PM Modi asked to take on the US to ensure TB drugs remain affordable

A TB patient buying medicines at a hospital in Kanpur | Chandan Khanna/AFP/Getty

Modi announced India’s plan to eliminate TB by 2025 four months ago, but American intervention has put spanner in the works.

New Delhi: Public health activists have urged Prime Minister Narendra Modi to step in to make the ongoing negotiations at the UN for a political declaration on tuberculosis more effective.

The move comes four months after Prime Minister Narendra Modi had announced that India was on its way to eliminate TB by 2025, five years ahead of the global target of 2030.

But now meeting the target may not be as simple as it looked earlier since the American intervention in the UN negotiation on behalf of its pharmaceutical industry is seen to have weakened the fight against TB, the world’s top infectious killer.

According to experts, the US pressure has diluted global commitment to TRIPS (Trade-Related Aspects of Intellectual Property Rights) flexibilities, which ensure access to affordable TB medicines, vaccines and diagnostics. This was reflected in the draft of the political declaration on TB circulated on 20 July.

This means the newer TB drugs, such as ‘wonder drug’ Delamanid and Bedaquiline, will become a distant dream for the patients in developing nations, including India.

Worried over the TB burden in India, which faces close to 2.8 million new cases every year, 25 health organisations and 32 public health activists have written a letter to PM Modi drawing his attention to the ongoing negotiations.

For the past two months, talks have been going on to finalise the political declaration on TB ahead of a key meeting in New York on 26 September

How TRIPS flexibilities will help  

TRIPS flexibilities, as highlighted in the Doha Declaration, uphold the right of World Trade Organisation (WTO) member states to include in their patent legislation a provision for “use without authorization” of the patent holder.

Article 5 of the Doha Declaration says that the WTO member states have the freedom to determine the grounds for compulsory licensing and that public health crises, including those linked to the epidemics human immunodeficiency virus (HIV) infection, tuberculosis, malaria and other diseases, can represent a national emergency or other circumstance of extreme urgency.

Following the Doha Declaration, several compulsory licences were issued for generic manufacture of patented drugs. In essence, it allows countries with manufacturing capacity to adopt legislation that permits the granting of compulsory licences for the production of pharmaceutical products for export, and countries that lack manufacturing capacity to introduce equivalent legislation to facilitate import.

What activists say in their letter

“The current text includes a cruel joke that ‘IP rights are an important incentive in the development of new health products’,” says the letter written on 31 July, a copy which is accessed by ThePrint.

“It is widely acknowledged that IP directs investment choices away from public health needs of developing countries such as TB, considered less profitable, and steers investments to areas where pharmaceutical corporations can maximise profits for diseases affecting more affluent populations,” (sic) it reads.

The letter points out that the language has been tweaked in the TB declaration, which calls on governments in rich countries to contribute appropriately to research and development and increase financing in order to close the estimated $1.3 billion gap per year for tuberculosis research.

“Language on the norms that should govern such funding has been weakened and undermined by the current text in the draft of the TB political declaration,” says the letter, a copy of which is marked to health minister J.P. Nadda, external affairs minister Sushma Swaraj and minister of commerce and industry Suresh Prabhu as well.

India must support South Africa

Rounds of negotiations ensued with the Group of 77 nations pushing for inclusion of references to TRIPS flexibilities and the US against it last month. However, the final text of the political declaration that was circulated on 20 July does not include substantive reference to the flexibilities demanded.

If no country has any objection to the final draft, it would be adopted by the UN General Assembly at the high-level meeting on tuberculosis, scheduled for 26 September in New York.

But South Africa broke its silence on 24 July and re-opened the negotiations to address these concerns.

TB patients and health activists have urged the Indian government to support South Africa on its principled position. “Discussions are still on and we are optimistic that decision will be in the benefits of patients across the globe including Indians,” said Vikas Sheel, joint secretary (Revised National Tuberculosis Programme), health ministry told ThePrint.  “We applaud South Africa for the step in speaking up.”

According to Ashwani Mahajan, national co-convener of Swadeshi Jagaran Manch (SJM), an RSS wing, high-level talks are going on between the officials in government and UN officials.

“We are quite sure that the essence of TRIPS will not be diluted,” he added.

Experts urge India to take a stand

Mohga Kamal-Yanni, senior health adviser at Oxfam, said it is critical that India and other countries make efforts to retain their rights to grant permission for compulsory licences to local drug manufacturers and to supply low-cost generic versions of patented TB drugs at affordable rates.

“India has committed to eliminate TB by 2025. TB medicines available in India are expensive and to meet its goal, India must ensure access to affordable medicine,” she added.

According to Oommen C. Kurian, fellow, Observer Research Foundation (ORF), the US funds 60 per cent of global TB drug research.

“Given the recklessness that their political leadership has demonstrated, one hopes that this battle has no long-term access implications,” he said.

Malini Aisola from All India Drugs Action Network (AIDAN), one of the 25 organisations that wrote the letter to PM Modi, said the persistent attempts to delete references to TRIPS flexibilities are aimed at discouraging developing countries taking advantage of these flexibilities to protect public health. “We must not give up,” she added.