhwala, ikupezeka pa intaneti, 15).
Kulola bungwe la WHO kuulula mavutowa komanso kufunsa mwachindunji maboma a mayiko omwe akutukuka kumene kungakhale kofunika kwambiri poletsa ma patent kuti aletsenso kupeza mankhwala. Lipoti la Doctors Without Borders lomwe latulutsidwa ku Assembly lidawonetsa kuti maunduna ambiri aboma akungopereka ziphaso zosavomerezeka chifukwa ogwira nawo ntchito ali ocheperako kwambiri kuti awone bwino zomwe akufuna, osayang'ananso zomwe zili mumgwirizano wa TRIPS kuti adziwe zomwe zingasinthe paumoyo wa anthu. zilipo kwa iwo (16). Lingaliro lololeza kulowererapo kwa WHO lidapangidwa ndi Brazil koyambirira kwa Msonkhano, koma nthumwi zaku US zidakwanitsa kukankhira zokambiranazo mpaka sabata yachiwiri yandondomeko powonjezera zokambirana pazinthu zina ndikuchedwetsa misonkhano mosalekeza (mwa, mwachitsanzo, pontificating molakwika. Pokambirana za Edzi kuti kachilombo ka HIV kamayambitsa chiwopsezo chachikulu chotenga kachilomboka kudzera mu mkaka wa m'mawere kotero kuti zolowa m'malo mwa mkaka wa m'mawere ziyenera kuganiziridwanso kuti zitumizidwe kumayiko omwe akutukuka kumene - kubwereza kochititsa mantha kwa zomwe zidathandizidwa ndi Nestle m'mbuyomu zomwe zapangitsa kuti makanda akhale ndi vuto lalikulu la zakudya. mayiko osauka, 17). Chifukwa chakuti mayiko ambiri osauka sangakwanitse kusunga nthumwi zawo kumalo okwera mtengo a Geneva kwa sabata imodzi, kukankhira chinthu mu sabata yachiwiri ya msonkhano wa Msonkhano kumalepheretsa nthumwi za mayiko omwe akutukuka kumene kuti asapezeke pamsonkhano wovota pa chisankho.
US idaperekanso lingaliro lina, ponena kuti chitetezo chowonjezera cha patent chingathandize kupititsa patsogolo mwayi wamankhwala m'maiko omwe akutukuka kumene polimbikitsa kafukufuku ndi chitukuko (R&D, 1). Mawu awa ali ndi zolakwika zingapo. Zimanyalanyaza, choyamba, chifukwa chomwe kafukufuku ndi chitukuko cha matenda monga matenda ogona ndi khungu la mitsinje ndi ofooka kwambiri ndikuti osauka, omwe ndi omwe amazunzidwa kwambiri ndi ma syndromes, alibe mphamvu zogulira. Iwo ndi osauka, choncho makampani opanga mankhwala sangapange phindu lalikulu kuchokera kwa iwo. Kukhala ndi Patent m'mayiko osauka sikungasinthe; m'malo mwake, kukulitsa ma Patent kumayiko osauka kungangothandiza makampani opanga mankhwala okhala ku US kuti azilamulira zigawo zapamwamba zamayiko omwe akukumana ndi kusagwirizana komwe kukukulirakulira. Brazil, m'zaka za m'ma 1970, idaletsa ma Patent pazamankhwala palimodzi koma kulowetsedwa kwamankhwala mdziko muno kudakwera kasanu chifukwa chagulu la osankhika (18). Pakadali pano, kukulitsa chitetezo cha patent ku US kwapangitsa kuti mankhwalawo akhale opindulitsa kwambiri (avoteredwa ndi Fortune Magazine ngati bizinesi yopindulitsa kwambiri padziko lonse lapansi kwazaka 11 motsatizana, 19) kuti kafukufuku wawo ndi chitukuko "cholimbikitsa" chatsala pang'ono. adatsika pamapu. Pfizer, kampani yayikulu kwambiri padziko lonse lapansi, idapanga mankhwala amodzi okha kuchokera ku ma laboratories ake pazaka zisanu zapitazi (Viagra), pomwe amagula makampani ang'onoang'ono ndikugulitsa zinthu zawo (mwachitsanzo, zindikirani kupezeka kwaposachedwa kwa Pharmacia, 20). Oposa theka la msika wamakono waku US muzamankhwala atsopano ndi mankhwala "inenso", kapena kukonzanso kwamankhwala omwe alipo, omwe amagulitsidwanso atasinthidwa pang'ono (19).
