Intellectual property and access to medicines: an analysis of legislation in Central America

787Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Intellectual property and access to medicines: an analysis of legislation in Central America Alejandro Cerón a & Angelina Snodgrass Godoy b Abstract Globalization of intellectual property (IP) protection for medicines has been advancing during the past decade. Countries are obliged to adapt their legislation as a requirement of their membership to the World Trade Organization or as a condition of being part of international trade agreements. There is a growing recognition that, in low-income countries, stronger IP protection is a barrier to access to medicines. At the same time, the number of low-income countries writing national legislation to protect IP for pharmaceutical products is growing worldwide, but little research has been done on the ways in which this process is happening at the national level. This paper aims to contribute to the understanding of the implementation of IP legislation at the national level by providing a comparative analysis of the countries that are part of the United States–Dominican Republic–Central America Free Trade Agreement (DR-CAFTA). The analysis shows three trends. First, countries have often implemented stronger IP protection than required by trade agreements. Second, some countries have adopted IP protection before signing the trade agreements. Third, the process of ratification of DR-CAFTA increased public debate around these issues, which in some cases led to IP legislation that considers public health needs. These trends suggest that industrialized countries and the pharmaceutical industry are using more tactics than just trade agreements to push for increased IP protection and that the process of national legislation is a valid arena for confronting public health needs to those of the industry. Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español. .ةلاقلما هذهل لماكلا صنلا ةياهن في ةصلاخلا هذهل ةيبرعلا ةمجترلا a Department of Anthropology, University of Washington, Seattle, WA, United States of America (USA). b Law, Societies and Justice Program and School of International Studies, University of Washington, Seattle, WA, USA. Correspondence to Angelina Snodgrass Godoy (e-mail: agodoy@u.washington.edu). (Submitted: 21 June 2008 – Revised version received: 17 December 2008 – Accepted: 12 January 2009 – Published online: 20 August 2009 ) Introduction Much has been written about the impact of intellectual prop- erty (IP) provisions on access to medicines in the developing world.1–7 In recent years, this discussion has often centred on the impact of free trade agreements with the United States of America (USA) that contain elevated protection for pharma- ceutical IP. Typically, views are deeply polarized: some decry the free trade agreements’ provisions as inevitably disastrous for public health8–13 while others argue that IP protection does not constitute a significant obstacle to access to medi- cines.14–18 As countries contemplate ratification, the lack of available studies forecasting the impact of such regulations (or the lack of agreement on which studies to trust) has further hampered the discussion. The United States–Dominican Republic–Central America Free Trade Agreement (DR-CAFTA) provides an important case study to examine the broader dynamics of national and international law and their public health im- pacts. DR-CAFTA is the largest free trade agreement to date to incorporate stronger IP provisions than those required by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. At the time of its drafting it was widely hailed by both supporters and opponents as heralding the dawn of a new era in IP protection. It also has served as a stepping stone to the Colombia and Peru agreements, and others under negotiation with other South American coun- tries. Understanding the way DR-CAFTA’s IP provisions may affect access to affordable medicines in Central America and the Dominican Republic can help predict the impact of other related agreements still under negotiation, such as those with Malaysia, Thailand and the United Arab Emirates. Assessing DR-CAFTA’s current impact on access to medicines is a complex undertaking, beyond the scope of the present study. As a first step towards that end, however, we seek to determine which legislative changes have been implemented in each Central American country as a result of its adherence to DR-CAFTA. This study draws on analysis of the text of international agreements (DR-CAFTA and the TRIPS Agreement), analysis of national