The document discusses the relationship between the World Trade Organization (WTO) and public health. It provides an overview of the WTO, including its structure and agreements. It then examines 8 specific health issues - infectious disease control, food safety, tobacco control, environment, access to drugs and vaccines, health services, food security and nutrition, and emerging issues - and how they interact with or are addressed by WTO agreements. The conclusion emphasizes that the WTO dispute settlement body has enabled the continued free trade while also allowing countries to regulate issues like taxing imports to make essential goods more affordable.

1. World Trade Organization
Agreement
&
Public Health
Presenter : Dr Dharanidhar Singh
Moderator: Prof. Ratan K. Srivastava

2. Learning Objectives
What is WTO ?
Agreements
8 Specific Health Issues
Conclusion
Why &
How WTO
& GATT
WTO.pptx
Structure Of WTO

3. World Trade OrganizationWTO.pptx
• Marrakesh Agreement
• by 123 nations on 15 April 1994
• 7.5-year-long Uruguay Round and establishing
the World Trade Organization,
• Established: 1st January 1995

4. WTO contd…
• HQ Location: Geneva, Switzerland
• 164 Members, 23 Observer & 8 nonmember (as on
july 2016
• Purpose : To Regulate International Trade & to serve
as a forum for trade negotiations.
• DG: Roberto Azevêdo ( 2013- present)

6. WTO Structure
• Ministerial Conference : The WTO's top decision-making body
• The General Council
• Trade Policy Review Body
• Dispute Settlement Body (DSB) : Appellate Body Dispute Settlement Panels
• Council for TRIPS
• Trade Negotiations Committee
• Negotiating Group on Market Access
• Negotiating Group on Rules Committee on Trade and Environment
“decisions are made by consensus. Voting is possible but it has never been used in the WTO”

7. National
treatment
WTO PRINCIPLES

8. WTO Agreements Aggrements.pptx
1. GATT : General Agreement on Tariffs & Trade
2. GATS : General Agreement on Trade in Services
3. TRIPS : Trade Related aspects of Intellectual Property rights
4. TBT : Agreement on Technical Barriers Trade
5. SPS : Sanitary & Phyto Sanitary Agreement
6. TRIMS : Trade Related Investment Measures
7. AOA : Agreement On Agriculture

9. 1.INFECTIOUS DISEASE CONTROL
2.FOOD SAFETY
3.TOBACCO CONTROL
4.ENVIRONMENT
5.ACCESS TO DRUGS AND VACCINES
6.HEALTH SERVICES
7.FOOD SECURITY AND NUTRITION
8.EMERGING ISSUES
SPECIFIC HEALTH ISSUES AND WTO
AGREEMENTS

10. Cross-border movements:
The risk of infectious disease rises with increased mobility of
people, growth in international trade in food and biological
products, and social and environmental changes.
Dispute Case
Safety of imported fish during a cholera outbreak,
Tanzania Vs European Communities (EC) ,early1998
1. INFECTIOUS DISEASE CONTROL

11. WTO SPS Committee : that there was no proven risk of cholera transmission
from the foods in question ,the E C agreed to resume trade on 1 July 1998
Tanzania
unfairly blocking fruit,
vegetables and fish products, in
light of a cholera outbreak in
Tanzania, Kenya, Uganda and
Mozambique.
Restriction Severely affects it’s
economy
Safety of imported fish during
a cholera outbreak,1998
European Communities (EC)
WHO investigator :ban on fish imports
NOT necessary, since fish products were
not consumed in raw form in Europe.