Lingaliro lakuti mpikisano wamtundu uliwonse udzasokoneza makampani amanyalanyazanso zonse zomwe zilipo. Malinga ndi zolemba zamisonkho zamakampani omwe adapeza (zopezeka ku Securities and Exchange Commission), Merck chaka chino adawononga 13% ya ndalama zake pakutsatsa ndipo 5% yokha pa R&D, Pfizer adawononga 35% pakutsatsa ndipo 15% yokha pa R&D, ndi Makampani onse adawononga 27% pazamalonda ndi 11% pa R&D (Onani Zowonjezera 1). Pakadali pano, Africa yonse ya kum'mwera kwa Sahara imangopanga 1.3% yokha ya msika wamankhwala ndipo makampani amawononga 0.2% ya ndalama zake za R&D pa matenda aku Africa, kutanthauza kuti vuto la R&D pa "matenda osasamala" (osanyalanyazidwa ndi omwe sakudwala, ndi) zidzapitirira mpaka malingaliro ozikidwa pa msika atasweka (21). Ngakhale mayiko otukuka akuyimira pafupifupi 90 peresenti ya malonda ogulitsa mankhwala padziko lonse lapansi, 90 peresenti ya anthu 14 miliyoni omwe amafa chifukwa cha matenda opatsirana ali m'mayiko omwe akutukuka kumene (2). Chomwe chikuwonekera kuchokera ku manambalawa ndikuti vuto la R & D pa matenda omwe amakhudza makamaka osauka, ndi vuto la kupeza mankhwala osokoneza bongo chifukwa cha ma monopoles amtengo wapatali, amagwirizana kwambiri ndi ndondomeko ya "malonda aulere".
Pamene dziko la Brazil likufuna kuyambika kwa njira ina ku msonkhano wa zaumoyo ku Health Assembly, kuyitanitsa bungwe la WHO kuti likambirane ndi mayiko omwe akutukuka kumene pankhani ya patent, US idasiya chigamulo chake cholimba cha patent, makamaka chifukwa inalibe thandizo kuchokera kumayiko ena (2). Koma chigamulo chaku Brazil chitafika pansi Lachitatu lino, nthumwi zaku US zidayesanso kuzifooketsa. Nthumwiyo idakana kuvomereza chigamulocho mpaka kutchulidwa konse kwa Doha Declaration kuchotsedwa, mpaka kutchulidwa konse kwa mgwirizano wamayiko apakati komanso mayiko ambiri kuchotsedwa (kulepheretsa Secretariat ya WHO kufunsira maboma pazochita zawo zamalonda, popeza zisankho za Msonkhano zili ndi mphamvu zolamula) , ndi kuchotsa chinenero cha "katundu wa anthu" m'ndime za R&D nkhani (22).
Mosasamala kanthu za kufowoka kwa chigamulocho, lembalo pomalizira pake linaperekedwa, ndipo limapereka chifukwa cha chiyembekezo. Choyamba, kukhazikitsidwa kwake kumapangitsa kuti Mtsogoleri Watsopano wa WHO, yemwe akubwera, atengepo kanthu mwamphamvu kwambiri, ndipo watenga pulojekiti yowonjezera mwayi wopeza mankhwala ochepetsa kachilombo ka HIV kwa anthu 3 miliyoni omwe ali ndi kachilombo ka HIV. pazaka zisanu (ntchito yocheperako, chifukwa ikafika gawo limodzi mwa magawo makumi awiri a omwe akufunika pakali pano). Koma Director-General akusankha Dr. Jim Yong Kim (Co-director of progressive health service group Partners in Health, yomwe imayendetsedwanso ndi Dr. Paul Farmer) kuti akhale mlangizi wamkulu wa polojekiti ya "scaling-up". Popeza Dr. Kim mbiri yosasinthasintha yolimbikitsa ndi kulunjika ntchito kwa osauka, ndi kutsutsa kwake kosalekeza kwa zotsatira za neoliberalism pa umoyo wa anthu, pali zifukwa zambiri zokhalira ndi chiyembekezo (23). Nkhani ina yabwino ndi yakuti chigamulo cha ku Brazil chimafuna gulu latsopano lomwe lidzapange ndondomeko yopangira mankhwala a "matenda osasamala" (2).
Lingaliro latsopano la chimango choterocho lapangidwa kale ndi James Love wa Consumer Project on Technology, yemwe amadziwika kuti ndi katswiri wapadziko lonse pankhaniyi (onani kopi yomwe ilipo pa intaneti: 24). Kwa iwo omwe, chifukwa cha kupitirizabe kusankhika kwa malingaliro awa, amasiyidwa kutali ndi zipinda zopangira zisankho ku Geneva, palinso mwayi watsopano wochitapo kanthu. Chimodzi mwazovuta ndi ulamuliro wamakono wamankhwala, pambuyo pake, ndikuti ntchito zambiri zovuta zachitukuko cha mankhwala sizimachitidwa kudzera m'ma laboratories amakampani opanga mankhwala, koma kudzera m'ma laboratories omwe amathandizidwa ndi boma (zopereka ndalama) zamayunivesite, ambiri omwe amalipidwa ndi okhometsa msonkho. kudzera ku National Institutes of Health. Ambiri mwa ma laboratorywa amangogulitsa zinthu zawo kumakampani pamitengo yotsika kwambiri kuti amalize chitukukocho ndipo nthawi zina mayeso azachipatala pagulu (ngakhale omalizawo amalipidwanso kudzera ndalama za okhometsa msonkho). Mankhwala asanu apamwamba omwe amagulitsidwa pamsika waku US, mwachitsanzo, anali ndi 85% ya machitidwe awo a R&D kudzera mundalama za okhometsa msonkho (kuphatikiza mayeso azachipatala; 19). Kusintha chikhalidwe cha kukhudzidwa kwa yunivesite ndikofunikira kwambiri popanga njira ina yopangira mankhwala ndi kugawa. Ndondomeko yotereyi ikumangidwa momwe mayunivesite amatha kutenga nawo mbali mu ndondomeko ya R & D yomwe imasiya malingaliro a msika ndikupita kumalo komwe mankhwala akhoza kuonedwa kuti ndi abwino kwa anthu. Ophunzira akutsogolera, ndipo aliyense ndi wolandiridwa kuti alowe nawo: www.essentialmedicines.org.