legislation in Central American countries and in the Dominican Repub- lic, and interviews with public health and trade officials and representatives of civil society in Costa Rica, El Salvador and Guatemala. Our research documents a dramatic tightening of Cen- tral American IP regulation in the wake of DR-CAFTA. At the same time, however, our findings suggest that the rela- tionship between the text of international agreements (both DR-CAFTA and TRIPS) and the “public health sensitivity” of legislation19,20 is not as direct as many assume. First, in some cases restrictive reforms were adopted prior to the rati- fication of the agreements themselves. Second, in many cases countries have implemented more restrictive standards than those required in these agreements. Third, in some cases, the DR-CAFTA ratification process actually led to the implemen- tation of legislation sensitive to public health. Our purpose is not to argue that trade agreements like DR-CAFTA are not important in determining IP policy, but rather to emphasize continuities between these agreements and broader trends in IP policymaking, which are often eclipsed by the intense 788 Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central America Alejandro Cerón & Angelina Snodgrass Godoy focus on trade agreements and their ratification. We explain the reasoning for these arguments here, using the ex- amples of new IP provisions imported by DR-CAFTA to Central America, and conclude with a discussion of their broader implications. IP in Central America All of the CAFTA countries are mem- bers of the World Trade Organization (WTO). To comply with the TRIPS Agreement, El Salvador passed its first IP legislation in 1993–94; the remain- ing countries of the region passed legislation in 1999-2000. Prior to this time, effective IP protection was not applied to pharmaceutical products in the region, as in much of the rest of the world. Although the new IP legislation was motivated by pressures common to all the Central American countries, both its content and the political will to enforce it have varied widely from country to country, and within coun- tries across time. DR-CAFTA was ratified by a slim margin in the Congress of the USA in August 2005, after having been ratified by the Dominican Republic, El Salvador, Guatemala, Honduras and Nicaragua earlier that year. Costa Rica approved it through a referendum in late 2007. While many of the IP provisions DR-CAFTA requires were anticipated by TRIPS, there are several key points where the agreement im- poses a more stringent standard, and on which its implementation has therefore required “TRIPS-plus” reforms to ex- isting legislation. Yet as Table 1 reveals, in some cases these provisions were implemented well before DR-CAFTA. In other cases, laws were passed as late as 2007 but regulations had yet to be devised for their implementation. As Table 1 shows, both the content of legislation and the dates of its passage vary widely from country to country. In many cases – that of Guatemala in particular – IP restrictive legislation was passed before the ratification of DR-CAFTA, and the political contro- versies associated with the ratification process led to the eventual repeal of such legislation in favour of alterna- tives more sensitive to public health.27,28 Guatemala is not the only country in which this occurred. In Table 2, we analyse the leg- islation in force in Central America both before and after the passage of DR-CAFTA. We note the presence of “opportunities” and “threats” to public health, using a framework for Table 1. Changes in pharmaceutical IP legislation in Central America and the Dominican Republic21–26 Legislation Patent period (years) Patent extension Test Data Exclusivity Period, in years “New product” definition Linkage Costa Rica Law 6867 (1983). Invention Patents Law Law 7979 (2000). Modifications to Patents Law 20 no 0 n/a no Law 7975–2000. Undisclosed Information Law n/a n/a unspecified restrictive no Law 8632 (2008). Modifications to Patents Law 20 yes n/a n/a yes Dominican Republic Law 20 (2000). Industrial Property Law 20 no unspecified restrictive no Law 424 (2006). CAFTA Implementation Law 20 yes 5 broad yes El Salvador Decree 604 (1993). IP Law 15 no unspecified restrictive no Decree 35 (1994). IP Law’s Code Decree 912 (2005). Modification to IP Law 20 yes 5 broad yes Guatemala Decree 57 (2000). Industrial Property Law 20 no 15 restrictive no Decree 76 (2002). Modifications to Industrial Property Law 20 no unspecified restrictive no Decree 9 (2003). Modifications to Industrial Property Law 20 no 5 broad no Decree 34 (2004). Modifications to Industrial Property Law 20 no unspecified restrictive no Decree 30 (2005). Modifications to Industrial Property Law 20 no 5 broad yes Decree 11 (2006). CAFTA Implementation Law 20 yes 5 broad yes Government Decree 351 (2006). Regulation of Pharmaceuticals n/a n/a n/a broad yes Honduras Decree 12 (1999). Industrial Property Law 20 no unspecified restrictive no Decree 16 (2006). CAFTA Implementation Law 20 no 5 broad yes Nicaragua Law 354–2000. Patent Law for Inventions 20 no unspecified restrictive no Law 579 (2006). Modifications to Patent Law 20 no 5 restrictive no Health Ministry Regulation 115 (2006) n/a n/a 5 restrictive yes Law 634 (2007). Modifications to Patent Law 20 yes n/a n/a n/a CAFTA, Central America Free Trade Agreement; IP, intellectual property; n/a, not applicable. 789Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central AmericaAlejandro Cerón & Angelina Snodgrass Godoy Table 2. Public health sensitivity in IP legislation in Central American countries and the Dominican Republic Opportunities Threats Pa te nt ab ili ty ex em pt io ns Bo la r- ty pe ex ce pt io n Ot he r e xc ep tio ns to pa te nt ri gh ts Pa ra lle l i m po rt Gr ou nd s fo r co m pu ls or y lic en ce Gr ou nd s fo r go ve rn m en t u se Pa te nt e xt en si on Li nk ag e Da ta p ro te ct io n “N ew p ro du ct ” de fin iti on Gr ac e pe rio d “N ew u se s” pr ot ec tio n Costa Rica Pre-DR-CAFTA + + + 0 + + 0 0 + 0 0 0 Post-DR-CAFTA + 0 0 0 + + – – – – 0 0 Dominican Republic Pre-DR-CAFTA + + – 0 + + 0 0 + 0 0 0 Post-DR-CAFTA + + – 0 + + – 0 – – – 0 El Salvador Pre-DR-CAFTA + 0 – 0 + 0 0 0 + 0 0 0 Post-DR-CAFTA + + – 0 + 0 – – – – – 0 Guatemala Pre-DR-CAFTA + 0 + 0 + + 0 0 – 0 0 0 Post-DR-CAFTA + + + 0 + + – – – – – + Honduras Pre-DR-CAFTA – 0 – 0 + + 0 0 0 0 0 0 Post-DR-CAFTA – + – 0 + + 0 – – – – 0 Nicaragua Pre-DR-CAFTA + 0 – 0 + + 0 0 + – 0 0 Post-DR-CAFTA + + – 0 + + 0 – – – – 0 DR-CAFTA, United States–Dominican Republic–Central America Free Trade Agreement; IP, intellectual property; TRIPS, Trade-Related Aspects of Intellectual Property Rights. + TRIPS flexibility or the TRIPS Plus provision allows an interpretation that privileges breaking the IP protection for public health needs. 0 TRIPS flexibility or TRIPS Plus provision is not explicitly included in the legislation. – TRIPS flexibility or the TRIPS Plus provision privileges the IP protection even if it confronts public health needs. Source: based on data from Central American legislative assemblies5,20–26. analysing the public health impact of IP developed by Chaves & Oliveira.20 “Opportunities” include mechanisms that harmonize IP protection with public health objectives, such as speci- fications to limit patents, exceptions to patent rights that offer opportunities for timely generic drug production, and provisions for parallel importation, compulsory licensing and government use. “Threats” include patent term extension, mandated linkage between health safety requirements and patent protection, and test data exclusivity that delay the availability of generic drugs. More detailed analysis of these opportunities and threats can be found elsewhere.5,29–32 A detailed discussion of all the specific provisions detailed above would occupy more space than this paper permits. To illustrate the broad trend, therefore, we discuss two of the TRIPS- plus provisions and their application in contemporary Central America in greater depth: (i) patent extensions, and (ii) the definition of a new product subject to test data protection. Both of these provisions provide clear il- lustrations of what Peter Drahos33 has called “the global intellectual property ratchet”, whereby the USA and Euro- pean Union have used a combination of multilateral and bilateral strategies to push in concerted fashion for ever higher IP standards. As Table 3 and Table 4 show, in both of these provi- sions, TRIPS imposed a standard which was subsequently superseded by DR-CAFTA, which many Central American countries chose to interpret in ways that raise the bar even higher for IP protection. TRIPS established, for the first time, a 20-year patent term. Yet DR- CAFTA mandates the extension of patents beyond 20 years to compensate for “unreasonable” delays in the grant- ing of the patent or marketing approval for the drug, when such delays have been caused by the government. In Central America, there is considerable variation in how this requirement is interpreted in national law. First, what constitutes an “unreasonable” delay? And how much time should be granted as compensation? As Table 3 shows, in El Salvador and Nicaragua, national