Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil

Abstract

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.

Transnational Mobilisation on Access to Medicines: The Global Movement Around the Imatinib Mesylate Case and Its Roots in the AIDS Movement

“…The PMA case, together with strong leadership from the Brazilian government, strong activist mobilisation and a number of other factors laid the groundwork for the Doha Declaration of 2001 (Abbott and Reichmann, 2007;Kerry and Lee, 2007;Forman, 2008;Nunn et al, 2009), which clarified much of the legal uncertainty that had existed around the TRIPS agreement, particularly with regard to flexibility in domestic law designed to safeguard public health and affordability of drugs. In the declaration, WTO member countries state that:…”

“…The claims of the access to medicines movement-revolving around the central moral assertion that the need for access to medicines and the suffering of patients who are denied access overrides the well-established property rights of patent-holders (and perhaps that medicines as a life-saving commodity in a certain sense represents a public good)-are fairly radical and challenge the interests of a massive and influential industry in the Global North (see Smith and Siplon, 2006;Nunn et al, 2009;'t Hoen et al, 2011;Kapstein and Busby, 2013).…”

What contribution have human rights approaches made to reducing AIDS-related vulnerability in sub-Saharan Africa? Exploring the case study of access to antiretrovirals

“…By 2010 the government was treating 194,984 people (50% to 89% of those in need) (2), contributing to significant reductions in AIDS-related mortality and morbidity (40% and 70%, respectively) (22). This program is largely attributable to domestic human rights advocates who successfully persuaded courts to interpret the Brazilian Constitution's right to health to include access to AIDS medicines (21), motivating government to pass a 1996 law guaranteeing free universal ARV access (21). Resultant rising treatment costs led the Brazilian health minister to consider a compulsory license to enable local ARV manufacture (21), prompting the United States to lodge a WTO complaint in 2001.…”

“…This program is largely attributable to domestic human rights advocates who successfully persuaded courts to interpret the Brazilian Constitution's right to health to include access to AIDS medicines (21), motivating government to pass a 1996 law guaranteeing free universal ARV access (21). Resultant rising treatment costs led the Brazilian health minister to consider a compulsory license to enable local ARV manufacture (21), prompting the United States to lodge a WTO complaint in 2001. Transnational AIDS groups mobilizing against South Africa's PMA litigation joined action against this complaint, as the Brazilian Government strategically (and successfully) promoted a right to medicines at the United Nations (21).…”

“…Brazil was the first middle-income country to offer free AIDS treatment, initiating a public sector program in the early 1990s and committing to provide free universal access in 1996 (21). By 2010 the government was treating 194,984 people (50% to 89% of those in need) (2), contributing to significant reductions in AIDS-related mortality and morbidity (40% and 70%, respectively) (22).…”