Public health related TRIPS flexibilities and South-South co-operation as enablers of treatment access in Eastern and Southern Africa: perspectives from producing and importing countries

Abstract

Eastern and southern Africa, a region that is home to a twentieth of the world’s population, accounts for half the number of people living with HIV globally, including an increasingly drug resistant Tuberculosis epidemic. The high mortality and untold human suffering associated with HIV in the region during the late 1990s and early 2000s has mostly been mitigated by a rapid scale up of national HIV treatment programmes over the past decade, largely made possible by generic competition from Indian pharmaceutical manufacturers. The sustainability of treatment programmes in the region depends on various factors. National HIV treatment programmes are largely financed by multilateral donor mechanisms which are facing a decline in funding for the first time in the history of the AIDS response. Indian pharmaceutical manufacturers are increasingly encountering patent barriers stemming from the country’s implementation of its intellectual property obligations under the World Trade Organisation’s TRIPS Agreement. As eastern and southern African countries increasingly focus on local pharmaceutical production and south-south co-operation as vehicles for treatment sustainability, this thesis examines the extent to which public health related flexibilities present in the TRIPS Agreement can be used to as enablers of affordable treatment, both in domestic intellectual property legislation, and relevant regional platforms. The thesis undertakes case studies of the policy and legislative environment in two countries with very different profiles: The United Republic of Tanzania as a least developed country with a nascent local pharmaceutical manufacturing industry and South Africa, as the country with the largest pharmaceutical industry on the continent present the full range of country profiles in the region. Conclusions are drawn regarding the optimization of legislative and policy frameworks to facilitate both the importation and local production of health technologies. Finally, the thesis explores challenges and opportunities facing various south-south co-operation initiatives in the region.