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Introduction Every year millions of people, mainly coming from developing and least developed countries, are affected by infectious diseases, such as HIV/AIDS, malaria and tuberculosis. In the same time, and although international research and development achievements have accomplished to find proper treatment and medication, access for almost half of them, is still not affordable. This is a result both of international agreements that protect pharmaceutical companies intellectual property rights through patents (TRIPS Agreement) and the manufacturing incapacity of those countries to produce adequate medication. The relationship between IP rights and public health has been a matter of serious concern the last decades. The controversial debate that arose in 1998 after the South Africa case, when 39 multinational pharmaceutical companies sued the Government of South Africa for its attempts to increase the availability of affordable medicines, led to the need for accurate implementation and clarification of the TRIPS flexibilities. The Doha Declaration on the TRIPS Agreement and Public health, adopted in 2001, stipulated that in case of conflict between IPRs and public health the former should not be an obstacle to the realization of the latter, and clarified the legitimacy of measures, such as compulsory licensing and parallel imports of patented drugs, for the protection of public health. The subsequent interim waiver decision of August 2003 came into force as a means to improve and facilitate access to medicines, through facilitation of importation of generic medicines. However, nowadays, developing and least developed countries have to face the obstacles imposed by the new TRIPS plus clauses, which are agreements that impose higher standards and more limited exceptions than those provided by the TRIPS Agreement and thus purport to eliminate the flexibilities offered by the Doha Declaration and the 2003 Decision. On the other hand, health as a human right is recognized in national and international levels and is a matter of great concern for the United Nations and the World Health Organization (WHO), but also a part of international instruments, such as the Universal Declaration of Human Rights (UDHR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR). Despite the wide recognition of health as a human right, until today the developing world still faces barriers raised by the high prices of drugs needed for essential treatment, as a result of strong intellectual property protection. The first chapter.. The second chapter The last chapter.. Chapter 1 Human right to health In 1946, the preamble of the World Health Organization (WHO) Constitution declared the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition . Since then, the so called right to health has become part of the international customary law and has been incorporated in numerous international agreements, treaties and declarations. The Universal Declaration of Human Rights (UDHR), although not legally binding under international law, evolved the interpretation of the right to health stating that everyone has the right to a standard of living adequate for the health and wellbeing of himself and his family, including food, .. and medical care and necessary social service, and the right to security in the event of .. sickness, disability .. or other lack of livelihood in circumstances beyond his control . But the most prominent provisions on the right to health are set out in the International Covenant on Economic, Social and Cultural Rights (art.12) which stipulates and recognizes health as the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Besides the international instruments which frame the protection of health and create binding obligations to the state parties, the human right to health has also been vaguely interpreted as an aspect of the human right to life. The latter, recognized by international tribunals as jus cogens, should according to the literature, include the right to health in cases where deficiencies in access to life-saving medicines deprive people of life. Still today the international debate on the interpretation and the different applications of the right to health remains controversial, raising concerns of being too vague and interlacing with other human rights 2.2. International Covenant on Economic, Social and Cultural Rights (ICESCR) The International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted by the United Nations General Assembly in 1966 and entered into force in 1976, is a multilateral treaty that counts today 168 members. It binds member states to cooperate and work for the implementation and commitment to the standards contained in it, with regards to economic, social and cultural rights. Article 12 of the Covenant contains the leading provisions for the right to health in the international human rights framework. According to it (12.1), the state parties recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The provisions (12.2) further define the states obligations, in the form of appropriate steps to be taken, for the realization of this right and include among others the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would assure to all medical service and medical attention in the event of sickness. The Covenant is monitored by the Committee on Economic, Social and Cultural Rights (ESCR Committee), a group of independent experts responsible for monitoring its implementation in the member States. In 2000, the Committee issued the General comment no. 14, as an authoritative interpretation of the content and normative notion of the highest attainable standard of health. 