Kerry Vanessa Bradford, Lee Kelley
Harvard Medical School, 260 Longwood Avenue, Boston MA 02115, USA.
Global Health. 2007 May 24;3:3. doi: 10.1186/1744-8603-3-3.
The World Trade Organisation's Declaration on the TRIPS Agreement and Public Health (known as the Doha Declaration) of 2001, and subsequent Decision on the Interpretation of Paragraph 6 reached in 2003, affirmed the flexibilities available under the Agreement on Trade Related Property Rights (TRIPS) to member states seeking to protect public health. Despite these important clarifications, the actual implementation of these measures to improve access to medicines remains uncertain. There are also concerns that so-called TRIPS-plus measures within many regional and bilateral trade agreements are further undermining the capacity of the poor to access affordable medicines.
The paper reviews policy debates among governments, nongovernmental organisations and international organisations from 1995, and notably since 2003, surrounding access to medicines and trade agreements. The provisions for protecting public health provided by the Doha Declaration and Paragraph 6 Decision are reviewed in terms of challenges for implementation, along with measures to protect intellectual property rights (IPRs) under selected regional and bilateral trade agreements.
While provisions, in principle, were affirmed for member states under the TRIPS agreement to protect public health, numerous challenges remain. Implementation of the flexibilities has been hindered by lack of capacity in many LMICs. More intransigent have been stark inequalities in power and influence among trading nations, leaving LMICs vulnerable to pressures to permit the globalization of IPRs in order to protect broader trade and economic interests. Such inequalities are apparent in proposals or adopted TRIPS-plus measures which re-establish the primacy of trade over public health goals.
Despite being hailed as a "watershed in international trade", the Doha Declaration and Paragraph 6 decision have not resolved the problem of access to affordable medicines. The way forward must begin with a simplification of their content, to enable actual implementation. More fundamentally, once agreed, public health protections under TRIPS must be recognised as taking precedent over measures subsequently adopted under other trade agreements. This requires, above all, setting aside such protections as a basic need and shared goal from trade negotiations at all levels.
世界贸易组织2001年的《与贸易有关的知识产权协定》（TRIPS协定）与公共卫生宣言（即《多哈宣言》）以及2003年达成的关于第6段解释的后续决定，肯定了《与贸易有关的知识产权协定》（TRIPS协定）为寻求保护公共卫生的成员国提供的灵活性。尽管有这些重要的澄清，但这些改善药品可及性措施的实际实施情况仍不确定。人们还担心，许多区域和双边贸易协定中的所谓“TRIPS-plus”措施正在进一步削弱穷人获得负担得起药品的能力。
本文回顾了自1995年以来，尤其是2003年以来，政府、非政府组织和国际组织围绕药品可及性和贸易协定展开的政策辩论。从实施挑战的角度审视了《多哈宣言》和第6段决定提供的保护公共卫生的条款，以及选定区域和双边贸易协定下的知识产权保护措施。
虽然原则上TRIPS协定肯定了成员国保护公共卫生的条款，但仍存在诸多挑战。许多低收入和中等收入国家能力不足阻碍了灵活性的实施。更顽固的问题是贸易国家之间在权力和影响力方面存在严重不平等，使低收入和中等收入国家容易受到压力，为了保护更广泛的贸易和经济利益而允许知识产权全球化。这种不平等在提议的或已通过的“TRIPS-plus”措施中很明显，这些措施重新确立了贸易相对于公共卫生目标的首要地位。
尽管《多哈宣言》和第6段决定被誉为“国际贸易的分水岭”，但它们并未解决获得负担得起药品的问题。前进的道路必须从简化其内容开始，以实现实际实施。更根本的是，一旦达成一致，TRIPS协定下的公共卫生保护必须被视为优先于其他贸易协定随后采取的措施。这首先需要在各级贸易谈判中将此类保护作为基本需求和共同目标搁置一旁。
