Expanding Drug Access in Brazil: Lessons for Latin America and Canada

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ABSTRACT

This paper discusses Brazil's efforts to provide essential medicines for its population while meeting international trade obligations. In the 1950s and 1960s, Brazil's pharmaceutical industry was largely overtaken by foreign companies. To counteract this, Brazil enacted a law in 1971 that allowed the production of patented drugs in order to provide affordable medicines, encourage research and development, and reduce dependency on imports. Eventually, pressure from the United States government (through tariffs and sanctions) drove Brazil to introduce pharmaceutical patent laws. Local interests prevailed, however, through Brazil's liberal interpretation of the TRIPS Agreement, which included a provision that pharmaceutical products must be "worked" or manufactured locally or the government could turn to the use of compulsory licensing. Brazil's willingness to use the threat of compulsory licensing compelled drug companies to lower HIV/AIDS drug prices substantially. Finally, the paper discusses how Canada can facilitate improving drug access in Latin America through helping Brazil expand its role as a manufacturer and providing medicines to countries without manufacturing capabilities.

MeSH terms: Drug access; essential medicines; TRIPS Agreement; Brazil; Canada

The management of pharmaceutical expenditure has become a focus of most governments around the world, irrespective of national income level, given the increasing demands (e.g., aging of the population, health care restructuring, the development of new drug therapies) for pharmaceutical products and their rising costs, both of which put pressure on public health budgets as well as on private health spending. For low- and middle-income countries, the standards imposed by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, are an additional obstacle in their efforts to ensure affordable medicines to their populations and manage pharmaceutical costs. The TRIPS Agreement is governed by the World Trade Organization (WTO) and obliges countries to harmonize intellectual property law for pharmaceutical products (thus reducing generic competition in the market). This obligation makes it increasingly challenging for governments in Latin America as well as in other regions to ensure that their populations have access to medicines and that they meet international trade obligations. Pharmaceuticals, when they are readily available, affordable, of good quality, and used appropriately, can provide a cost-effective solution to many health care problems. Essential drugs at a reasonable price can cure or prevent many of the diseases that plague the poor throughout Latin America.

This paper explores the history of how one country in the region - Brazil - has dealt with external pressures from international trade agreements on domestic policy priorities such as ensuring access to essential medicines. Given that pharmaceutical policy lies at the crossroads of commercial and social policy, it can result in uncomfortable choices or trade-offs for governments to make. The Brazilian case is highlighted because it has managed to make these choices well. Brazil's approach towards seeking to ensure access to essential medicines for its population while meeting international obligations is instructive for other countries in Latin America and for Canadian policy-makers working in die region, who all seek strategies to improve drug access while managing international obligations. Through the Canadian International Development Agency (CIDA), Canada has an interest in seeing Brazil improve its health status and economic development.1

Brazil is a middle-income country with a persistent and acute poverty problem. The Brazilian health system has both public and private facilities ranging from basic health care units to complex hospital facilities.2 Pursuant to Article 196 of the 1988 Constitution, access to health services which arguably includes access to basic medicines - is considered a constitutional right. …