2.2.1 Normative content of article 12 According to the ESCR Committees General Comment no. 14, the right to health is an inclusive right extending further than proper and timely appropriate health care, to what is called the underlying determinants of health, which include access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. Furthermore, it should be considered as straightly related and an integral component of other rights, such as, among others, life, human dignity, non-discrimination and equality. There are some misconceptions regarding the interpretation of the right to health that need to be clarified. First of all the right to health cannot be conceived as the right to be healthy.States cannot guarantee universal health conditions disregarding genetic factors or individual lifestyle choices and individual freedom of choice. Thus, the right to health refers more to the realization of the highest attainable standard of health and enjoyment of good health conditions, services and facilities.Second, the right to health is not only a long term policy goal for the States but it is grounded on specific and immediate efforts to achieve this goal and specific steps that need to be taken to guarantee its full realization.Lastly, a States lack of resources or difficult financial situation cannot be considered as a justification for not providing the maximum of the efforts and sources available to fulfill its obligations. Taking these into consideration the right to health is composed by the following essential elements. Availability, accessibility, acceptability and quality. To begin with, health care facilities, goods and services must be available for everyone and in a sufficient quantity at each State. This includes at least the underlying determinants of health as well as access to essential drugs as defined by the WHO Action Programme on Essential Drugs. Following, services, goods and facilities should be accessible to everyone within each States jurisdiction. Accessibility means first of all non-discrimination on the grounds of race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and civil, political, social or other status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health. Further on, accessibility means physical reach of pharmaceuticals for all sections of the population and in this case for the population suffering from HIV/AIDS, malaria and tuberculosis. The next overlapping dimension of the notion of accessibility, according to the General Comment no. 14 is affordability. This means that economic accessibility has to be based in the principle of equity, ensuring access for all, regardless their economic position. The right to seek, receive and communicate information regarding health issues is the last factor of accessibility. Third, health services, goods and facilities should be culturally acceptable and respectful of medical ethics and lastly they must be scientifically and medically appropriate and of good quality. 2.2.2 Appropriate steps to be taken Article 12.2 provides a non-exhaustive catalogue of examples of steps that can be taken by the States, serving as guidance for the achievement of full realization of the right to health. For the purposes of this paper focus will be given on Articles 12.2(c) and Article 12.2 (d) of the ICESCR. The prevention, treatment and control of epidemic, endemic, occupational and other diseases indicates a public health dimension in the right to health. For the purpose of this step, States need, according to General Comment no.14, to establish prevention and education programmes, mainly for sexually transmitted diseases, such as HIV/AIDS, and the promotion of social determinants of good health. This includes the implementation of medical care for urgent situations and humanitarian assistance in emergency situations, but also the provision of disaster relief and States efforts, individually or jointly, for the availability of relevant technologies. Article 12.2(d) contains a provision for the creation of conditions which would assure to all medical services and medical attention in the event of sickness. This includes appropriate education and health treatment, screening programmes and the provision of essential drugs, as well as organization of the health sector and participation of the population both in health services and in political decisions relating to the right to health Furthermore, article 4 of the Covenant provides a limitation clause on the ground of which many times public health issues have been used by States to limit the exercise of other fundamental rights. The CESCR Committee emphasizes that the purpose of this article is more to protect individuals rights than promote any limitations and that such limitations shall be justified and in accordance with international law and human rights standards, in the interest of legitimate aims and strictly for the promotion of general welfare. Lastly, any limitation, according to article 5 of the Covenant should be proportional, of limited duration and subject to review. 