implementing legislation establishes a 550 day limit to the extension of pat- ents (El Salvador’s Decree 912–2005, Art. 57, Nicaragua’s Law 634, Art. 1). In the Dominican Republic, the limit is set at 3 years (Law 424–06, Art. 2). In Guatemala, no limit is established (Decree 11–2006, Art. 61). In Costa Rica, the limit is set at 18 months (Law 8632, Art. 2) while in Honduras there is still no legislation extending pat- ent protection. This clearly illustrates how a drug could be off-patent in one country, yet still protected in another, 790 Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central America Alejandro Cerón & Angelina Snodgrass Godoy Table 3. Patent extension in Central American countries TRIPS CAFTA Costa Rica Dominican Republic El Salvador Guatemala Honduras Nicaragua Limit to patent extension – [No limit] 18 months 3 years 550 days No limit No extension 550 days CAFTA, Central America Free Trade Agreement; IP, intellectual property; TRIPS, Trade-Related Aspects of Intellectual Property Rights. Table 4. Definition of new product for test data protection in Central American countries Definition of new product Interpretation TRIPS n/a n/a CAFTA A new product does not contain chemical entities previously approved in the country. old + new = old Costa Rica Products using new chemical entities. old + new = new Dominican Republic, El Salvador, Honduras Product does not contain chemical entities previously approved in the country. old + new = old Guatemala, Nicaragua Product contains a chemical entity not previously approved in the country. old + new = new CAFTA, Central America Free Trade Agreement; IP, intellectual property; n/a, not applicable; TRIPS, Trade-Related Aspects of Intellectual Property Rights. despite both countries sharing the same international obligations. The definition of which products receive test data protection provides a second illustration. During the period of test data exclusivity, generic manu- facturers cannot demonstrate the safety and efficacy of their product to the drug regulatory authority merely by proving bioequivalence to an existing drug. TRIPS mandates the protection of test data for products using new chemi- cal entities, but DR-CAFTA requires test data exclusivity for new products. CAFTA defines new products by their novelty in the market in question, such that a product that had been registered elsewhere in the world, yet not in the specific DR-CAFTA country, could still demand test data exclusivity under this standard. As shown in Table 4, several Cen- tral American countries, in specifying what constitutes a new product, go beyond DR-CAFTA’s requirements, defining compound products that include a new substance as an entirely new product. For example, under cur- rent Salvadoran regulations, if one ingredient in a compound product has not been registered previously, the entire product is considered new. By contrast, in Honduras, a compound product including elements that were not previously registered would not be considered new and hence would not receive test data protection. These concerns about what con- stitutes a new product are particularly important in the case of the newer antiretroviral drugs, most of which are compounds that include at least one previously known substance. Depend- ing on the definition adopted, these may or may not be eligible for test data protection. Because brand-name antiretrovirals are extremely expensive, and in the Central American cases their costs are primarily borne by govern- ments, just a few months’ delay in a generic alternative’s entry to market can mean millions of dollars spent, often at the expense of other public health priorities. Discussion In the DR-CAFTA region, while all countries are bound by the same in- ternational laws, specific provisions in national law as well as varying levels of political will and resources to implement such laws lead to dramatically different consequences among countries. This complicates the task of assessing the impact of international trends, for most often the aspects which most decisively determine the extent of their applica- tion are found in national laws, regula- tions and practices. These forms of IP lawmaking typically fly “below the radar screen” for those engaged in debates about trade and access to medicines, but they are a critically important site for attention in determining the impact of the current trade regime on health. Our analysis of the implementation of the transnational IP norms yields some surprising findings. First, some- times IP legislation was passed before ratification of the agreement (Table 1). Second, IP