At TPP, Vietnam, developing nations come under US onslaught on affordable cancer treatments A man holds a placard as he takes part in a protest against Trans-Pacific Partnership (TPP) trade talks outside the prime minister's official residence in Tokyo, Japan in April 2014. Photo credit: Bloomberg Vietnamese cancer patients, many of whom have succumbed to the disease due to high drug prices, are likely to pay even more if their country falls prey to a US-led attack aimed at handing out largesse to American Big Pharma in a regional free-trade pact, critics say. The US, which has already sought to hand stronger monopolies to the drug industry in the ongoing negotiations for the Trans-Pacific Partnership (TPP), continues to push for measures that would significantly constrain affordable access to life-saving drugs, according to a document released October 16 by WikiLeaks. Health activists said this move threatens access to affordable cancer treatments, particularly in developing countries like Vietnam, where the average person earns less than $15 a day. “One of the most frightening revelations in the text is a proposal to monopolize new cancer treatments for up to 12 years, which would price many people out of access,” Peter Maybarduk, director of US-based Public Citizen's Global Access to Medicines program, told Thanh Nien News. “It’s an unfortunate and deadly capitulation to the pharmaceutical giants,” Maybarduk said. According to what WikiLeaks said in May 2014 was the latest draft text of the intellectual property chapter of the TPP, the US Trade Representative proposed a long automatic monopoly period (marketing exclusivity) for biologic drugs, which are the latest and most effective treatments for cancer, health activists said after reviewing the leaked document. “The text reveals that the US is still insisting upon extension of data exclusivity for 8-12 years on biologic drugs,” Patricia Ranald, coordinator of the Australian Fair Trade and Investment Network, said.  “Pharmaceutical companies already have the right to charge monopoly prices on patented medicines for 20 years, so this will delay cheaper generic versions of these medicines for even longer.” According to another Wikileaks document leaked in November 2013, a raft of US-proposed provisions would extend and strengthen existing monopolies on medicines, and restrict the ability of governments to exercise safeguards and flexibilities to protect public health and ensure affordable drug prices, the activists said. They would also delay market entry of generic equivalents of patented medicines, which would raise the cost of medicines and thereby increase private and public spending on them. According to the leaked text, the US is also pushing for 20-year patent protection in certain areas related to public health such as therapeutic, surgical, and diagnostic methods, which are not provided under World Trade Organization rules. Health activists said making the regional intellectual property rules tougher could prevent other countries like India, which is not part of the TPP negotiations, from continuing as a generic supplier to low- and middle-income countries. Such provisions have pitted the US against most of the other negotiating countries, except for its closest allies, the leaked document showed. When the intellectual property chapter was first leaked in November of last year, it showed that Australia closely aligned with the US throughout the text. But according to the May 2014 document, the US has got, in a move that comes as no surprise, a different closest ally: Japan. “Multinationals are pulling the strings for almost all legislation in the US and Big Pharma has perhaps the most control,” Dennis McCornac, a professor of economics at Loyola University in Baltimore (Maryland), said. “Japan also has a developed and important pharmaceutical industry which will also benefit from the TPP proposals,” McCornac said. “I know Japan will fight against the US if Japan would get hurt, but the government in Japan is now very conservative and aligns with the multinationals and want to be on good terms with the US as the US is a good ally against China.” Patients wait for health check at the Tumor Hospital, a major cancer treatment facility in Ho Chi Minh City. Photo: Thanh Tung Cancer concerns Many in the pro-TPP camp see the pact as key to ensuring the US will continue to write the rules for trade in the Asia-Pacific region and stay central to the global economy at a time when many are organizing their manufacturing, agriculture, and service sectors around China. Its proponents say the TPP would create a free-trade zone from Australia to Peru with $28 trillion in economic output, or 39 percent of the global total, according to a recent Bloomberg report. The countries in the pact are the US, Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam. But the TPP comes at a bad time since Vietnam is struggling to deal with rising cases of cancer among its population of 90 million. At a conference on October 18, health experts said the number of patients contracting certain types of cancers have doubled or even quadrupled over the past decade. Cancer patients are also getting increasingly younger, they added. Vietnam records around 150,000 new cases of cancer annually, more than half of them fatal, according to figures released by the World Health Organization. At least 50 percent fail to seek timely treatment, many simply because they cannot afford it. But Nguyen Chan Hung, a prominent doctor who chairs the Vietnam Cancer Society, disputed the WHO figures on cancer cases in Vietnam. “According to my calculation, there are up to 85,000 cancer-caused fatalities every year in Vietnam,” Hung told Thanh Nien News. India-ed out of the job To make matters worse, health activists say the US government and its Big Pharma continue to put relentless pressure on access to affordable measures outside of the TPP negotiations. India, considered the “pharmacy of the developing world”, has amended its patent laws to dovetail with WTO provisions, but has taken advantage of flexibilities within the WTO framework to protect its domestic generic drug industry and keep drug prices low for its people, many of whom continue to live in poverty, according to an article in October by Truthout, a nonprofit that provides news and commentary on a daily basis. The article revealed this month that aggressive lobbying by pharmaceutical interests pushed the US Congress and White House into mounting pressure on India