2.2.3 States Obligations The wide recognition of the right to health and access to medicines both in international and national level and the inclusion of it in international human rights instruments bear statement to its high importance and obliges state parties to take positive actions and ensure its full realization. Apart from the aforementioned obligations of taking the appropriate steps and that of non discrimination (article 2.1., 2..2) the covenant provides for progressive realization of the right to health. This does not mean that States can deprive their obligations from all meaningful content. On the contrary, State parties have a specific and continuing obligation to move as expeditiously and effectively as possible towards the full realization of article 12. More particularly three types of obligations are required for the full realization of health, the negative obligation to respect and the positive obligations to protect and fulfill. The obligation to respect means that States must refrain from interfering with the enjoyment of the right to health and should abstain from actions that have adverse effects on peoples health. It includes among others the obligation to refrain from denying or limiting equal access to all, from discriminatory practices and policies, to prohibiting traditional preventive care and marketing unsafe drugs. Further, the obligation to protect is a positive right, which means that it implies positive and specific actions from the States. More precisely States must take actions in the form of measures or legislation that will ensure equal access to health care and health related services provided by third parties. Inter alia, it indicates to the States to ensure that any privatization of the health sector must not constitute a threat to health services and it implies the assurance that third parties will not limit peoples access to health related information and services. Lastly the obligation to fulfill includes detailed plans for the realization of the right to health in the form of legislative implementation and recognition in the national political and legal systems, including immunization programmes against the major infectious diseases, information campaigns mostly for HIV/AIDS and adoption of health policies that would assure the achievement of the highest attainable standard of health. The obligation to fulfill entails further on the obligations to facilitate, provide and promote. 2.2.4. Private actors obligations States are, traditionally, the sole subject of international law and thus the sole subject that enters in bilateral and multilateral legally binding agreements and incurs rights and obligations under international treaties. The General Comment no. 14, acknowledges that but also recognizes a role for the non state actors (NSAs). This is crucial for the full realization of the right to health , due to the fact that NSAs and especially pharmaceutical companies play the largest role in determining whether medicines are equitably available and accessible. Pharmaceutical companies are largely responsible for determining for which diseases drugs are developed, where drugs will be sold and at what cost. According to the General Comment no. 14 While only States are parties to the Covenant and thus ultimately accountable for compliance with it, all members of society – individuals, including health professionals, families, local communities, intergovernmental and non-governmental organizations, civil society organizations, as well as the private business sector have responsibilities regarding the realization of the right to health. State parties should therefore provide an environment which facilitates the discharge of these responsibilities. Regardless of this passage, the nature of NSAs accountability is not further defined but as an element of the obligation to protect, which requires states to prevent third parties, including non state actors, from interfering with the right to health. That having said the Covenant is not establishing any binding legal obligations for NSAs under international law, adequate to protect violations of the right to public health by non state actors. The same applies for the Preamble of the Universal Declaration of Human Rights where is stated that every individual and every organ of society… shall strive…to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance. and further on in article 30 Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.. That means that NSAs along with states should not only respect human rights but also abstain from destroying them. Even though the Declaration is not a treaty and thus not binding under international law, parts of it have become customary law and therefore binding for states. The recognition of the private sectors accountability for human rights violation and the enforceability of human rights obligations for NSAs is a much discussed topic in international law regime. Even thought significant progress has been made towards that, the human rights regime must evolve to ensure all parties responsible for human rights violations and the failure to address human rights deficits, including NSAs, are held directly accountable. This need is nowadays more and more urgent if one considers how crucial is