legislation often imposes a stricter standard than that required by the agreement itself (Table 2). And third, in some cases, specific aspects of national legislation became more pub- lic health sensitive over the course of treaty implementation (Table 2, Table 3 and Table 4). How do we make sense of these findings? First, the passage of trade agreements with strong IP provisions is just one of the most visible of many related tactics that, taken together, constitute a sustained campaign. While debates over ratification capture the most attention, it is not only through formal ratification that these processes advance the “global IP ratchet”. In the case of Central America, interviews suggest that some countries passed more-restrictive-than-necessary IP leg- islation at a time when TRIPS did not yet warrant such measures because of their eagerness to curry favour with the USA by demonstrating readiness for inclusion in an eventual DR-CAFTA. In this sense, although this early legislation preceded the passage of DR-CAFTA, it was still influenced by the prospect of its eventual passage. Furthermore, the actual text of these agreements is just one of the ways in which trade deals determine policy. In the Dominican Republic and Guatemala, media reports indicate that the USA continued to push for 791Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central AmericaAlejandro Cerón & Angelina Snodgrass Godoy higher IP standards in excess of what the agreement required, even after rati- fication. In Guatemala, in the context of intense debates over IP and access to medicines, the American ambassador published an editorial in a major daily newspaper threatening the country’s exclusion from the benefits of the trade deal if the country was perceived as fail- ing to “take seriously” its international commitments; 34 in other countries, similar messages may have been re- layed in private meetings. The fact that countries imposed higher IP standards upon themselves following ratification may reflect lack of sophistication in the drafting of national legislation, but it may also speak to the persistence of pressures from powerful trade partners. Finally, although the openings for democratic participation are limited, the ratification process does afford some positive opportunities for political mo- bilization around the right to health. In Central America, the passage of DR-CAFTA created more controversy than the passage of TRIPS-compliant legislation somewhat earlier; in some limited cases, the discussion prompted by DR-CAFTA led to re-examination of previous laws that had been passed with little debate. The best example of this is Guatemala, where civil soci- ety’s engagement with the ratification process led to the overturning of more restrictive IP legislation in favour of more public health sensitive alterna- tives, when they reduced the test data protection period from 15 to 5 years (Table 1). Although focusing on the ratification process exclusively may obscure the multifaceted ways in which IP policy is determined, public health advocates should not lose sight of the opportunities that it affords. Conclusion During the process of trade agreement ratification, attention is often focused on the implications of IP for public health. This public scrutiny can have positive effects. At the same time, our findings show that more sustained at- tention to these issues is needed: not only did most Central American coun- tries pass laws mandating the bulk of DR-CAFTA’s IP provisions well before the signing of the agreement, but they continued to implement these provi- sions much later than the agreement’s ratification. The window of oppor- tunity for public health intervention in policy discussions therefore cannot afford to be limited to the period imme- diately surrounding treaty ratification. Similarly, the topics under scrutiny must extend beyond the text of these agreements alone. National imple- menting legislation varies greatly from country to country, and is affected by conditions external to the negotiations of the agreement. Both before and fol- lowing DR-CAFTA’s ratification, the Central American countries responded to pressure from such forces by tight- ening their IP norms. This suggests the importance of understanding trade agreements as part of a broader, longer- term strategy on the part of the trans- national pharmaceutical industry and its allies. Our purpose is not to suggest that the treaty’s impact is negligible, but rather that these changes must be understood in broader perspective as, overall, contributing to a tightening of IP norms in the