By Aparajita Lath*
The World Health Organization (WHO), in collaboration with the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO), hosted the 10th Trilateral Symposium on Human Health and Climate Change in Geneva this November. This article reflects the significant effort made to put climate-sensitive diseases, many of which are neglected tropical diseases (NTDs), at the forefront of these talks.
Speakers at the Symposium included the Directors General of all three organizations as well as representative government officials, non-governmental organizations (such as Médecins Sans Frontières/Doctors Without Borders and the Drugs for Neglected Diseases Initiative), and industry participants (Novartis).
The context was set in general terms, with the aim to put public health concerns at the center of climate change action. To establish the health impact of climate change, speakers highlighted various issues. For instance, increase in pollution due to increased carbon emissions is leading to a rise in respiratory illness, and rising temperatures are increasing natural calamities such as floods and fires, adding pressure on health systems. The focus of this article, NTDs, include diseases such as dengue, malaria, and leishmaniasis.
NTDs are typically diseases that affect populations in warmer regions. For instance, the mosquito Aedes aegypti — the main vector of dengue, Zika, Chikungunya and yellow fever viruses — is currently limited to tropical and subtropical regions because it cannot survive cold winters. Since these diseases affect populations that are low-income with little economic power or political voice, research into these diseases has been neglected so far. As per a WHO study, the burden of NTDs continues to be unequally borne by a small number of countries: 16 countries bear 80% of this burden.
With climate change, this may shift. Regions that will see milder winters due to climate change may soon become exposed to what used to be tropical diseases. For example, sporadic dengue cases have been reported in the last decades in high-income countries such as Portugal, Italy, France, and Australia. However, interactions between the microbial world, the environment, and human activities are complex and manifold. In addition to environmental factors, social determinants may also affect the extent to which diseases spread. For example, for diseases such as dengue, basic sanitation services, such as access to safe and clean water and regular garbage collection, along with measures to mitigate climate change, are important considerations.
At the same time, spread of NTDs to high-income countries may trigger more research and development into treatments and cures. But this may not solve the issue of global inequities, since new medicines and treatments may continue to remain out of reach for poorer countries. In this regard, symposium participants deliberated strategies for a way forward, including increased public-private partnerships.
Organizations and governments that partner with private companies to target NTDs should focus not only on the development of new medicines, but also should work to ensure that they are meaningfully accessible as treatments to affected populations. One way forward that was discussed was a collaborative and voluntary mechanism. Pharmaceutical companies should consider adopting an “access by design” approach, i.e., embedding fairer and equitable access to intellectual property at all stages of drug development and deployment. Instead of focusing only on the last mile, the idea is for pharmaceutical companies to review their intellectual property strategies right from the stage of research and development to distribution and treatment. Having equitable terms embedded in their internal policies and contracts may help increase access to both treatments and knowledge. Such an internal access by design approach may also motivate others in the industry to follow. Governments, on the other hand, will have to identify priority diseases, come up with action plans, and ensure that pharmaceutical companies are accountable and are in fact implementing equitable access by design approaches. This may not be straightforward, since internal access principles on pricing may be challenging for external parties to review. But the hope is that partnerships are meaningful and based on good faith, in a way that balances innovation and public health.
This symposium is not the first time WHO has taken up the interplay between climate change and NTDs. For instance, the WHO has published an “Atlas of Health and Climate” and the 2017 WHO roadmap for NTD controls. Today, however, climate change and its effects are starting to feel psychologically, temporally, and socially closer than before. Given this new urgency felt by people in countries with money and power, concrete steps to tackle NTDs may be on the horizon.
*Assistant professor, National Law School of India, Bangalore. LL.M, HLS and Student fellow, PFC, 2022-2023. Participated in the 10th WHO-WIPO-WTO Trilateral Symposium held on November 14, 2023, Geneva, Switzerland (scheduled as part of the 19th WIPO-WTO Colloquium for Teachers and Researchers of IP, November, 2023). I would like to thank Dr. G.D Ravindran (Professor and Head, Family Medicine, St. John’s Medical College and Hospital, Bangalore) for taking time out to speak to me about NTDs.