the role of NSAs in the private sector in the provision of social and economic goods and the high tendency of the states to privatize traditional public sectors such as public health. Chapter 2 3.1 Intellectual property rights – patents Intellectual property refers to creations of the mind and is divided into industrial property (including patents for pharmaceuticals) and copyright. Intellectual property rights (IPR) give to the creators or owners of patents, trademarks and copyrighted works the exclusive right over the use of the creation for a certain period of time. The first attempt for the international recognition and protection of intellectual property rights occurred in the previous century. Paris Convention for the Protection of Industrial Property, signed in 1883, and the Berne Convention for the Protection of Literary and Artistic Works, signed in 1886, dominated for more than a century the international framework of IPRs protection. In 1995, the Agreement on Trade Related Aspects of Intellectual Property (TRIPS Agreement) came into force, to globalize all aspects of intellectual property and impose minimum standards of protection for all the World Trade Organization (WTO) members. Patents, under the TRIPS Agreement, are protected for a minimum of twenty years, and they offer the exclusive right to the owner of the invention, either a product or a process, to exclude third parties, without consent, from making, using, offering for sale, selling, or importing them. Patents are territorial in nature, which means that protection is granted only in the jurisdiction where it is filed, under specific application procedures and specific requirements, which are not universal but differ among jurisdictions. By its exclusive character and the simultaneous minimum protection of twenty years, patents actually create monopolies for their owners and they serve as a reward for the effort and the cost of research and development (RD) and, to the common state of mind, as an incentive for the researchers and inventors to continue producing better and more efficient products for consumers. Furthermore, they are also considered to encourage innovation and create benefits from the disclosure of valuable and important information. 3.2 TRIPS Agreement The Agreement on Trade-Related Aspects of Intellectual Property (TRIPS) was for the first time introduced during multilateral negotiations in the Uruguay Round and came into effect on 1995. It was the first time in history of intellectual property regime that a set of uniform rules, which impose high standards of IPR protection, was strongly linked to the WTO, as it was introduced as part of the trade package that ended up in its creation. But what is even more special about the TRIPS Agreement is that for the first time intellectual property was bound to global trade, a fact that is explicitly obvious even in the title of the Agreement (Trade-Related). Unlike the previous intellectual property conventions, on which TRIPS was based and supplemented, what was now new was that the new rules and standards relate both to the availability and enforcement of rights. This means, first of all, that member states are bound by the lower standards of protection, imposed by the Agreement, either in the sense of initially introducing intellectual property regimes domestically, or in the sense of reforming their already existing rules in order to be TRIPS compliant. The correlation of TRIPS with WTO, further explicitly implied that the dispute settlement procedures of the latter would be set in forth and in case of any violation by any member state, remedies and damages can be sought and trade sanctions can be imposed, through the Dispute Settlement Understanding (DSU) procedures. These innovations where introduced and adapted through strong pressure to developing countries and negotiations, that had the characteristic of all or nothing. In other words, all member states, seeking to be part of the WTO shall agree to its satellite agreements, part of which is the TRIPS Agreement. This in practice took the form of a concession of rights by developing countries in order to maintain or achieve free access to the industrialized markets. During the Uruguay Round the industrialized countries actually showed their teeth to the developing world. Several factors played an essential role to thiswith the most prominent being a major decline in profits that the US was facing in the 80s due to the piracy and counterfeiting activities of the Asians newly industrialized countries in the fields of technology. This profit – based conception led to the lobbying, mostly by huge pharmaceutical companies, to the US Government and to the subsequent pressure, imposed to the South, during the Uruguay Round negotiations, for the link of intellectual property with trade. The result was pretentious and aimed to the domination of the North to the South and to a counter balance of the formers declining competiveness in the market. 