Draft UN non-communicable diseases (NCDs) Declaration, Sept 18 version

On September 18, 2018, negotiations closed on what may be the final draft of the “Political Declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases.”

The Declaration addresses the measures UN members will undertake and the mandate of UN agencies, to prevent and treat diseases like cancer, heart disease, diabetes, asthma, genetic disorders and other illnesses that have in the past received less attention by global public health officials than diseases spread through direct or indirect human contact such as influenza or HIV.

A copy of the draft Declaration is available here: 18sept-ncd-resolution

The paragraph op20 on intellectual property rights was controversial, and the compromise reached was this:

    OP20. Promote increased access to affordable, safe, effective, and quality medicines and diagnostics and other technologies, reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) as amended, and also reaffirming the 2001 WTO Doha Declaration on the TRIPS Agreement and Public Health which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products;

One significant outcome of the TRIPS language is that the negotiators clearly state the 2001 Doha Declaration on TRIPS and Public Health, and the mandate to promote “access to medicine for all”, applies to drugs for cancer, rare diseases and other treatments that are very expensive, and for which access is unequal.

Since the Doha Declaration was adopted in 2001, the relevance of the agreement to cancer, diabetes and other non-communicable diseases has periodically been a source of controversy. The United States, sometimes joined by the European Union, Switzerland, Japan and other countries, has frequently opposed UN documents that associate the 2001 Doha Declaration on TRIPS and Public Health with NCDs. On other occasions, the United States and other countries have acknowledged that it does. Consider, for example, this report by Debra Cohen for the British Medical Journal, regarding a 2011 negotiation on NCDs, while President Obama was president.

The BMJ understands that the perceived threat to intellectual property forced US like-minded countries—such as Japan, Australia, New Zealand, Canada and Switzerland— to form a group with the EU to protect their interests. They did not want the declaration to mention TRIPS, the Doha Declaration or even epidemics—a medical word with huge financial ramifications.

But it was the US who were taking a particularly hard line and they would have rather walked away from the discussions than concede any ground on intellectual property. . . .

Aware that the negotiation would stall, the EU stepped in to agree text. As a sop to Brazil, Mexico and India, the US like-minded groups have allowed the inclusion of TRIPS in exchange for no mention of the Doha Declaration or epidemics.

In the current negotiations on NCDs, the Trump administration fought for months to block any reference to the Doha Declarations, but the reference is now in.

What about the other issues? The draft is nine pages long and covers a large number of topics. Parts will be useful, others are weak. There is no acknowledgement that prices for new drugs, vaccines and other medical technologies are excessive or even expensive. There are four references to partners or partnerships with industry or multi stakeholders including one that includes a reference to conflicts of interest.

There is a reference to mobilizing “adequate, predictable and sustained resources” for the prevention and control of non-communicable diseases, but the illustrative examples are things like “Official Development Assistance” or “voluntary innovative financing mechanisms and partnerships, including with the private sector.” The word “tax” does not appear.

    OP30. Commit to mobilize and allocate adequate, predictable and sustained resources for national responses to prevent and control non-communicable diseases and to promote mental health and well-being, through domestic, bilateral, and multilateral channels, including international cooperation and Official Development Assistance, and continue exploring voluntary innovative financing mechanisms and partnerships, including with the private sector, to advance action at all levels;

There is no mention of the basic policy incoherence of using temporary monopolies and high prices to induce investments in R&D, and the predictable barriers and inequities for access, or the notion that R&D incentives need to be delinked from prices.

The Declaration ends with a call for another high level meeting in 2025, to review the progress achieved.

    OP34. We request the Secretary-General, in consultation with Member States, and in collaboration with the World Health Organization and relevant funds, programmes and specialized agencies of the United Nations system, to submit to the General Assembly, by the end of 2024, for consideration by Member States, a report on the progress achieved in the implementation of the present political declaration, in preparation for a High-Level Meeting for a comprehensive review, in 2025, of the progress achieved in the prevention and control of non-communicable diseases and promotion of mental health and wellbeing.