Since publication of the UNDP book by Inge Kaul et
al. on Global Public Goods (GPGs), the concept has become more prevalent in
the public debate on international cooperation. This trend is accelerating as
the Johannesburg conference on sustainable development approaches. Many stakeholders
in international cooperation and development aid have appropriated the notion,
especially in the field of health.
Actually, at first glance, health seems to be an obvious example of a public good:
everybody wants to be healthy and everybody looks for care in the case of bad
health. Aspiration for health is without doubt universal.
But health is also a complicated concept that is historically, socially and culturally
assembled. What constitutes good health in one country may not necessarily be
perceived as good health in another. This may have implications when discussing
health in a global context but this difficulty is not taken into account by authors
of the UNDP book, in which the definition remains very vague.
At the same time, obvious inequality in health care between the western world
and developing countries exists, in terms of pathologies, equipment and accessibility.
Political influence is also unequal: developing countries have deteriorated public
health systems, while the North has both the ideas and the funding necessary to
reform these systems. In western countries, commitment to international health
always has security-oriented motivations (especially with regards to the threat
of epidemics). So in such a clearly unbalanced situation, political struggle may
emerge at any time, and western countries therefore require instruments to legitimate
political interference.
The concept of GPGs appears to be the most recent instrument to legitimate western
domination in the field of international health and to disguise a security-oriented
policy with altruistic language.
In fact, the rise in popularity of the GPG concept goes hand in hand with the
definition of new international health priorities, which are motivated by security
reasons, such as the outbreak of new diseases (like AIDS) or the return of old
ones (plague, cholera and tuberculosis).
Since the year 2000, most international agencies (United Nations, World Bank,
WHO, European Union…) and even national institutions (such as the CIA) have
placed the question of public health on their agendas and have decided to steer
collective action towards the fight against the three major (and most deadly)
diseases: AIDS, tuberculosis and malaria. A Global Fund to fight AIDS, TB and
malaria has been founded to finance this collective action.
Throughout the process, agencies involved in security matters (the UN and the
CIA) haven't used the GPG concept, whereas agencies involved in development use
it as a means to legitimate and make their commitment to projects that are obviously
security-oriented appear more altruistic.
However, these agencies each use their own definition of GPGs. The World Bank
has an imprecise definition referring to "the fight against infectious diseases".
The European Commission calls for strengthening research and development for specific
GPGs like vaccines against HIV/AIDS and malaria. For the WHO, development of new
drugs and vaccines for the poor is one example of international public goods in
the field of health. The choice of two different definitions by the WB on the
one hand and the EU and WHO on the other hand reflects two different positions
with regards to the most important problem in the sanitary debate, i.e. the problem
of access to medicine for poor countries. In this context, the GPG notion doesn't
clarify the debate, but on the contrary opens the door for new political debate
concerning the subject of essential drugs.
Currently, in the field of health, the GPG concept lends itself to ambiguity.
Even if the first to develop this concept excluded drugs from its definition,
it is nonetheless very easy to consider them as GPGs. Of course, both economic
theory and common sense regard medicine as a private good,. But at the same time
it is a very special good that is absolutely necessary in order to maintain or
achieve good health.
Development agencies, in particular those having progressive attitudes towards
drug access, choose to consider some drugs and vaccines, or at least the research
aimed producing new drugs and vaccines, as GPGs. But civil society goes farther,
and for NGOs, there is no doubt that drugs are GPGs. Currently, there is a wide
gap between the health situation and the production of drugs to fight major diseases
and between the health situation and the drug market.
Therefore, in order to successfully complete its communicable disease control
programme, the international community must enforce regulations to balance the
situation. To do so, it must deal with the pharmaceutical industry's strong lobby
on the one hand, and with civil society on the other hand, especially big NGOs
like Oxfam or MSF which advocate free access to medicine.
The main battlefield lies within the WTO process and especially in the TRIPS Agreement
and its implications for access to medicine in developing countries. Developing
countries and NGOs mobilized in order to impose a "health exception"
at the Doha conference in November 2001. The conference reached a compromise in
which it was agreed that the TRIPS Agreement does not and should not prevent members
from taking measures to protect public health. So the final declaration of the
TRIPS Agreement on public health reaffirms the right of WTO members to use, to
the full, the provisions of the TRIPS Agreement, which provide flexibility for
this purpose. The declaration also authorizes the extension until January 1, 2016
of the transition period for the least developed members to implement or enforce
pharmaceutical patent protection.
In fact this compromise doesn't go very far and is very difficult to implement.
Nevertheless, it is considered a victory by developing countries and NGOs. But
above all it is an example of how we can switch from one definition to another
in the imprecise realm of GPGs. Conceived in the beginning in an attempt to avoid
political struggle and to promote governance, this notion reintroduces political
trends to the debate, especially in the field of health where the notion of drugs
must be taken into account, even if drugs are initially private goods. Moreover,
drug production and trade are also at the heart of a complex network of economic
and ideological interests.