3.3 Provisions and flexibilities Patents are available for any invention, including products or processes, in all fields of technology, provided that they are new, involve an inventive step and are capable of industrial application. This is stated in article 27 of the TRIPS, which constitutes the legal basis for patent protection and further recognizes that protection is granted without discrimination as to the place of invention, the field of technology and whether products are imported or locally produced. Each member state, though, as provided in par.2, can exclude from patentability inventions the commercial exploitation of which is necessary to protect ordre public or morality, including to protecthealth provided that such exclusion is not made merely because the exploitation is prohibited by their law, such as diagnostic, therapeutic and surgical methods for the treatment of humans or animals. Furthermore, as stated above, article 28 of the TRIPS, not only confers to the owner the exclusive rights mentioned therein, but also the right to assign, or transfer by succession, the patent and to conclude licensing contracts. For the purposes of establishing and preserving a balance in the implementation of the TRIPS Agreement, article 30 stipulates exceptions to the exclusive rights conferred by a patent, provided that such exceptions do not unreasonably conflict with a normal exploitation of the patent and do not unreasonably prejudice the legitimate interests of the patent owner, taking account of the legitimate interests of third parties. The following article 31, which is of high importance, grants the right of other use of a patent without the authorization of the patent holder, such as the use by the government or third parties authorized by the government (compulsory licensing). According to it, such use can only be permitted if the proposed user had previously made real efforts to obtain authorization from the patent holder on reasonable terms and conditions, but the efforts have not been successful within a reasonable time. This requirement may be waived in cases of a national emergency or other circumstances of extreme urgency (such as HIV/AIDS, malaria and tuberculosis epidemics) or in cases of public noncommercial use. Further on, article 31 contains provisions on the scope and duration of such use, which should be limited to the purpose for which it was authorized, non-exclusive and non assignable and authorized predominantly for the supply of the domestic market of the member authorizing such use. The latter, as is more specifically shown above, turned out to be a very controversial provisions on the relationship between TRIPS and the pharmaceutical industry since it theoretically opened the way to member states to surpass patents in order to produce generic medicines domestically, but in practice the majority of developing countries lacked the requisite domestic generic manufacturing capacity to use these provisions. Lastly, article 31 stipulates that the patent holder should be paid adequate remuneration for the use of the patent, taking into account the specific circumstances of each case. 3.4 Trips and patented pharmaceuticals TRIPS establishment as part of the WTO package created a number of issues, mostly regarding the linking between patents on pharmaceuticals and access to medicines. This issue became extremely controversial with adverse effects for an enormous part of the worlds population, mainly coming from developing and least developed countries (LDCs). Before the TRIPS Agreement, most of the developing worlds IP regimes were not TRIPS-compliant. In India, for example, one of the biggest markets of pharmaceutical industries in the world, patents in pharmaceutical products were not admissible and therefore protected, under the 1970 Indian Patents Act. Protection was granted only with regards to the processes, and this led to a rapid expansion of the domestic pharmaceutical sector and the subsequent mass production and exportation of low cost generic manufactured drugs to other countries with the same regime. The set of minimum standards of protection established by the TRIPS Agreement and its obligatory implementation for all WTO members, thoroughly transformed this regime. First of all pharmaceutical patents may be patented, offering the patent holder exclusive rights and control for a minimum period of twenty years. This results to the granting to pharmaceutical companies of a dominant position in the market and to the subsequent elimination of competition from generic drugs maufacturers. The monopoly period that is created is being exploited by the pharmaceutical companies in order to set high prices for the medicines produced, without any limits or restrictions. The concept of competition from generic drugs manufactures is crucial for the access to affordable medicines, since naturally their entrance in the market results to drug prices reduction. As an example during the HIV/AIDS crisis in the end of the previous century the annual prices for antiretroviral treatment was accounting for more than 10.000 USD. After the introduction of generic drug manufacturers in Brazil there was a decline of 96 percent, to 350 USD. The aforementioned data actually prove the perception that strong patent protection in the pharmaceutical industry imposes high obstacles in the access to affordable medicines and consequently equals to a straight attack on the human right to health. This perception that patents have adverse effect on access to medicines was also acknowledged by the WTO with the adoption of the Doha Ministerial Declaration on Public Health and Trade (the Doha Declaration) in Doha, Qatar in November 2001. 