University of Oxford

From the abstract: "This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These include developing country coalitions and citizens in developed countries through participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration."


The paper describes the impact of larger countries in trade negotiations and how this may affect access to essential medicines, using the World Trade Organisation (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) as an example. It examines the role of citizens in developing countries and poses the question, “How can an individual influence his or her government's trade policy?” The answers, in short, are: 1) organising to form consumer groups; 2) joining and financially supporting civil society organisations (CSOs) advocating for access to essential medicines; 3) writing to senators, representatives, or members of Parliament arguing why a change in foreign policy is necessary; 4) making health and human rights a key electoral issue and applying pressure during presidential and senatorial campaigns; and 5) lobbying for access to essential medicines to pressure candidates, while exposing their opinions and decisions to the press.


The author uses the Doha Declaration on TRIPS and Public Health as an example of a way that developing countries and citizens in developed countries, represented by CSOs working together, can increase the voices and interests of those most in need of affordable medicines. In this agreement, a coalition of developing countries sought explicit assurance that they would not be subject to WTO penalties regarding medicine manufacture and medicine patents. The 4 factors, according to the author’s analysis, that enabled this negotiation were:

1. CSOs framed intellectual property as a public health issue about saving lives, and this captured the attention of mass media in
   industrialised countries;
2. the developing country coalition did not fragment and pursued a common objective in WTO negotiations;
3. the coalition was large, joined by a substantial number of developing countries; and
4. the coalition eventually made a compromise and went after what was achievable given the existing trading structures, instead of what was ideal.

The author concludes, as stated previously, that coalitions, civil society, citizenship, compromise, communication, and collaboration are needed to move forward. This includes pushing the issue of access to essential medicines onto the political agenda through the use of media, and pressuring governments to prioritise health concerns through lobbying, protesting, and supporting CSOs. "Health activists must communicate to the media, so that the media can frame the issue of access to essential medicines in an appealing manner."

Public Health Ethics Journal July 2008; Vol. 1(2): pages 83–88.