November 24-25, 1999

Friday: 5:00 PM

Dr. James Orbinski

President, MSF International Council

I cannot begin to close the conference without first commenting on Ms. Hvid’s remarks only a few moments ago. I must say very frankly that I am extremely disappointed in the perspective that the EC will bring to Seattle. Let me first comment on her view of essential drugs. The fact that the vast majority of drugs on the essential drugs list are not patented is no accident. Many expensive essential drugs are not on the list because one criteria for inclusion is low price. According to her view, life-saving essential medicines that are too expensive are not in fact essential drugs, and should not be on the list. This is verging on Orwellian double-speak. It is not a counter-argument.

Essentially, the views of the EC as expressed by Ms. Hvid give intellectual property rights priority over human rights, and in this context, particularly the right to health care. This is unacceptable. As well, there will be no health exceptions supported by the EC. She proposes simple "technical assistance" to developing countries to assist in the implementation of TRIPS. In this context, technical assistance is like applying Band-Aids to bullet wounds - it does nothing but hide the injury. The fact is that the market has failed. Of some 1200 new chemical entities developed since 1975, only 11 are specific to tropical diseases. In fact, the pharmaceutical record is the clearest evidence of any form of market failure. The EC is essentially asking us to "trust", to "have faith" in the "mantra of the market" when the record of the market leaves 17 million people dead every year of curable or neglected diseases. This is the status quo. Well, let me be very clear: the status quo is not good enough.

So, how to close our conference? This is a daunting task, unless one sees the conference as a beginning from which we must go forward. But before touching on this, let me start with a few observations that became very clear to me over the course of the conference.

The first is the nature of the problem, or why we are here. More than ninety percent of all death and suffering from infectious diseases occurs in the developing world. For example, 33 million people live with HIV around the world, and 60 million are at risk of African Sleeping Sickness . And as I said a moment ago, 17 million people die every year of curable or neglected diseases. This is the problem.

The second observation: there is a wealth of difference between a want and a need. I want a cappuccino, I need water; I want a fur coat, I need clothing; I want a face lift or a cure for my impotence, I need a life-saving essential drug to survive. So, there is a wealth of difference between consumer wants, and human rights - and by extension, a wealth of difference between private interests and public goods.

The third observation: globalization is not new. People have been trading between states for centuries, and they will likely continue for centuries more. Yet what is new is the speed and scope of globalization in the last 25 or so years. This is creating a growing dichotomy between trade and human rights and between business interests and public interests. And peripheral to this dichotomy sits the state. Will it assume its responsibility to ensure peoples’ rights? Or will it allow private sector interests to take priority over peoples irreducible needs? Which way will it go? Well, in the last two days, we have seen two very different choices. Yesterday we heard from the Dutch foreign Ministers’ office, and their position was very clear - it gives priority to the right to health over the privilege of trade. On the other hand, we have heard form Ms. Hvid of the EC, and their position is quite different, but also very clear.

What is obvious to me after these two days is that in the name of expanding markets, peoples needs are increasingly commodified, and are increasingly only recognized to the extent that they can be commodified. Here, only the only value is that which has monetary value. I quite simply, reject this. In this market ideology, who benefits, and then who suffers? Well, the short answer is the rich, and then the poor. Who gets treatment for baldness and obesity, and who festers with tuberculosis and wastes with AIDS? Again, the rich, and then the poor. This is wrong. Period.

The negative effects of Globalization are not inevitable. What is inevitable though is the wake-up call that they represent. Let me say very clearly that health care is not a commodity, it is a right. TRIPS represents the rules of market value. TRIPS does not determine social values, people do. Governments, in failing to address the failure of the market, have themselves failed in their responsibility to promote, to protect and to fulfill the rights of people. And to be deliberately repetitive, this is not good enough.

If people determine values, where are they, and how must they act? Well, let’s look at a few very recent historical examples. Twenty five years ago, the environmental movement was insignificant - all but non-existent as a peripheral, marginal package of ideas and values that had no political significance. Today, it is a force to be reckoned with that has very real and far-reaching political power. The movement to ban land-mines started a few short years ago, among a small group of NGOs committed to a principled idea. Seven years later, a virtual tidal wave of demand from global civil society brought 134 countries - with a few notable exceptions, including the G-1 - to sign a convention banning the use of land mines. There is a lot of work to be done yet on this issue, but what a beginning. Two years ago, the MAI was virtually killed in its tracks by a ground-swell of civil society indignation at a process that was secretive, lacking in transparency, and profoundly lacking in simple democratic space.

There is no question that we live in a global liberal hegemony. And yes, there is no question too that there are clearly some positive effects to globalization. But again, the negative effects of globalization are not inevitable. They are a wake-up call.

MSF was founded in 1971 in a disgust against laws, rules, policies and state practices that are a direct insult to the dignity of people. One of the first names of MSF was the "Committee Against Genocide in Biafra". Over our 28 year history we have been - and are today - committed to bringing direct medical humanitarian action to bear, and to publicly witnessing - to speaking out - on the reality and injustice that people in crisis face. Here today, in this room of over 350 people, there are over 100 different NGOs, all with a history and a commitment that resonates in some ways with ours. We must take this energy and make real what is clearly an emerging global civil society coalition - a coalition that is committed to assuming our responsibility to push, cajole and force governments to assume their responsibility in promoting, protecting and fulfilling the rights of people, and here particularly the right to health care. This is not an overnight battle. Seattle is the beginning of a process, and likely a long one that will last at least three years. Building and maintaining this coalition will certainly pose an organizational challenge. I pledge that MSF will do all that it can to make this happen. There is also a challenge to be clear about what we want.

We must insist that governments overcome access barriers to essential medicines. We must insist too that Research and Development for neglected diseases be stimulated, and that health exceptions to trade agreements be established in the interests of the public good, and not in the interests of the private sector. We must insist that governments clearly and firmly establish the priority of the public’s health over the privilege of trade. Here, there is a bit of a challenge for us, as the schizophrenia of government can be quite disconcerting, as a minister of trade says one thing, a minister of health another, and the prime minister something else. Pushing governments to be coherent will not be easy. Over the coming days, many of the NGOs here will be working in group sessions to prepare for Seattle. I wish them good work and most of all, clarity in their thinking and purpose for Seattle. We want to be sure that one outcome of the December Seattle meeting is a WTO working group on access to essential medicines.

We must also insist that the WHO show active, forward looking and unwavering leadership that ensures that the right to health will be protected, promoted and fulfilled. We will not accept that the WHO goes to Seattle with the view that "health must not be a barrier to trade", as WHO’s Mr. Scholtz said yesterday. There will be hundreds of ministers of trade in Seattle with that view. They don’t need WHO’s help. There are millions around the world who do, though. WHO’s responsibility is to ensure that "trade does become a barrier to health". WHO has to move beyond technical tinkering, and become an institutional counter-weight to the WTO. It must assert the right to health care over the privilege of trade.

We must also ensure that the "compulsory licensing" and "parallel imports" provisions of TRIPS are protected, promoted and used to increase access to essential medicines. We must also demand that rich governments go on public record - saying they will not bully poor governments into not using these provisions that protect the health of people through better access to essential medicines.

It is the dignity of people that has brought us together in the last days. It has also been the right to health care, and our responsibility to ensure that governments fulfill their duty as states to promote, protect and fulfill this right; and finally, is has been to ensure that the "market mantra" does not become the funeral song for the poor and the marginalized.

We are more than consumers, we are citizens. We have a responsibility to define what we see as of value, to ensure that "want does not over-ride need", and that "need takes priority over want". So lets’ get started. Thank-you.