3.5 The road to Doha Declaration – Big Pharma vs Nelson Mandela In the end of the previous century around 10 million people were killed by infectious disease, due to the lack of access to medicines because of the restrictive prices on antiretroviral, 90 percent of which were coming from developing countries. In the desperate need to facilitate access to medication the government of South Africa established in 1997 the Medicines and Related Substances Control Amendment Act No. 90 of 1997 (Amendment Act), which introduced a legal regime to increase the availability of affordable medicines. The agenda of the Amendment Act provided for generic drugs that would substitute the not protected by patents medicines, transparent pricing and parallel importation of patented medicines. In 1998 the South African Pharmaceutical Manufacturers Association and 39 multinational of the pharmaceutical sector, suited South Africas government, alleging that the relevant Act was violating the TRIPS and the countrys Constitution. The United States but later on also the European Commission put strong pressure to South Africa to amend its legislation, by threatening the government with trade sanctions and by withholding trade benefits. AIDS activists and NGOS demonstration all around the world highlighted public rage and increased pressure, which resulted into the US changing its policies in 1999. By the time of the Court procedure the pressure reached such a level, that pharmaceutical companies were obliged to withdraw from the case and bear a big loss. This case was particularly important for two reasons. First, the interpretation of TRIPS flexibilities and their relation to public health became extremely urgent and second it imposed a limit on industrialized countries claimed freedom to put pressure in the developing world without consequences. The former issue became the main subject of the Fourth Ministerial Conference of the WTO, in Doha, Qatar, held in 2001, which resulted in the adoption of the Declaration on TRIPS and Public Health (the Doha Declaration). The Doha Declaration was one of the most important developments in the area of intellectual property rights in WTO, because it recognized the intensity of public health concerns, mainly on HIV/AIDS, malaria and tuberculosis, in developing and LDCs because of the launch of prices caused by strong IPR protection, and stated the predominance of public health over IP protection in cases of conflict. As stated in par. 4 of the Declaration We agree that the TRIPS Agreement does not and should not prevent Members from taking measures to protect public health. Accordingly, while reiterating our commitments to the TRIPS Agreement, we affirm that the Agreement can and should be interpreted and implemented in a manner supportive of WTO Membersright to protect public health and, in particular, to promote access to medicines for all. In other words, the text acknowledged the right of WTO members to take measures to protect public health and allowed them to surpass patents in cases where IPR protection impedes this right (such as the case of high prices in access to health because of patented medicines). Furthermore, par. 5 of the Declaration identified measures and flexibilities (compulsory licensing and parallel imports) that can be used by developing and LDCs to overcome barriers imposed to public health by intellectual property protection. It stressed the point that the grounds for compulsory licensing are unlimited and not confined only to cases of emergency or extreme urgency and that member states are free to determine what constitutes a national emergency. The latter, along with the presumption that HIV/AIDS, tuberculosis and malaria can represent such an emergency and public health crisis, is crucial, because in such cases articles 31b of the TRIPS requirements for prior negotiations with the patents owner can be surpassed. Lastly and regarding parallel imports, the Declaration affirmed the right to member states to establish their own regime of exhaustion of rights that would allow parallel imports of an IPR protected product that has been legitimately marketed in another country. 3.6 Post Doha Declaration (par. 6) One problem that was recognized by the Doha Declaration but remained unsolved was the lack of capacity of the majority of the developing countries to use the provisions of compulsory licensing. Article 31 (f) of the TRIPS limits the use of compulsory licensing predominantly for the supply of the domestic market. This is an unresolved issue for poor countries that lack the manufacturing capacity to produce drugs and have the need to import them. Notwithstanding the commitment of the WTO countries to find an expeditious solution to this problem, the solution came two years after, by the Decision of the General Council on the implementation of paragraph 6 of the Doha Declaration on TRIPS and Public Health (2003 WTO Decision). Ellen F. M. t Hoen, TRIPS, pharmaceutical patents, and access to essential medicines a long way from Seattle to Doha 2002 Chicago Journal of International Law, 3(1) Chic J Int Law, 39 http//hdl.handle.net/10144/28436 accessed 15.04.2016. http//www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/november/20171121_righttohealth_report Pharmaceutical Manufacturers Association of South Africa v President of the Republic of South