India: ‘the pharmacy of the developing world’
I was recently on a trip to India, and as I’m liable to do, on my way back home I went to the airport pharmacy in New Delhi International Airport. Surprisingly, there was a much longer queue there than anywhere else in duty-free. But it wasn’t because everyone needed something to sort out their stomachs. The real reason the line was so long was because people from other countries could get all of the medicines they might get at home but for much, much less.
That scene at Delhi airport is a pretty good metaphor for what’s happening in much of the world today. India supplies nearly all of the developing world’s high-quality, inexpensive generic medicines. All of the most important global health programmes – including PEPFAR and the Global Fund Against AIDS, TB and Malaria – also get their medicines from India generic drug-makers. Médecins sans Frontières has gone so far as call India “the pharmacy of the developing world”.
As the United States and other countries move to develop their trade relations with Prime Minister Modi’s administration, it’s important to keep this in mind. Developed country governments need to allow the Indian government to maintain the legal protections it has put in place to ensure that poorest and most marginalised people around the world have access to the most affordable medicines possible.
Almost two decades ago, India modified its intellectual property laws in order to meet the requirements of the World Trade Organisation. While, as required, it introduced patent laws giving companies temporary monopolies over new medicines they had discovered, it attempted to balance the impact of this with a number of internationally sanctioned protections to safeguard public health. Unfortunately, many of these protections are being threatened by developed countries’ trade agendas without enough consideration of the impact it would have on most of the world.
Ultimately, what we want to see is countries move towards public health systems that ensure that as many medicines are as easily available and accessible for as many people as possible. But while this is a goal that we need to push for, in most places the reality is still that people need to pay for their medicines out of their own pockets. In fact, in many developing countries medicines account for the majority of money that people spend out of their pockets on health. And that’s even with the low-cost generics that are flowing out of India, so imagine if that pipeline were to be shut.
International trade law allows and human rights obligate the Indian government to make use of all of the tools at its disposal to ensure that medicines are as affordable as possible to its people. What this may mean is that, at times, it is allowed to limit the impact of intellectual property on the price of new medicines, while at the same time making sure that it is strengthening health systems to ensure that those medicines actually get to the people that need them. But what it also means that other countries have to respect India’s right to do so.