Developed countries, dwindling national flexibilities, and access to essential medications during public-health emergencies

Dr Olugbenga Olatunji, Lecturer, The University of Sydney

Photo by Diana Polekhina on Unsplash

In a recently published paper, I historicise the gradual but potent attacks of the developed countries on the breadth and effectiveness of flexible obligations in international patent agreements. Flexibilities are usually included in these agreements to strike a balance between the monopolistic nature of patent rights and the right of states to suspend or abridge them in national interests. The paper discusses this flexibility-winding-back phenomenon through the lens of two treaties – the Paris Convention for the Protection of Industrial Property (Paris Convention) and the Agreement for the Trade-Related Aspects of Intellectual Property Rights (TRIPS). This post summarises the highlights of this paper. Given the currency of this topic, especially in view of the COVID-19 pandemic, a cursory comment is also provided on the recently adopted Decision of the World Trade Organisation (WTO) on improved access to COVID-19 vaccines.

Paris Convention – the ‘draining’ of a hitherto broad flexibility reservoir

The Paris Convention (PC) was adopted in 1883 to regulate industrial property (IP) like patents, trademarks, service marks, geographical indications, utility models, etc. It is pivoted on a tripartite principles of national treatment (NT), priority rights (PR), and common rules (CRs). NT (article 2, PC) requires subscribers to the PC to extend to citizens of other subscribers the same level of IP protection enjoyed by their citizens. PR (article 4, PC) is particularly useful for applicants who intend to protect their IP in multiple jurisdictions, as it allows them a grace period within which to submit applications for the same IP in other jurisdictions without losing the filing date of their first application – the duration of PR depends on the type of IP involved. Lastly, CRs outline principles of general application in respect of each of the IP categories covered in the agreement (e.g., see articles 4, 4bis, 4ter, 4quater and 5).

Two broad heads of patent-related flexibilities in the PC are discussed in the paper. The first and the most comprehensive one is the ‘non-binding’ nature of the PC tripartite principles. This is because these principles (NT, PR, and CRs) are only activated for members who offer protection for any of the IP categories under the PC. This approach is particularly advantageous in that a member may invoke not offering patent protection as a policy tool for expanding national technological base and promoting access to needed medications. Even where patent protection exists, this fluid approach means members could suspend or abridge patent rights to cater to access demands during public health emergencies. The second (equally broad) flexibility is forfeiture/revocation (article 5, PC). PC subscribers are empowered to revoke granted patents for abuses of patent rights like non- or insufficient working of the patents or other anti-competitive practices. This makes sense given one of the oft-cited justifications for rewarding creativities with monopoly rights is to foster industrial development through technical education and technology transfer.

Next, the paper traces the barrage of attacks directed at the broader forfeiture/revocation flexibility incorporated into the original PC (see 3.2). The first stop is the 1900 Brussels Revision which imposed two conditions for using the exception: first, members must wait 3 years post-patent-filing before invoking the flexibility even after non- or insufficient working of the invention had been established; and second, affected patentee must have no justification for not working or for insufficiently working their inventions (see article 2). The 1925 Hague Revision heralded a further tightening of this flexibility by requiring, in addition to the Brussels conditions, that forfeiture/revocation would only be available if the remedy of compulsory licensing (CL) could not resolve an alleged patent abuse (see article 5). In 1934, the London Revision added another condition, to wit, flexibility not to be available unless an alleged patent abuse remains unredressed two years after the grant of CL (see article 5(4)). The 1958 Lisbon Revision completes this process by refining the period within which CL could issue in addition to providing that CL must only be non-exclusive (see article 5(4)).

Cumulatively, all of these revisions decimated the revocation/forfeiture exception as patentees are now allowed to ‘justify’ alleged abuse of patent rights. Interestingly, the developed countries still yearned for more pro-patentee revisions and were only stopped by the increased membership of low-and-middle-income-countries (LMICs) who not only opposed further pro-patentee revisions, but also unsuccessfully pushed pro-access revisions of their own (e.g., see Loughran at 424-31). This stalemate led to a US-championed forum-change to the General Agreement on Tariffs and Trade (GATT) – now the WTO.                          

Transition to GATT, TRIPS, and access concerns

Sections 4, 5, and 6 of the paper examine the behind-the-scenes political intrigues that produced TRIPS as well as potential effects of the new treaty on access. In a nutshell, TRIPS’s structure mirrors that of the PC to the extent that it provides for NT, PR, CRs, and flexibilities. However, one distinction between TRIPS and the PC is that TRIPS exterminates the most consequential flexibility under the PC, namely, deference to members on if and how to incorporate the three pillars of the PC at national level. Hence, TRIPS now requires that all WTO members must entrench in their national laws TRIPS minimum standards, including provisions on enforcements and dispute resolutions. This universalisation of minimum standards is an incredible win for developed countries and their multinational corporations (MNCs) for two reasons: one, it makes it easier for their MNCs to obtain and enforce IP protection in LMICs; and two, with no obligation to exploit patents in countries of grant, it arguably legitimises ‘rent-seeking’ behaviour also in LMICs. It is for these reasons, among others, that TRIPS has been criticised as an impediment to access (e.g., see FM Abbott article).