region, the impact of which has yet to be fully understood. Further study is required to deter- mine the extent to which these laws, once widely implemented, limit access to medicines in Central America. Also, while the country-by-country analysis undertaken here is absolutely necessary to understand the impacts of regional free trade agreements on the ground, given the global market in medicines, national analyses alone provide insuf- ficient measures of the impacts of these norms. In Central America, for example, many generic medicines are imported from countries outside the region, including Colombia and India. In reaction to the rising IP demands of American free trade agreements (in the case of Colombia), direct chal- lenges from American pharmaceutical companies (as in India), and political pressures from the American and other governments, these countries tighten their national IP legislation, which inevitably impacts the drugs they export. In Central America and other areas without major drug production capacity, the availability of generic medications is not only influenced by local legislation but by decisions made in far-away courts and congresses, which may cut off the flow of affordable medications at its source. As the public health community strives to better understand the impact of IP norms on access to affordable drugs, it is impera- tive that we undertake research that is both rooted in national particularities and sensitive to the crosscutting effects of changes at the international and transnational level. ■ Funding: This work was funded by the Puget Sound Partners for Global Health and by a grant from the Na- tional Science Foundation (award number: 0617374). Competing interests: None declared. Résumé Propriété intellectuelle et accès aux médicaments : analyse de la législation en Amérique centrale La protection de la propriété intellectuelle (PI) concernant les médicaments a progressé vers la mondialisation au cours de la dernière décennie. Les pays membres de l’Organisation mondiale du Commerce ou parties à des accords commerciaux internationaux ont été dans l’obligation d’adapter leur législation. Il est de plus en plus reconnu que, dans les pays à faible revenu, le renforcement de la PI est un obstacle à l’accès aux médicaments. Dans le même temps, le nombre de pays à faible revenu qui se dotent d’une législation nationale en faveur de la PI pour les produits pharmaceutiques est en augmentation partout dans le monde, mais peu de recherches ont été menées sur la façon dont ce processus s’opère au niveau national. Le présent article vise à faire comprendre comment la législation sur la PI est mise en œuvre au niveau national par une analyse comparative de la situation dans les pays signataires de l’Accord de libre-échange entre l’Amérique centrale, les États-Unis d’Amérique et la République Dominicaine (DR-CAFTA). Cette analyse fait apparaître trois tendances. Premièrement, les pays ont souvent mis en place une PI plus forte que celle requise par les accords commerciaux. Deuxièmement, certains pays ont adopté une protection de ce type avant d’avoir signé ces accords. Troisièmement, le processus de ratification du DR-CAFTA a intensifié le débat public autour de ces questions, ce qui, dans certains cas, a conduit à la prise en 792 Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central America Alejandro Cerón & Angelina Snodgrass Godoy Resumen Propiedad intelectual y acceso a los medicamentos: análisis de la legislación en América Central Durante la última década ha avanzado la globalización de la protección de la propiedad intelectual (PI) de los medicamentos. Los países están obligados a adaptar su legislación como requisito de su pertenencia a la Organización Mundial del Comercio o como condición para participar en acuerdos comerciales internacionales. Una idea cada vez más aceptada es que en los países de ingresos bajos esa mayor protección obstaculiza el acceso a los medicamentos. Al mismo tiempo, crece en todo el mundo el número de países de ingresos bajos que promulgan legislación nacional para garantizar la PI de productos farmacéuticos, pero son escasas las investigaciones realizadas sobre la manera en que se está llevando a cabo ese proceso en cada país. Este artículo pretende ayudar a comprender mejor la aplicación de la legislación sobre PI a nivel nacional, ofreciendo para ello un análisis comparativo de los países que forman parte del Tratado de Libre Comercio entre los Estados Unidos, la República Dominicana y América Central (DR-CAFTA). El análisis pone de relieve tres tendencias: en primer lugar, los países han aplicado a