At that time, in its unilateral moratorium, the U.S. insisted that a Paragraph 6 agreement be limited to "AIDS, tuberculosis, and other infectious epidemics of comparable gravity and scale, including those that may arise in the future." The U.S. went on to list comparable infectious diseases, including "for example, ebola, African trypanosomiasis, cholera, dengue, typhoid, and typhus fevers." (The deep irony of this list was that there were few if any patented medicines for any of these neglected diseases because drug companies generally refused to research tropical diseases that mainly impact poor people in developing countries.)

The alleged big break-through of the August 30, 2003 Agreement on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health was that the United States Trade Representative and Big Pharma had reluctantly backed down from their narrow reading of the scope of diseases covered by the Doha Declaration. No longer was the U.S. insisting on the existence of public health emergencies (never in the text of the Doha Declaration) nor on a set list of covered diseases. Like the rest of the world, the U.S. implicitly promised that the Doha Declaration and the Paragraph 6 Agreement could be used to address the full spectrum of public health needs facing developing and least developed countries ? asthma as well as AIDS, pneumonia as well as tuberculosis, diabetes as well as malaria. This broader interpretation was fully consistent not only with Paragraph 1 of the Doha Declaration, but even more so with respect to Paragraph 4, which affirmed "that the [TRIPS] Agreement can and should be interpreted and implemented in a manner support of WTO members' right to protect public health and, in partiucalry, to promote access to medicines for all."

Now, on the eve of Canada's effort to reform its national legislation to permit its generic drug industry to supply needed medicines to developing countries, we see that the U.S. is continuing to insist on a restrictive interpretation of the Doha Declaration and the Paragraph 6 Agreement. When the U.S. was asked by Canada to waive any rights it might have under the NAFTA (North America Free Trade Agreement), the U.S. did so with great theatrical flair at a press conference on October 7, 2003, but then it added an ominous footnote.

As reported today in the Globe and Mail (Canada): "A senior Canadian official said the United States did not place any restrictions on the drugs Ottawa's initiative covers, adding that it is understood that shipments, in keeping with the WTO deal, would be for treating only AIDS, tuberculosis, malaria and other public health emergencies." Far from representing "no restrictions," the U.S. position is back to its old shenanigans ? "emergencies" only, primarily HIV/AIDS, tuberculosis and malaria.

Public health activists like Doctors without Borders and the Consumer Project on Technology, and AIDS treatment activists like Health GAP, the Treatment Action Campaign, and the Canadian HIV/AIDS Legal Network, have consistently and heatedly argued that developing countries should have sovereign rights to define and respond to their own public health needs and to ensure "access to medicines for all" as promised by Paragraph 4 of the Doha Declarations. Likewise, developing countries have consistently, for two years, remonstrated against U.S. efforts to restrict disease coverage and to force health systems to show preference for people dying of AIDS versus those dying from diabetes.

There is a grotesque inequity in a world where rich developed countries like the U.S. and Canada could issue TRIPS-compliant compulsory licenses and produce medicines internally for any public health need, including for example the much-hyped Anthrax scare, but a poor developing country can access medicines only for a predetermined number truly catastrophic conditions.

The U.S., once again, leads the world in hypocrisy ? it touts its compassion at Cancun and in Ottowa and then does Pharma's dirty work behind closed doors. It says "we won't object" in bold face, while in the fine print it says "as long as you do it our way."

The U.S. is legally and morally obligated to clarify that it will in fact implement the Paragraph 6 Agreement in good faith and that it will not stand in the way of exporters who want to supply the medicine chest of developing countries that utilize the Paragraph 6 mechanisms for any public health need that those countries identify. It simply won't do for the U.S. to continue to block access to a comprehensive array of medicines for a comprehensive scope of diseases. More particularly, the U.S. should renounce a restricted-disease interpretation of the Paragraph 6 Agreement; it should renounce and waive any residual rights it or its investors might have under NAFTA; and it should cease and desist from seeking heightened, TRIPS-plus, and Doha-plus intellectual property protections in its ongoing bilateral and regional trade negotiations, like those with Central America, the South African Customs Union, and the FTAA. -end-