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The Doha Declaration Plus Ten The year 2011 represents the 10th anniversary of the Doha Declaration on the TRIPS Agreement and Public Health. The anniversary is being recognized in a substantial number of forums, including with the joint participation of the Directors-General of the World Health Organization (WHO), World Intellectual Property Organization (WIPO) and World Trade Organization (WTO) (a more detailed account of the state of play with respect to medicines in the decade since the Doha Declaration, and proposals for the future, is in Frederick M. Abbott, 2011).
The social forces that gave rise to the Doha Declaration focused attention on public health and access to medicines problems confronting large parts of the world's population. Funding for procurement and distribution of medicines, particularly to treat HIV/AIDS, malaria and tuberculosis has risen. Support has increased for research and development (R&D) on drugs and vaccines for diseases predominantly affecting individuals in developing countries. Nonetheless, major problems involving innovation and access to health care and medicines remain to be addressed, including in the more advanced economies. The economic difficulties facing the advanced industrial economies in 2008-2011 have exacerbated, and will continue to exacerbate, problems in providing essential health services as countries at all levels of development are restricting payments for government services. It is an opportune occasion to reflect on multilateral institutional mechanisms for improving global public health.
Secretariat Cooperation, Member State Game-Play During the course of the past decade cooperation has improved among the secretariats of the WHO, WIPO and WTO in the field of public health. Cooperative projects have been carried out, including those involving the establishment of technical resource centres, conducting research on technical subject matter, and trilateral support of member state negotiating exercises. This cooperative work is undertaken both formally at the request of member states, and informally among individuals working for the institutions.
When attention is turned to relationships among the member states of the three institutions, the situation in respect of public health is more problematic. Governments continue to view the alternative forums of WHO, WIPO and WTO as mechanisms for securing strategic advantage. If negotiations in one forum take a problematic turn, proposals can be made in the other forums to limit or reverse the perceived adverse impact. Some of the larger advanced industrial actors appeared disaffected with the Geneva process as a whole, and have moved the principal focus of rulemaking and enforcement efforts to bilateral and regional forums.
It should not be surprising that individuals working in multilateral institution secretariats are better able to cooperate than are country/regional governments. Governments are complex enterprises whose officials are responding to various internal and external pressures that restrict their perspective. A senior government official negotiating in Geneva might consider some new proposal to be a reasonable approach to achieving a global objective, but that official’s personal conclusion may be at * Edward Ball Eminent Scholar Professor of International Law, Florida State University College of Law.
odds with the perspective of important home-country constituencies. The complexity of each individual government is multiplied 150 times in the major multilateral institutions.
It is an interesting question whether the international community would be better served by according a more powerful role to the "technocrats" at institutions like WHO, WIPO and the WTO.
On one hand, there would almost certainly be greater prospects for progress in the formulation of rules-making proposals. Simply in terms of numbers, it would be easier to craft agreement among 15 or 20 technocrats than it is to establish agreement among 150 governments (or 60 actively negotiating governments). On the other hand, the "democracy deficit" and potential for undue influence/corruption loom over any suggestion to enhance the role of the technocrats.
There is no self-evident solution to promoting cooperation among governments at the multilateral level -- as witnessed by the apparent failure of the Doha Development Round. It is certainly possible that the idea of intrusive multilateral governance is not feasible because of its inherent complexity and the constant pressures toward national autonomy.
New Instruments, Multiple Forums When governments are successful in negotiating new rules in individual multilateral forums, they are nonetheless left with problems of inconsistent rules. A lack of advance planning and legal integration was a major gap in the negotiation of the Nagoya Protocol (F. M Abbott, 2010), and is bound to lead to confusion and difficulty. It is not so difficult to foresee similar cases arising from new negotiating efforts.