The above notwithstanding, the paper acknowledges the simultaneous inclusion of flexibilities like parallel importation and compulsory licence in TRIPS. Theoretically, these could be used by members to temperate potential threats that TRIPS may constitute for access. The problem here though is that the freewill of LMICs to utilise flexibilities is tremendously constrained by developed countries, using different political-cum-economic stratagems to thwart their attempts. Apart from political/economic might, developed countries have also deployed Free Trade Agreements (FTAs) to diminish the scope and effectiveness of flexibilities post-TRIPS. FTA IP chapters are notorious for enacting TRIPS-plus obligations – obligations far higher than TRIPS minimum (see section 6). Countries like India, Brazil, Argentina, Thailand, and South Africa (just to mention a few) have been strategically targeted by the US, for example, either for using or attempting to use TRIPS flexibilities (e.g., see Drahos and Braithwaite).

In section 7, the paper identifies four ways through which this continuing attack on national flexibilities could exacerbate the access situation in LMICs, namely by:

  • legitimising external influence in national IP rule-setting (US & EU use trade access to control IP rule-settings in several LMICs);
  • imposing additional constraints on the use of certain flexibilities (e.g., compulsory licence for export and parallel importation);
  • unjustifiably adopting higher IP regime in the mistaken belief that this would foster technology transfer and FDI (e.g., Tanzania and Kenya); and
  • threatening the continued existence of India as the ‘pharmacy of the developing world’ (US has repeatedly placed India on a priority watchlist for using flexibilities, MNCs have developed strategies for challenging legitimate use of flexibilities in India, and a section of the Indian generic industry is becoming exceedingly pro-patent owing to influence from MNC collaborators).         

Postscript: the WTO Decision on improved access to COVID-19 vaccines   

Since early 2020, the world has witnessed a once-in-a-lifetime pandemic which originated in China in December 2019. The resulting shortage of PPEs, ventilators, diagnostics, vaccines, and therapeutics, later complemented by a wave of vaccine nationalism among developed countries, led South Africa and India to submit a proposal in October 2020 to the WTO offering ways out of this access quagmire. This proposal called for a blanket waiver of section 1 (copyright and related rights), section 4 (industrial design), section 5 (patents), and section 7 (protection of undisclosed information) of Part II of TRIPS for 3 years to enable a fast-tracked containment and treatment of COVID-19 infections.

After over 18 months of negotiations, a Decision finally emerged at the Ministerial Conference held in June 2022. Unsurprisingly, this Decision has no scintilla of resemblance to the original proposal from India and South Africa. Instead, it considerably reflects an alternative proposal sponsored by the EU, which identifies the overhauling of TRIPS’s CL framework as the holy grail to improved access for COVID-19 vaccines and therapeutics. It is worth noting however, that though based on the EU proposal, the Decision is narrower in scope. For instance, unlike the EU proposal, the approved Decision will only apply to vaccines, while negotiations regarding diagnostics and therapeutics will follow 6 months from the date of adoption (see paras 1 and 8).

The Decision’s substantive provisions may be grouped into three: the first refines TRIPS provisions on article 31 CL by removing the need for prior authorisation under article 31(b) and re-defining adequate remuneration under article 31(h) (paras 3a and 3d). In the second group are provisions focused on addressing some of the criticisms raised against article 31bis (CL for exports). These provisions clarify the circumstances for waiving TRIPS article 31(f) (para 3b); the re-exportation of imported vaccines (para 3c); and the timing of communication of actions under the Decision to Council for TRIPS (para 5). The last group of provisions addresses the issue of duration (5 years, though extendable) (para 6), and the problem associated with access to test data where CL has been granted under articles 31 and 31bis (para 4).       

In retrospect, the process that produced this Direction confirms how emboldened the developed countries have become, not only in attacking national flexibilities pre-TRIPS, but also in manipulating LMICs to ‘voluntarily’ surrender flexibilities. As explained in the paper, this domination is heightened by the successful linkage of trade and IP under the WTO, such that developed countries can now use trade access as a carrot-and-stick instrument to reward cooperating LMICs (increased trade access) or punish recalcitrant ones (withdrawal of trade access). This seems to explain why the India-South Africa proposal did not see the light of the day (in whole or in part) despite the tremendous supports it garnered within and outside the WTO. It also seems to explain why LMICs with capacity to manufacture COVID-19 vaccines would agree to undertake not to use the Decision, even though the Decision is intended to benefit all LMICs (see footnote 1 of the Ministerial Decision).                      