menudo medidas de PI más enérgicas que las exigidas por los acuerdos comerciales; segundo, algunos países han adoptado medidas de PI antes de firmar los acuerdos comerciales; y, tercero, el proceso de ratificación del DR-CAFTA estimuló el debate público sobre esas cuestiones, debate que en algunos casos desembocó en legislación de PI que tiene en cuenta las necesidades de salud pública. Estas tendencias llevan a pensar que los países industrializados y las empresas farmacéuticas están empleando otras tácticas aparte de los acuerdos comerciales justos para intentar conseguir un mayor nivel de PI, y que la legislación nacional es un terreno válido para confrontar las necesidades de salud pública y los intereses de la industria. compte des besoins de la santé publique dans la législation sur la PI. Ces tendances laissent à penser que les pays industrialisés et l’industrie pharmaceutique utilisent des moyens tactiques autres que les accords internationaux pour promouvoir un renforcement References 1. Cohen JC, Illingworth P. The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements. Developing World Bioeth 2003;3:7-48. 2. Hestermeyer H. Human rights and the WTO: the case of patents and access to medicines. Oxford: Oxford University Press; 2007. 3. Malpani R, Kamal-Yanni M. Patents versus patients: five years after the Doha Declaration [Oxfam briefing paper no. 95]. Oxford: Oxfam International; 2006. 4. Drug patents under the spotlight: sharing practical knowledge about pharmaceutical patents. Geneva: Médecins Sans Frontières; 2003. 5. Musungu S, Oh C. The use of flexibilities in TRIPS by developing countries: can they promote access to medicines? (Study 4C). London: Commission on Intellectual Property Rights, Innovation and Public Health; 2005. 6. Shaffer ER, Waitzkin H, Brenner J, Jasso-Aguilar R. Global trade and public health. Am J Public Health 2005;95:23-34. PMID:15623854 doi:10.2105/ AJPH.2004.038091 7. Public health, innovation and intellectual property rights: report of the Commission on Intellectual Property Rights. Geneva: World Health Organization; 2006. 8. Abbot F. Intellectual property provisions of bilateral and regional trade agreements in light of US federal law. Geneva: International Centre for Trade and Sustainable Development; 2006. 9. Bernieri RC. Intellectual property rights in bilateral investment treaties and access to medicines: the case of Latin America. J World Intellect Prop 2006;9:548-72. doi:10.1111/j.1422-2213.2006.00302.x 10. Correa C. Efectos del CAFTA sobre la salud pública en Guatemala. Geneva: Médicins Sans Frontières; 2005. 11. Cortes ME, Zerda A, Sarmiento D, De La Hoz G. Modelo prospectivo del impacto de la protección a la propiedad intelectual sobre el acceso a medicamentos en Colombia. Bogotá: Pan-American Health Organization; 2004. de la PI et que le processus d’élaboration d’une législation nationale est une arène valide pour confronter les besoins de la santé publique à ceux de l’industrie. صخلم ىطسولا اكيرمأ في تاعيشرتلل ليلحت :ةيودلأا لىع لوصحلاو ةيركفلا ةيكللما دقعلا للاخ ًادرطم ًام ُّدقت ةيودلأل ةيركفلا ةيكللما ةيماح ةَملْوَع تققح في ةيوضعلا لىع لوصحلل طشرك اهتاعيشرت فييكتب ةمزتلم نادلبلاف .مصرنلما ةصاخلا ةيلودلا تاقافتلاا نم ًاءزج نوكتل طشرك وأ ،ةيلماعلا ةراجتلا ةمظنم ىوقلأا ةيماحلا لِّثتم لخدلا ةضفخنلما نادلبلا في هنأب كاردلإا دادزيو .ةراجتلاب ديازتي ،هسفن تقولا فيو .ةيودلأا لىع لوصحلا مامأ ًازجاح ةيركفلا ةيكلملل ةيكللما ةيماحل ةينطو تاعيشرت عضت يتلا لخدلا ةضفخنلما نادلبلا ددع يتلا ثاحبلأا نأ لاإ ،لماعلا ءاجرأ عيمج في ةينلاديصلا تاجتنملل ةيركفلا .ةليلق ينطولا ديعصلا لىع ةيلمعلا هذه اهيف متـت يتلا قرطلا لوح ىرجت ةيركفلا ةيكللما تاعيشرت قيبطت مهف في ماهسلإا لىإ ةقرولا هذه فدهتو ءزج يه يتلا نادلبلا ينب نراقم ليلحت ءارجإ للاخ نم ،ينطولا ديعصلا لىع ةيروهمجو ةيكيرملأا ةدحتلما تايلاولا ينب ةرحلا ةراجتلاب صاخلا قافتلاا نم هاجتلاا ،تاهاجتا ةثلاث ليلحتلا حضوأ دقو .ىطسولا اكيرمأو ناكينيمودلا هبلطتـت مام ىوقأ ةروصب ةيركفلا ةيكلملل ةيماح ذفنت نأ بلغي نادلبل لولأا لبق ةيركفلا ةيكللما ةيماح تنبت نادلبل نياثلا هاجتلااو .ةيراجتلا تاقافتلاا لىع لدجلا اهيف داز نادلبل ثلاثلا هاجتلااو ،ةيراجتلا تاقافتلاا لىع اهعيقوت ةرحلا ةراجتلا قافتا لىع اهقيدصت ىدل اياضقلا هذه لوح يبعشلا ديعصلا ،ىطسولا اكيرمأو ناكينيمودلا ةيروهمجو ةيكيرملأا ةدحتلما تايلاولا ينب ةيركفلا ةيكللما لوح تاعيشرت روهظ لىإ تلااحلا ضعب في كلذ ىدأ دقو تاهاجتلاا هذه يرشتو .ةيمومعلا ةحصلا في تاجايتحلاا رابتعلااب ذخأت مدختست ةينلاديصلا تاضرحتسلما ةعانص تاكشرو ةيعانصلا نادلبلا نأ لىإ عفدلل كلذو ةيراجتلا تاقافتلاا في درو ام لىع صرتقت لاو ةفلتخم بيلاسأ ةبلح ينطولا عيشرتلا ةيلمع لِّثتمو .ةيركفلا ةيكللما ةيماح ةدايز هاجتاب كلت ينبو ةيمومعلا ةحصلا اهبلطتت يتلا تاجايتحلاا ينب ةهجاوملل ةيقيقح .