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Health

How India Helped 'Harmonise' UN Declarations on TB and Non-Communicable Diseases

After months of negotiations, two political declarations on TB and non-communicable diseases are now ready for the United Nations General Assembly to adopt this month.

New Delhi: If there is a striking similarity in key portions of the recently finished UN political declarations on tuberculosis (TB) and non-communicable diseases (NCDs), it might be because of India’s efforts.

“Our strategy was to use the NCD text to get what we wanted in the TB text,” said a senior Indian diplomat in an off-the-record briefing with The Wire.

While diseases like TB plague largely developing countries, NCDs are globally prevalent but also growing in developing countries like India.

“We knew that the NCD text mattered a lot to the US, EU and other developed countries. So we supported the US in the negotiations, to get the language that supported the right to affordable medicines and the language that upheld TRIPS,” said the Indian diplomat.

“Once that language was safely in the NCD text, we told the US that they couldn’t now have a double-standard with poorer countries by not allowing the same commitments in the TB text. Our lives are not worth less than theirs.”

This was some of the strategies used by India along with other G77 countries, to get to where we are: after months, the political declarations of both the texts on TB and NCDs now have a strong language that commits countries to access to affordable medicines and the use of TRIPS (Trade-Related Aspects of Intellectual Property Rights) flexibilities.

But this was not the case throughout. The Wire was first to report in July that the final iteration of the declaration on TB had suddenly dropped references to affordable medicines and TRIPS. References to TRIPS have been a standard feature on many of these political declarations and it affirms the right of developing countries especially to assert their right to access affordable medicines.

Also read: Draft UN Text on TB No Longer Carries Provisions on Affordable Medicines

Trade-Related Aspects of Intellectual Property Rights – TRIPS – is a multilateral agreement with members of the World Trade Organisation. It deals with intellectual property rights, and specifically here, it upholds the rights of developing countries to check the prices of medicines and keep them affordable, overriding patents.

For months, diplomats have been hashing out the specifics of these two important political declarations on health, for the UN high level meetings (UNHLM) on tuberculosis and non-communicable diseases. The discussions on these two texts were happening separately yet simultaneously. The declarations will be adopted by the United Nations General Assembly on September 26 and September 27 respectively.

The Wire has contacted negotiators at the United Nations on the TB declaration from three other countries and will update this if they reply.

Also read: UN Political Declaration on TB Likely to Be Re-Opened, With Pushback Against the US

What do the two texts say?

The Wire had reported in July that there was likely to be a “harmonisation” and “common strategy” between the TB and NCD texts.

Sample the relevant sections of the two texts to see how this harmonisation has taken place:

The UNHLM final political declaration on TB carries a paragraph numbered 19. It is the very first commitment in the text and says clearly that countries “commit” to promote access to affordable medicines, in line with TRIPS.

19. Commit to promote access to affordable medicines, including generics, for scaling up access to affordable tuberculosis treatment, including multidrug-resistant and extensively drug-resistant tuberculosis treatment, 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… [emphasis added]

Likewise, the UNHLM political declaration for NCDs carried paragraph 20, which also said that the countries would “promote” the access to affordable medicines, also in line with TRIPS.

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… [emphasis added]

US tries to disassociate itself

The US has been pushing developing countries in the G77 to drop their desire to have a language that upholds and affirms TRIPS. Apart from strong-arming them in the TB declaration – which was reported in the US press and in The Wire – the US showed its opposition to allowing developing countries to access TRIPS flexibilities in the recent UN resolution on malaria as well.

“The US is trying a few tactics. They either ask for these references to be deleted, if not then they ask for there to be a vote, or they disassociate with the resolution, or they walk out all together,” said the Indian official.

This is indeed what the US government has been doing – on this recent United Nations text on malaria, the US issued a statement distancing itself from the text which had language in paragraph 34 that protected access to medicines. In it, the US called it “inappropriate” to suggest TRIPS references. Their statement argues against compulsory licensing, which is an important feature of the TRIPS which helps countries override medicine patents: “intellectual property is essential for the development of new medicines” and “The United States is therefore concerned that the threat or use of compulsory licenses will choke the research and development that will be needed to save lives in the future.”

South Africa’s role in the negotiations

So far, South Africa has publicly been taking the shine for asserting the rights of developing countries in the UNHLM TB declaration – South Africa has been tackling TB aggressively, accelerating their enrollment of patients and also rapidly rolling out new drugs Bedaquiline and Delaminid for their drug resistant TB patients.

When the TB text was finalised without the provisions on TRIPS as The Wire had reported, South Africa “broke silence” on the text, opposing it. Since these are political declarations and not resolutions, they need to be unanimously agreed on. With South Africa’s dissent, the text had to be renegotiated and this happened over the last two months, ultimately leading to the text which was finalised last week and will be adopted on 26 September.

The final text of the NCD declaration has been published this week and no country broke silence, meaning it will likely be formally adopted as the final declaration on September 27.

When South Africa broke the silence on the TB text in July, they had been very insistent on having at least two things in the text which for them were rigidities: A reference to TRIPS flexibilities and a reference to the need for “delinkage” (delinkage is the idea that research and developments costs of drugs should not be linked to the prices of medicines, to keep the prices low). In June, Politico Europe reported that the US and EU were trying to get references to “delinkage” out of the text.

The Indian diplomat explained that for other countries, TB was neither a political issue nor a major public health issue. For the Indian negotiators however, this was the one thing they had to secure and bring home. “India’s goals here were that we wanted the text to “commit,” and not just say weak things like the declaration “recognises” the urgency of the situation. From references to TRIPS being completely dropped from the text, to now having it as the very first commitment in the text, we won a lot.”

Does any of this matter? To the skeptics, the senior Indian diplomat explains, “Theory and practice will always differ but doesn’t mean that the theory is not worth fighting for. That’s what these months of negotiations were about. Because if we gave up on this now and let it go, there’s no telling if we may ever have got this back into these texts again.”