Moving forward despite dwindling flexibilities

It is indisputable that there is no quick fix to the ubiquitous conundrum of inadequate access, especially during a deadly pandemic like COVID-19. However, a few potential solutions may be explored. The lead recommendation in the paper is a political one, which makes sense given the political nature of this problem. Thus, since the laws of many LMICs provide for TRIPS flexibilities, they are advised to muster political will to use these flexibilities not minding any threat of economic sanctions from their developed country counterparts. India is a leading example here as it has defied repeated US harassments aimed at preventing it from using flexibilities. Second, while the June Decision falls short of the widely supported proposal, LMICs could still take advantage of the clarified provisions of TRIPS articles 31 and 31bis CLs. This recommendation, however, circles back to the need for LMICs to show unabashed political will to use the Decision. Third, LMICs may also consider the possibility of using the WTO platform to secure an undertaking from developed countries not to interfere in attempts by LMICs to use flexibilities. Lastly, not all countries can or should venture into pharmaceutical production; as such, a specialised agency could be instituted (perhaps, within the WHO) to coordinate the donation of urgently needed pharmaceutical products to these vulnerable countries where patent is not the issue.

Indigenous Peoples’ Inclusion in Food Governance

For NAIDOC Week, Dr Mark Lock speaks to Dr Belinda Reeve about championing health equity for First Nations Australians and their meaningful inclusion in all dimensions of food governance. 

Reposted with permission from the Sydney Environment Institute website:

Red native fruit plant.
Santalum acuminatum, desert bush tucker peach quandong, Australian native fruit via Shutterstock, ID: 734790040.

Industrialised, corporatised food systems contribute to some of the most urgent challenges facing the planet. These include climate change, the depletion of environmental resources, rising food insecurity, high rates of non-communicable diseases, and poor working conditions in the food and agricultural sectors. The dominant food system – and the policies, laws, and practices that govern it – has also marginalised, oppressed, and ignored the voices, perspectives, and participation of Indigenous Peoples, Black People and People of Colour. This occurs even at the highest levels: the recent United Nations Food Systems Summit has been criticised as privileging corporate, agro-industrial, and Global North interests at the expense of human rights, the Global South and Indigenous food systems.  

In light of growing interest in Indigenous food sovereignty, anti-racism and decolonising the food system, The Charles Perkins Centre’s Food Governance Node will be hosting an event on Wednesday 27 July on the ‘Inclusion of Indigenous Peoples in Food Governance in Australia and Aotearoa/New Zealand’. Here, we speak to Dr Mark Lock, Senior Lecturer at the University of Technology Sydney, Research Fellow at Deakin University, and one of the event’s panellists.   

Dr Belinda Reeve: Could you please tell us a bit about your background?  

Dr Mark Lock: I’m from the Ngiyampaa mob and with ancestry from the First Fleet (on the maternal side) and from Latvia and England (on the paternal side) but grew up with ridgy-didge Koori experience in rural NSW, before moving to Newcastle 30 years ago. I study committees and governance because it was invisible people on secret committees who made decisions about Aboriginal people, without Aboriginal people. That’s from the experience of my Nan, a Stolen Generations survivor. She is also why I continue to do research on the participation of Aboriginal people in policy​making processes, such as food and nutrition policy. It’s also why I research cultural safety because Indigenous people are diminished, demeaned and disempowered through poor governance. I currently work as a Research Fellow with the Murnong Health Research Mob (at Deakin University, School of Health & Social Development, Faculty of Health), and I’m also Senior Lecturer at the School of Public Health, University of Technology Sydney. 

Your current research focuses on the Commercial Determinants of Indigenous Health. Could you please explain this research lens to us? 

​Commercial activities influence our society in many ways. It can be advertisements on social media platforms, sponsorship of sporting teams, funding research activities, lobbying politicians, to bringing jobs and products to local communities. So, if business activities are a normal part of our society in many positive ways, then it also holds true that there are negative influences on health and wellbeing. However, it is only recently that Indigenous health policy makes specific mention of commercial determinants of health. In other words, governments have focused on behaviour change programs, health promotion activities, and legislation that influences public services to be health promoting, and ‘businesses and the market’ operate outside of healthy public policy. This means concepts such as health equity are not included in the governance of commercial activities. 