Africa. Case No 4183/98, filed Feb 18, 1998 Carlos M. CORREA, ICTSD-UNCTAD Dialogue, 2nd Bellagio Series on Development and Intellectual Property, 18-21 Sept. 03 Constitution of the World Health Organization (1946), Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946. Article 25 of the UDHR Article 12 of the International Covenant on Economic, Social and Cultural Rights Constitution of the World Health Organization (1946), Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946 Article 25(1) of the UDHR United Nations, International Covenant on Economic, Social and Cultural Rights, 16 December 1966, UNTS vol. 993 Street Children Case (Morales v. Guatemala), Judgment of Nov. 19, 1999 Inter-Am. Ct. H.R. (Ser. C) No. 63 Yamin A, Not Just a Tragedy Access to Medications as a Right Under International Law. (2003) 21(2) BU Intl LJ 325 Philippe Cullet, Patents and Medicines The Relationship Between TRIPS and the Human Right to Health, International Affairs Volume 79 Issue 1, 148. United Nations, International Covenant on Economic, Social and Cultural Rights, 16 December 1966, UNTS vol. 993 Article 12.1 of the ICESCR Article 12.2 (c-d) of the ICESCR United Nations Committee on Economic, Social and Cultural Rights, General Comment No. 14 The Right to the Highest Attainable Standard of Health (2000) (Art. 12 of the International Covenant on Economic, Social and Cultural Rights), E/C.12/2000/4, 11 August 2000 Ibid par.11 Ibid par.3 https//www.ohchr.org/Documents/Publications/Factsheet31.pdf Ibid par.8 Ibid par.9 Ibid par.9 https//www.ohchr.org/Documents/Publications/Factsheet31.pdf https//www.ohchr.org/Documents/Publications/Factsheet31.pdf United Nations Committee on Economic, Social and Cultural Rights, General Comment No. 14 The Right to the Highest Attainable Standard of Health (2000) (Art. 12 of the International Covenant on Economic, Social and Cultural Rights), E/C.12/2000/4, 11 August 2000 Ibid , see WHO Model List of Essential Drugs, revised December 1999, WHO Drug Information, vol. 13, No. 4, 1999 CESCR General Comment No. 14 Ibid Ibid Ibid Ibid Ibid Ibid Ping Xiong, Pharmaceutical Patents in the TRIPS Agreement and the Right to Health – Can These Rights Be Reconciled, 36 U.W. Austl. L. Rev. 115 (2012) CESCR General Comment no. 14 CESCR General Comment no. 14 CESCR General Comment no. 14 Ibid Ibid Ibid Ibid ibid ibid ibid ibid Ping Xiong, Pharmaceutical Patents in the TRIPS Agreement and the Right to Health – Can These Rights Be Reconciled, 36 U.W. Austl. L. Rev. 115 (2012) Rapporeur Ping Xiong, Pharmaceutical Patents in the TRIPS Agreement and the Right to Health – Can These Rights Be Reconciled, 36 U.W. Austl. L. Rev. 115 (2012) Comment Ibid Ibid Ibid Ibid The obligation to fulfil (facilitate) requires States inter alia to take positive measures that enable and assist individuals and communities to enjoy the right to health. States parties are also obliged to fulfil (provide) a specific right contained in the Covenant when individuals or a group are unable, for reasons beyond their control, to realize that right themselves by the means at their disposal. The obligation to fulfil (promote) the right to health requires States to undertake actions that create, maintain and restore the health of the population. Anand Grover Brian Citro Mihir Mankad Fiona Lander, Pharmaceutical Companies and Global Lack of Access to Medicines Strengthening Accountability under the Right to Health, 40 J.L. Med. Ethics 234 (2012) General Comment no 14 Ibid 57 Universal Declaration.. Ibid Ibid 57 Ibid WIPO What is intellectual property https//www.wto.org/english/tratop_e/trips_e/intel1_e.htm Paris Convention Berne convention Article 33 of the TRIPS Agreement Article 28 of the TRIPS Agreement Article 29 of the TRIPS Agreement Article 27 (1) of the TRIPS Agreement WIPO What is Intellectual property Anand Grover Correa Intellectual property rights Anand Grover Regime Shifting The TRIPs Agreement and New Dynamics of International Intellectual Property Lawmaking See correa .. Ibid Aricle 27 of the TRIPS Agreement Ibid Article 27 (2) of the TRIPS Agreement Article 27 (3.1) of the TRIPS Agreement See 68 Article 28 of the TRIPS Agreement Article 30 of the TRIPS Agreement Where other use.. Article 30 of the TRIPS Agreement Article 30 of the TRIPS Agreement Can incentives to generic manufacturers save the doha declarations paragraph 6 Correa Article 30 of the TRIPS Agreement In some countries such as India transition period granted Anand Grover.. he cites Doctors Without Borders, Untangling the Web of Price Reductions, June 2005, at 10, available at wwv.accessmed-msf. org (last visited May 10, 2012). World Health Organization The World Health Report 2001. WHO, 144, 2000 Pharmaceutical Manufacturers Association of South Africa v President of the Republic of South Africa. Case No 4183/98, filed Feb 18, 1998. Ellen Hoen Access.. Ibid Ibid Hoen Access.. Ibid Correa recent international developments Doha Declaration par. 1-2 Ibid Doha Declaration par 4 Hoen 52 ,1 Doha Declaration South center The Doha Declaration on TRIPS and Public Health Ten Years Later The State of Implementation ibid Article 31 f TRIPS Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health, Decision of the General Council of August 30, 2003 Y, -im9(c5a4MbAIbJBxL6kht Qp)mcalXm cv3FKq-K62pV5 6Q

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