ةيعانصلا تاكشرلاب ةصاخلا 793Bull World Health Organ 2009;87:787–793 | doi:10.2471/BLT.08.056010 Policy & practice Intellectual property and access to medicines in Central AmericaAlejandro Cerón & Angelina Snodgrass Godoy 12. Malpani R. All costs, no benefits: how TRIPS-plus intellectual property rules in the US–Jordan FTA affect access to medicines [Oxfam briefing paper no. 102]. Oxford: Oxfam International; 2007. 13. Shaffer ER, Brenner JE. International trade agreements: hazards to health? Int J Health Serv 2004;34:467-81. PMID:15346681 doi:10.2190/FB79- G25U-DWGK-C3QK 14. Attaran A. How do patents and economic policies affect access to essential medicines in developing countries? Health Aff 2004;23:155-66. doi:10.1377/hlthaff.23.3.155 15. CAFTA-RD: Desafíos y oportunidades para América Central. Washington, DC: The World Bank Central America Department & Office of the Chief Economist of Latin America; 2005. 16. Archila EJ, Carrasquilla G, Meléndez M, Uribe JP. Estudio sobre la propiedad intelectual en el sector farmacéutico colombiano. Bogotá: FEDESARROLLO, Fundación Santa Fé de Bogotá; 2005. 17. Attridge CJ, Preker AS. Improving access to medicines in developing countries: application of new institutional economics to the analysis of manufacturing and distribution issues [The World Bank health, nutrition and population discussion paper]. Washington, DC: The World Bank; 2005. 18. Herrling P. Patent sense: protecting intellectual property saves lives in the developing world. Nature 2007;449:174-5. PMID:17851514 doi:10.1038/449174a 19. Oliveira MA, Bermudez JAZ, Chavez GC, Velásquez G. Has the implementation of the TRIPS Agreement in Latin America and the Caribbean produced intellectual property legislation that favours public health? Bull World Health Organ 2004;82:815-21. PMID:15640916 20. Chaves GC, Oliveira MA. A proposal for measuring the degree of public health-sensitivity of patent legislation in the context of the WTO TRIPS Agreement. Bull World Health Organ 2007;85:49-56. PMID:17242758 21. Costa Rica Legislative Assembly [Internet site]. Available from: http://www. asamblea.go.cr/ley/leyes.htm [accessed on 28 July 2009]. 22. Guatemala Congress [Internet site]. Available from: http://www.congreso.gob. gt/gt/leyes.asp [accessed on 28 July 2009]. 23. Department of Pharmaceutical Products Regulation, Guatemala Ministry of Health [Internet site]. Available from: http://www.mspas.gob.gt/DGRVCS/ DRCPFA/Inicio.htm [accessed on 28 July 2009]. 24. Honduras National Congress [Internet site]. Available from: http://www. congreso.gob.hn/leyesa.htm [accessed on 28 July 2009]. 25. Legislation 1933-2007 (17 May 2008) and Law 634 (17 Sep 2007). Nicaragua National Assembly. Available from: http://www.asamblea.gob.ni/ [accessed on 28 July 2009]. 26. El Salvador Legislative Assembly [Internet site]. Available from: http://www. asamblea.gob.sv/ [accessed on 28 July 2009]. 27. Russell A, Baker B. Myths and realities: US pressure on Guatemala regarding data exclusivity, CAFTA and access to medicines [policy brief]. New York, NY: Health Global Access Project; 2005. Available from: http://www.healthgap. org/press_releases/05/021005_HGAP_BP_CAFTA_guatemala.html [accessed on 28 July 2009]. 28. Correa C. Protección de productos farmacéuticos y agroquímicos (‘productos regulados’) en DR-CAFTA. In: Regional Dialogue on Intellectual Property, Innovation and Sustainable Development, UNCTAD, ICTSD, CINPE, CEPAL and The World Bank Institute, Costa Rica, 10-12 May 2006. 29. Correa CM. Implications of bilateral free trade agreements on access to medicines. Bull World Health Organ 2006;84:399-404. PMID:16710551 doi:10.2471/BLT.05.023432 30. Bermudez JAZ, Oliveira MA, editors. Intellectual property in the context of the WTO TRIPS Agreement: challenges for public health. Rio de Janeiro: ENSP/ FIOCRUZ; 2004. pp. 23-61. 31. Weissman R. TRIPS-Plus provisions in trade agreements: consequences for public health. Washington, DC: Essential Action; 2007. Available from: http:// www.essentialaction.org/access/uploads/tripsplusprovisions.doc [accessed on 28 July 2009]. 32. CAFTA undermines affordable medicines: pharma’s role on USTR Advisory Committees [CPATH Memo no. 4-05]. San Francisco, CA: Center for Policy Analysis on Trade and Health;2005. 33. Drahos P. The global intellectual property ratchet: why it fails as policy and what should be done about it. New York, NY: Open Society Institute; 2003. 34. Hamilton J. TLC y genéricos sí coexisten. Siglo XXI Newspaper, 9 January 2005. Available from: http://old.sigloxxi.com/detallesnews_otraedicion. asp?pag=oaieec01.txt [accessed on 28 July 2009].