12. Chemical hazards in food-related products have been the
source of several limited, but highly publicized health crises
e.g. The contamination of animal feed by dioxin in Belgium,
1999
The widespread use of antibiotics in animal husbandry has
contributed to increased levels of antibiotic resistant
bacteria in humans
e.g. CODEX, 1961
2. FOOD SAFETY

13. Codex Alimentarius Commission
establish standards for food safety
Hazard Analysis
and Critical
Control Point
(HACCP)
Horizontal
approach
food additives/
contaminants/
toxins

14. EC in 1988 to completely
ban the use of growth-
promoting hormones
1998, the Appellate Body ruled that the EC was in violation of SPS
rules. As the international Codex standards existed for 5/6 hormones
at issue, panel judged that EC was required to justify its ban
EC was unable to act accordingly
and failed to lift its import ban,
on 12 July, 1999
USD $ 116.8M
CND $ 11.3M
EC hormone ban concerning
meat and meat products

15. Tobacco consumption rose in developing countries, due to
Transnational Tobacco Companies (TTCs) in markets of poor and
middle income nations
Higher tariffs on tobacco may (such as taxes), contribute to a rise in
consumer price, which leads to lower levels of consumption and
lower prevalence of smoking among youth .
Raising tariffs, however, runs counter to the general goal of trade
liberalization, which is to reduce or eliminate tariffs and non-tariff
barriers to international trade
3. TOBACCO CONTROL

16. 1966 Tobacco Act, Thailand prohibited
the importation of cigarettes and other
tobacco preparations, but authorized
the sale of domestic cigarettes
1989, The United
States complained
that the import
restrictions were
inconsistent with
GATT
The Panel found that the import restrictions were
inconsistent & not justified So not necessary
But
bans on advertising and point-of-sale promotion will
continue
Thai Cigarette Case

17. • tobacco taxes and prices,
• restrictions on advertising and promotion,
• counter-advertising,
• design of warning labels and packaging,
• clean indoor air policies,
• treatment of tobacco dependence
• combat illegal trade and smuggling,
• phase out duty-free sales
• Increase and harmonize taxes internationally
• packaging and labelling issues: bans on labels like "low tar" or "mild," smokers
gets false sense of security
Framework Convention on
Tobacco Control (FCTC). 1996

18. Economic growth is not sustainable in the long-term if it
comes at the expense of the environment
For example, modern equipment & production processes :
safer and less polluting "green" technologies
4. ENVIRONMENT

19. United States - Standards for Reformulated and Conventional Gasoline
• 1990 Clean Air Act, the Environmental Protection
Agency (EPA) promulgated the Gasoline Rule:
pollution from thecombustion of gasoline did not
exceed 1990 levels
• ("reformulated gasoline") vs ("conventional gasoline")
• "individual baseline“ vs "statutory baseline"
• Venezuela and Brazil claimed that the Gasoline
Rule was prejudicial to their exports to the
United States and that it favoured domestic
producers
• The panel agreed with the parties that a policy to reduce air pollution resulting from the
consumption of gasoline was a policy concerning the protection of human, animal and plant life or
health mentioned
• However, the panel found that the baseline establishment methods were not "necessary“
• The panel concluded that the Gasoline Rule could not be justified

20. • january 1995, the Committee on Trade and
Environment was established.
• CTE has brought environmental and sustainable
development issues into the mainstream of WTO
work.
The WTO Committee on Trade and
Environment ("the CTE")

21. • MEAs establish shared environmental goals for those
countries that ratify the agreements, and create policy
guidelines for national policy development and
implementation to achieve the goals
e.g.
• ozone depletion
• transport of hazardous waste.
• over 200 MEAs currently in force,
• over 20 contain trade provisions
Multilateral Environmental Agreements (MEAs)

22. WTO recommended Measures to make the drug more
affordable
• Price controls to restrict manufacturers' selling prices
• price negotiation for high volume or pooled purchasing
• reduced import duties and national or local sales taxes
• reduced distribution, dispensing and marketing costs
• promoting competition through generic products
• use of TRIPS safeguards, parallel imports and compulsory
licensing
5. ACCESS TO DRUGS AND VACCINES

23. • Swaziland :US$45 (ITN price)
• Sudan :US$30 (ITN price)
• putting them out of reach of most Africans.
• Utilization rates 10-30% overall, and cost is a major constraint.
Tanzania, 'malaria tax; in 1999:
first African country to, it
reduced the total
of taxes and tariff duty to 5 %
making mosquito nets US$3.50
Uganda ends "malaria taxes"
In its June 2000 budget, Uganda
eliminated taxes and import
tariffs on mosquito nets
and insecticides used to fight
malaria
Africa aginst
Malaria