to change its patent laws. In just the last two years the US has twice placed India on its Special 301 priority watch list for not meeting US intellectual property (IP) standards. The US Congress has also ordered two successful inquiries against India at the US International Trade Commission. The White House has also exerted direct pressure, sending Secretary of State John Kerry and Vice President Joe Biden to India to seek modification of its IP regime and also setting up a US-India IP working group that “put the US fox in the India chicken coop,” according to Brook Baker, an expert at the US-based Health Global Access Project (GAP). “Since India is a major exporter of generic medicines of assured quality, including for HIV/AIDS where it supplies 90 percent of the global supply in low- and middle-income countries, attacks on India are attacks on patients in other countries,” Baker said. The latest push from the Pharmaceutical Research and Manufacturers of America (PhRMA), an influential drug industry lobbying group, and its allies came in late September, as Indian Prime Minister Narendra Modi made his first visit to the US to meet with President Obama and prominent business leaders, according to Truthout. It is unclear if mounting pressure from the US is having an impact on Modi, who, as PhRMA is quick to point out, has declared India "open for business”, the Truthout article said. But Modi was quoted by India's Economic Times as saying: "I understand that you want to be compensated for your investments in [research and development]. At the same time, India needs medicines that are affordable for its population." The US Trade Representative has maintained there is a need for tough patent standards to "incentivize" drug companies to keep innovating. Unsurprisingly, US pharmaceutical giants back this view, saying the American patent regime fosters useful medical innovation. “As all of us around the world face the persistent problems of disease, poverty, natural disaster, and other challenges, we all need India and it’s 1.3 billion people to fully develop their latent capacity for innovation – and not only India, but Vietnam, too,” Patrick Kilbride, executive director for International IP Policy at the US Chamber of Commerce's Global Intellectual Property Center, said.  But activists rejected this, holding up plenty of data that suggest otherwise. “There is growing evidence the US IP-based incentive system for pharmaceutical innovation is broken. Fewer truly new and therapeutically important medicines are being invented as drug companies instead try to game the patent system to extend patent monopolies on existing medicines,” Baker said. A 2008 research paper titled "The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States" confirmed that pharmaceuticals spend about twice as much money marketing their drugs as they do on researching and developing them. Much of the research pharmaceutical companies do is simply not relevant to public health concerns, a Huffington Post report said in 2011. Money pours into research to reverse hair loss, for instance, while funding for diseases that mainly affect the poor, like tuberculosis, is in perpetual short supply, it said scathingly. Pharmaceutical insiders bristle at such allegations. “Critics will continue to say what they want, but the fact is most of the research and development for new medicines is completed by pharmaceutical companies,” Mark Grayson, a PhRMA spokesman, said. “If you wish to have new medicines you need to have an environment that recognizes the importance of innovation,” he said. 'Irresponsible public policy’ Some of the more controversial issues related to access to medicines await higher-level discussions this month. TPP negotiators have sat down again in Australia since October 19 with a ministerial-level meeting following on October 25-27. US President Barack Obama seeks a final announcement on the TPP on November 11, when he will be with other TPP country heads of state in China at a regional summit. Though Vietnam has objected to the US demands on medicine prices, by and large ranking Vietnamese officials in Hanoi have expressed high hopes for the TPP, which some believe will provide leverage against China's outsized economic influence. “The government has continued to push for negotiations on both multilateral and bilateral free trade agreements,” Prime Minister Nguyen Tan Dung told the National Assembly, Vietnam’s legislature, at its opening session Monday. At a meeting with US Trade Representative Michael Froman in Hanoi Tuesday, Deputy Prime Minister Vu Van Ninh also exhibited Vietnam’s determination to conclude the pact successfully. In Vietnam, claims of the TPP’s benefits have overshadowed its negative ramifications though the texts and contents of the pact remain shrouded in secrecy. People in Vietnam and Tunisia -- 95 percent -- had the most positive view of the benefits of growing trade among 44 countries covered by a recent poll by the Pew Research Center. On the contrary, citizens in two countries participating in the TPP negotiations show little enthusiasm for it: the US, the world's second-biggest trading country, was fourth from last and Japan, eighth. Truong Dinh Tuyen, a former trade minister who has advised the government on negotiations for entry into the WTO and now the TPP, has showed up to a number of economic forums trying to sell the benefits of joining the TPP, saying it would play a crucial role in restructuring the economy. But he declined to speak to Thanh Nien News over phone. “Don’t waste your time calling me again,” he said before hanging up brusquely. Even Hung, the leading Vietnamese cancer expert, declined to comment about medicine prices under the TPP, citing “lack of information” about the issue. The activists said that at the end of the day of all the TPP negotiating countries Vietnam has the lowest per capita income and thus faces the greatest development challenges. Oxfam, an international anti-poverty group, said thousands more Vietnamese could be pushed into poverty since they would have to choose between medicines and other basic necessities. “Although Vietnam is developing rapidly, its economic development is primarily benefiting elites and select sectors,” GAP’s Baker said. “Adopting heightened intellectual property burdens to gain temporary, short-term trade advantages for certain selectors is irresponsible public policy and goes against social solidarity for current and future generations.” By An Dien, Thanh Nien News