TRIPS AND PUBLIC HEALTH
Under the title “Cutting-Edge Health Technologies: Opportunities and Challenges”, the technical symposium discussed how scientific progress and advances in health technologies have contributed to unprecedented improvements in health outcomes. It also pointed to significant challenges such as the unequal distribution of gains in life expectancy and quality of life among low-, middle- and high-income countries, and the persisting inequities within countries. Panelists underlined that in order to bridge these gaps and to tackle the evolving global disease burden, it will be critical to focus on needs-driven research, technological advances for specific diseases, and the accessibility and affordability of new treatments.
In his opening remarks, WTO Director-General Roberto Azevêdo noted while improving access to existing technologies remained important, meeting future public health challenges would also demand attention to promoting innovation and affordability for new cutting-edge medical technologies. “Entire new categories of diagnosis, therapy and prophylaxis are being developed to respond to changing public health needs. It's essential to see this innovation press forward and to ensure access to the fruits of such innovation. The international intellectual property system, and the flow of international trade, are both critical in bringing to the public the necessary new technologies in safe and effective forms,” he said.
DG Azevêdo underlined that the intellectual property (IP) system exists to promote the development of new technologies and to facilitate their dissemination. He noted the importance of exploring issues such as how IP settings relate to new medical technologies, including gene-editing. These go beyond technical details about patentability standards and the scope of rights and exceptions, he said, explaining that how these rights are deployed has important implications for affordability.
He cited the example of chimeric antigen receptor, or CAR-T cell therapy, a therapy still under development which offers remarkable possibilities for treating certain cancers by genetically transforming a natural white blood cell so that it attacks cancerous cells when reintroduced into the patient's body. This promising area of medical research involves both public and private actors; the terms they choose to license their technologies will have important implications for how new treatments are rolled out. In addition, such therapies, though transformative, could involve costs that may strain health budgets. “These are complex questions that will benefit from the discussions like this one, bringing together a wide range of actors with a wealth of practical expertise,” DG Azevêdo added.
Highlighting the importance of the implementation of the WTO Trade Facilitation Agreement, which simplifies and accelerates border procedures, he stressed that trade, in the sense of the cross-border movement of goods and services, also contributes to public health by helping ensure the availability of new technologies. “No single country — and still less vulnerable developing countries — will ever be fully self-reliant for the medical technologies they need. Facilitating trade also means facilitating access to medical technologies and inputs, which reduces the ultimate cost of treatment,” he said.
Finally, DG Azevêdo reaffirmed the relevance of the WTO TRIPS Agreement in line with the Doha Declaration on TRIPS and Public Health, which sent a clear sign that IP rules must be seen within their wider policy framework. He stressed the importance of a further milestone with the 2017 entry into force of the TRIPS amendment that explicitly legalized a new pathway for access to affordable generic medicines for all. See his full speech here.
WHO Director-General Tedros Adhanom Ghebreyesus said that this year's symposium theme underscores the power of science, technology and innovation for improving health, at a time when advances in science and technology are opening up new horizons in public health “that were considered science fiction not so very long ago.” He mentioned robotic surgery, 3-D printing, virtual reality, wireless brain sensors, telemedicine and mobile health, artificial intelligence (AI) and machine learning. “We are seeing science and technology developing faster than the legislation can keep up, with significant ethical and social implications. We, as a global community, must not fall behind or become out-of-date,” he said.
Dr Tedros stressed that although technological advances have had a profound impact on human health, resulting in a dramatic increase in life expectancy, we continue to live in a world marked by shocking inequality. “People in high-income countries live an average of 18 years longer than those in low-income countries. And although more and more people have access to health services and products, they are paying more and more out of their own pockets to use them. 930 million people spend more than 10% of their household income on health care. Medicines are a significant driver of this out-of-pocket spending. This is not just an issue for low-income countries. It affects all countries,” he said.
In a context of high prices and rapidly-changing markets, there is increasing pressure on the financial sustainability of health systems globally, and on their ability to provide full and affordable access to quality care. “With ageing populations and increasing demand for long-term care, these challenges will only become more acute, not less,” Dr Tedros stressed.
Health is a human right for all people, not a privilege for the few, he said, and “no one should get sick or die just because they are poor, or because they cannot access the products or services they need.” In order to accomplish that, Dr Tedros noted that the complex links between innovation, public health, intellectual property rights and trade must be better understood, as well as the benefits, costs and limitations of mechanisms for incentivizing innovation and their impacts on the pricing of health products. “WHO is committed to a comprehensive health systems approach to improving access,” he said. See his full speech here.
WIPO's Assistant Director-General Minelik Alemu Getahun highlighted that cutting-edge technologies have revolutionized health care and will continue to do so, as they have the capacity to provide ever more advanced care with improved capabilities for research, diagnosis and treatment. Therefore, their overwhelming positive impact and potential on the health care sector needs to be fully appreciated while addressing the challenges these disruptive technologies present.
“Firstly, countries need to maintain an enabling environment for sustained research and development that allows for invention and innovation to flourish. Secondly, they also need to provide policy frameworks commensurate with the rapid pace of progress, reflecting societal values without unduly erecting barriers. Thirdly, there is an imperative to address in a balanced manner issues of accessibility and affordability,” he said.
The IP system faces a similar challenge, he added, in keeping pace with the ever-increasing rate of progress, continuing to incentivize and reward innovation, and ensuring the diffusion of knowledge to support continued innovation in a balanced and effective manner. WIPO encourages collaborative health innovation, for example through its Public-Private Partnership WIPO Re:Search which is now in its 8th year and has facilitated more than 150 research and development (R&D) collaborations in the fields of neglected tropical diseases (NTDs), malaria and tuberculosis.
The patent system is a major source of information on technology trends. Published patent applications reflect trends and developments, making available valuable data about actors and where R&D takes place, Mr Getahun said. WIPO has studied the fast-changing environment. The Global Innovation Index 2019 (GII), published by WIPO with Cornell University and INSEAD as well as WIPO’s first Technology Trends Report on Artificial Intelligence provided analyses from IP and innovation perspective, trends in medical innovation fields such as genetics and stem cells research, nanotechnology, biologics, and brain research, as well as the largely untapped opportunities AI represents for agriculture, healthcare and manufacturing.
“Today’s discussions will explore the landscape of cutting-edge health technologies and consider some of the opportunities and challenges of optimizing their use in a variety of settings. We should endeavour to make our discussions as accessible to the public as possible by elucidating concepts and providing clear, fact-based information related to these exciting and ever-evolving health technologies,” he said.
The two main panels of the Symposium broadened the debate on the opportunities and challenges of cutting-edge health technologies. The first panel discussed perspectives for future health outcomes through biotechnology, information technology and big data as applied in the medical and medical device sectors.
The second panel discussed the opportunities and challenges of optimizing the benefits of these new technologies. Panelists addressed the increasing costs for health care systems, access and affordability challenges and possible country options to facilitate wider use of these technologies, as well as the use of confidential patient information data, and resulting ethical considerations.
To mark 10 years of coordination between the WHO, WIPO and the WTO, each organization gave an update of recent work with bearing on the themes of the Symposium.
“Our work together represents a clear recognition that we cannot meet the needs and expectations of our members by working in isolation. More than the specific new issues explored at events like today's, we learn and benefit from one another's technical expertise. If we are to have the trade and intellectual property systems delivering for public health, then cooperation, coordination and a shared policy outlook is not just desirable — it is essential,” DG Azevêdo said.