It is inequitable that Indigenous peoples have the highest food prices in communities with lowest incomes and less access to education and employment opportunities – combined with low quality housing and health hardware. But put a mine in the ground and everything changes – fuel subsidies, extraordinary wages, low taxes, and incredible infrastructure to generate wealth for the nation, and massive profits and revenue for a few people. It’s in these very different comparisons (nutrition inequity and mining equity – pun intended) that shows the potential for commercial determinants of health.

“It is inequitable that Indigenous peoples have the highest food prices in communities with lowest incomes and less access to education and employment opportunities – combined with low quality housing and health hardware.”

You’ve also explored the themes arising in submissions to the Australian Government’s 2020 Inquiry into Food Pricing and Food Security in Remote Indigenous Communities. What were some of your findings? 

I’ve analysed 83 submissions from different organisations. I’m thinking about how commercial activities influence food security. There’s some interesting themes coming out as cultural norms, such as the absence of a framework for commercial determinants of Indigenous health; that health equity is excluded from corporate governance; that Indigenous people (and cultural knowledge) are mostly excluded from participating at decision-making tables; and that there is an enduring norm of hardship expected for Indigenous people in rural and remote communities. However, the great things to see and build on are themes such as cultural resilience where Indigenous peoples use commercial activities in an innovative way, that many commercial activities benefit from the inclusion of cultural knowledge, and of course the theme of ‘collaboration nation’ where Indigenous communities proactively form partnerships – between communities and businesses – to leverage reforms at the local level. 

“Commercial activities influence food security. There’s some interesting themes coming out as cultural norms, such as the absence of a framework for commercial determinants of Indigenous health; that health equity is excluded from corporate governance.”

The most illuminating aspect of the research is to make visible what is currently invisible. That’s the culture of commercial determinants, by which I mean to uncover the hidden pattern of values, norms and behaviours underlying the link between commercial activities and nutrition equity. Why is it normal for rural and remote Indigenous communities to suffer enduring nutrition hardship? How can the value system of Western monetary wealth be reconciled with Indigenous sovereignty? How can business behaviours towards equity be supported and rewarded? One thing is a clear theme, with this being the third inquiry on this topic, it’s time get on with actions that are aligned with a dedicated commercial determinants of health framework. 

“Inclusive governance is more than a principal and deserves to be empirically investigated. I know that’s not a simple ‘one-page’ answer, but food policy and governance are complex and nuanced with many stakeholders vying for a profitable wedge into the system. Simple policy​ on the run will not work.”

The focus of this event is on the inclusion of Indigenous peoples in food policy and governance. What do you think truly inclusive food governance looks like? 

I think about how Indigenous peoples can influence every ‘point and pathway’ of governance. So, I a) yarn with relevant Indigenous people from the beginning, b) map the governance system, c) identity every point and pathway where Indigenous people should influence the system, d) ethically research and gather knowledge, e) develop a system design where the process includes all stakeholders, f) build in evaluation, measurement, and monitoring, and g) close the loop by ensuring good ongoing governance with Indigenous communities.

Therefore, inclusive governance is more than a principal and deserves to be empirically investigated. I know that’s not a simple ‘one-page’ answer, but food policy and governance are complex and nuanced with many stakeholders vying for a profitable wedge into the system. Simple policy​ on the run will not work. Finally, thinking about my Nan and Stolen Generations as we come into NAIDOC Week 2022, I’d like to see the food and nutrition industry “Get Up! Stand Up! Show Up!” for nutrition equity with First Nations Australians. 

To hear more from Dr Mark Lock, register for the panel discussion, ‘Inclusion of Indigenous Peoples in Food Governance in Australia and Aotearoa/New Zealand’. 

Dr Mark J Lock is a Ngiyampaa First Nations Australian. He combines both cultural rigour and scientific rigour through a culturally safe research methodology. He has published on Aboriginal holistic health, participation in health policy, nutrition and food policy, and cultural safety in paediatric emergency departments, and cultural safety in research and policy. He is an ARC Discovery Indigenous Research Fellow (2013); Co-chair of the NSW Agency for Clinical Innovations Aboriginal Health Working Group on Patient Reported Outcome Measures; and Vice President of the Hunter Writers Centre. His advocacy – through Freedom of Information – resulted in the release of the Evaluation of the National Aboriginal and Torres Strait Islander Nutrition Plan, and in the release of the Scoping Study for an Australian National Nutrition Policy. 

Dr Belinda Reeve is a Senior Lecturer at the University of Sydney Law School and one of the co-founders of the Charles Perkins Centre’s Food Governance Node, a platform for interdisciplinary research on the role of law, regulation, and policy in creating a healthy and sustainable food system. She is also the lead researcher on an ARC Discovery Project investigating the role of Australian local governments and communities in strengthening food system governance at the local level.