24. • While the importance of patent protection is providing
incentives for R&D into pharmaceuticals is widely accepted
• Examples of internationally sponsored public/private
partnerships to address these problems are the Medicines for
Malaria Venture (MMV) and the International AIDS Vaccine
Initiative (IAVI).
Patent protection provides incentives for R&D
into new drugs

25. TRIPS Agreement contains public health safeguards
Making generic drugs available upon patent expiration
Canada - Patent protection of pharmaceutical products,
complaint by the European Communities
• In late 1997,EC : Canada's laws did not provide
adequate protection of patented pharmaceutical
inventions by allowing domestic generic
pharmaceutical makers to conduct tests and carry
out other preparations for producing a drug before a
patent expired
• stockpile generic drugs six months before a drug's
patent expires

26. • found that stockpiling of generic products was not
permitted under TRIPS
• manufacturers must wait until patent expiry before
starting commercial production.
• "Generic drug manufactures note that the ruling would
result in only modest production delays for generic
drugs, but goes a long way to protect consumer
interests by cutting time-to-market for generic drugs by
as much as 2-3years"

27. Compulsory licensing (and government use)
• Compulsory licensing enables a competent government
authority to license the use of an invention to a third party or
government agency without the consent of the patent-
holder.
• upon implying that some form of national emergencies or
other circumstances of extreme urgency
• Each Member has the right to determine what constitutes a
national emergency or other circumstances of extreme
urgency and that public health crises; relating to HIV/AIDS,
tuberculosis, malaria and other epidemics, can represent
such circumstances

28. Parallel imports
• Parallel imports enable a country to take advantage of
products which the right holder has put on the market in
another country at a lower price.
• cannot be raised as a dispute in the WTO unless
fundamental principles of non-discrimination are involved

29. 6. HEALTH SERVICES
mode 1 mode 2 mode 3 mode 4
Cross-border
supply of
health
services
• tele-health
Consumption
of health
services
abroad
• Medical
tourism
Commercial
Presence
• private sector
in health
services
• health
insurance ,
• foreign
investment
• joint ventures
Movement of natural
persons
• If foreign health workers
are seen as a desirable way
to alleviate health
professional shortages
and/or attract new
expertise and skills,
countries might undertake
GATS commitments under
this mode.

30. Food aid
• Under WTO rules, food aid is exempted from export subsidy
reduction commitments
• The new Convention came into effect on 1 July 1999. donors to
give full technical and financial assistance to least-developed and
net-food importing developing countries to improve their
agricultural productivity and infrastructure
• preventing developed countries from taxing their food exports
when prices are high.
7. FOOD SECURITY AND NUTRITION

31. if patents are given to genetically modified proteins or DNA that are key active
ingredients in new vaccines, it could lead to significant price increases
8. EMERGING ISSUES
Biotechnology Information
Technology
Traditional medicine knowledge
• patents for the production process
• Food security and safety an Inter-Agency Network for
Safety in Biotechnology (IANB) was formed in 1999 to
share information and to promote co-operation
amongst inter governmental agencies
• The Cartagena Biosafety Protocol :LMOs must seek
advance informed agreement from the importing
country & exporter risk assessment
Since 1998, WTO
members not
imposing customs
duties on electronic
transmissions
Protection of traditional knowledge
either through existing forms of
intellectual
property rights or other laws or through
a sui generis form of protection

32. CONCLUSION
• The Safety of imported fish during a cholera outbreak,EC hormone ban
concerning meat and meat products Thai Cigarette Case settlement
and continued free trade possible due to WTO DSB
• The commendable initiative taken by Uganda and Tanzania to make
ITN affordable was possible due to regulating tax import duties.
• WTO coherence with WHO & FAO,UN formed regulations like
FCTC,"the CTE“, MEAs, The Cartagena Biosafety Protocol , IANB came in
to existence.

33. “Protectionism does not produce wealth,
free trade and economic openness are
ultimately in everyone's interest”
……Thomas Piketty, French Economist

34. THANK
YOU