Zomwe zochitika pa World Health Assembly ku Geneva zikuwonetsa ndikuti kumenyera mwayi wopeza mankhwala sikunapambane pazandale, koma kuti US ikulekana kwambiri ndi malo ake okana deta. Ngakhale EU ikuwoneka kuti ikukayikira kupereka chithandizo, choncho ndikofunikira kuti kupita patsogolo kwa Msonkhanowo kusasokonezedwe pa Msonkhano wa Utumiki wa WTO wa September ku Cancun. Pamodzi ndi nkhani zaulimi zomwe zikukambidwa, ndime 6 zokambirana ziyenera kudutsa "zosinthidwa" za USTR ndikubwereranso ku Doha Declaration yoyambirira. Ndi ntchito ya nzika zaku US kukankhira boma lawo motsutsana ndi momwe likukhalira pano, komanso ntchito ya nzika za EU kuletsa European Trade Commissioner (DG-Trade) kuti ipereke udindo wa US. Koma chofunika kwambiri pa ndondomekoyi chidzakhala atumiki amphamvu a mayiko omwe akutukuka kumene monga ochokera ku South Africa ndi Mexico, omwe nthawi zambiri amathandizira US koma ali ndi mwayi wogwirizana ndi Brazil ndi India pa zokambirana za ndime 6. Ndondomeko zomwe zidzachitike pamsonkhano wotsatira zidzachotsa mayiko osauka kuti amve zambiri. โZokhalamo zobiriwiraโ makamaka zikuphatikizapo njira monga kuyika nthumwi ya ofesi ya zamalonda ku US m'chipinda chochezera kuti achedwetse kukambirana kwa masiku; mautumiki a mayiko omwe akutukuka kumene, angakwanitse kutumiza mtumiki mmodzi kapena awiri ku misonkhano ya WTO, choncho ndunazo ziyenera kulimba mtima ndi msonkhano wa maola zana, kapena kuchoka ndi kulepheretsa mwayi wawo wovota (25). Njira zoterezi "zomangamanga" zidzagwiritsidwa ntchito ku Cancun; zili m'manja mwa nzika zapadziko lonse lapansi kuziulula ndikuwapangitsa kukhala osatha ntchito. Miyoyo 24,000 yomwe imatayika chifukwa cha matenda omwe angapewedwe komanso ochiritsika tsiku lililonse ndiwofunika kuyesetsa, ndipo zomwe zikufunika kuti zisinthe zikuyenda kale.
Kuti mumve zambiri, onani www.geocities.com/medicinepolicy
Zothandizira:
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23) Kim, JY., Millen, J., Gershman, J. & Irwin, A. (2000). Kufera Kukula: Kusafanana kwa Padziko Lonse ndi Thanzi la Osauka. Boston: Common Courage Press.
24) http://www.cptech.org/slides/trips2rips.doc
25) O, C. Mphamvu ndale mu WTO. Yang'anani pa Global South Paper: http://www.focusweb.org/publications/Books/power-politics-in-the-WTO.pdf
Zowonjezera 1: R&D motsutsana ndi ndalama zotsatsa zamakampani aku US
Company
% Ndalama zomwe zaperekedwa ku:
Ndalama (mamiliyoni)
Marketing
R & D
phindu
Merck
$47,716
13%
5%
15%
Pfizer
$32,259
35%
15%
24%
Bristol-Myers Squibb
$19,423
27%
12%
27%
Abbott
$16,285
23%
10%
10%
Chingwe
$14,129
37%
13%
16%
Eli Lilly.
$11,543
30%
19%
24%
Schering-Pula
$9,802
36%
13%
20%
Allergan
$1,685
42%
15%
13%
Chiwerengero *
$166,678
27%
11%
18%
($ miliyoni)
$45,413
$19,076
$30,599
Gwero: Securities & Exchange Commission, 2002
*zonse zikuphatikiza data ya Pharmaca yomwe sinalembedwe pamzere wosiyana patebulo; Pharmaca idagulidwa posachedwa ndi Pfizer Corp.
ZNetwork imalandira ndalama kudzera mu kuwolowa manja kwa owerenga ake.
Ndalama