Industry Committee on April 18th, 2007

[Robert Fox, Executive Director, Oxfam Canada]

It's a pleasure to be here with you this afternoon. As you know, I'm the executive director of Oxfam Canada. Oxfam is very much involved in the work in southern Africa and around the world on these issues, both on the front lines in working day-to-day with creative, courageous people who are taking on these struggles, but also in global fora at the WTO, in the United Nations, and before this Parliament. We have appeared before you on this issue in the past.

I was in Zimbabwe the week before last and had an opportunity to meet with a range of people there who are dealing with these issues as part of their lives and, in some instances, as part of their looming deaths. Nothing focuses the mind like sitting in a cardboard space with someone who is withering before you, and then walking out and meeting someone you met six months ago when you were last in southern Africa who was in that same situation, and she is now one of the community organizers, one of the health promoters who is out there and is vital, active, and a leader in her community, is looking after her children, and is trying to make a living in Zimbabwe—which is not easy, but that's a whole other story for the moment—because she has now finally had access to ARVs. We talk about the Lazarus effect, but when you see it, it is absolutely incredible and it is absolutely compelling. That's the sort of issue we need to deal with.

This isn't only around HIV/AIDS. We recognize that there are increasing numbers of millions of people in developing countries for whom cancer is a real risk. The projected number of people with diabetes, for example, is supposed to increase from 30 million to 330 million in the next number of years.

This question of affordability of drugs is absolutely critical for all of us. There is no question that there are serious barriers that we have an obligation to overcome. The world bought into that. That's what the declaration in Doha was all about, but we have allowed the world's intent to be thwarted by corporate profits and the interests that back them.

When we look at what is happening right now at the global level in terms of the role of the United States government most particularly, the U.S. is being very aggressive in negotiating bilateral trade agreements and regional trade agreements that are actually TRIPS-plus. They're actually making it more difficult for people to access the drugs they need, not easier, and they're creating ever more barriers to affordable health care.

We look at the role of big pharma and we look at the rhetoric of big pharma. They talk about how much they need to invest in R and D. Let's face it. Only 14% of their revenues are invested in R and D, as opposed to 32% in administration and marketing. When we talk about their commitment to the south, of the 1,556 drugs that they have sought patent protection for in the last number of years—I have forgotten the number, but I'll find it for you, because it's in our brief—only 21 deal with diseases that are typical to the south, like malaria or bilharzia. These are the sorts of issues that are actually life-and-death not for those who consume designer drugs in the north, but for those who are living on less than a dollar per day in the south.

Yet big pharma has the nerve to be very aggressive in taking on countries in the south that are trying to assure access to drugs in the south. Novartis has the nerve to be taking the Government of India to court right now to indicate that it has to strike from its books legislation that will allow it to produce a cancer drug that would mean the difference between millions of people in India and around the world having access to treatment and not having it.

In Canada, of course, they didn't try bullying. Instead, they tried lobbying, but they were equally successful. We've tied our regime into so many knots of red tape that our capacity to break through this has in fact been completely stymied. Yet again, the will of Parliament and the will of Canadians has been thwarted by legislation that is far too timid and far too deferential to issues that have nothing to do with humanity, nothing to do with human rights, and nothing to do with getting people access to health care, and everything to do with protecting privilege and protecting profit.

When we look at what's on the agenda of the G8 summit in June, for example—the G8 summit that's supposed to return to the question of Africa—we look at the section of the draft agreements, because these things are all cooked up months in advance, as you know. The section of the accord at the G8 summit that deals with intellectual property is all about piracy. It's all about tightening the screws. It's all about ensuring that no one anywhere, under any circumstances, can more equitably and cheaply produce those drugs, instead of being about how we can in fact turn it around.

If we can take a drug that had been $10,000 per person per year and through generic production produce it for $139 per person per year, that should end the discussion. All of our efforts should be around how we ensure that this drug gets to people who are dying without it.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. Fox.

We will go now to Mr. O'Connor.

[Michael O'Connor, Executive Director, Interagency Coalition on AIDS and Development]

Thank you very much, Mr. Chair, for the opportunity to speak to the committee as you review this legislation.

I am with the Interagency Coalition on AIDS and Development, which is an umbrella group of 150 member agencies: front-line AIDS groups working in Canada, development agencies, professional associations, and labour organizations. I represent ICAD on international bodies like the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations AIDS program.

We had an opportunity to address this committee in 2004. As I look back at my notes, it is really quite interesting to compare some of the things that were brought up. Our concerns at the time are still coming up and need to be spoken about again.

At that time we noted that this was a very important piece of legislation. This is part of a comprehensive Canadian response to a health crisis in the world. As you know, there are three million people dying of AIDS every year, two million dying of TB, and a million dying, unnecessarily, of malaria. That commitment was made by Canadians, through their Parliament, and it was made with the best intentions.

Since 2004, a number of things have changed, which I would like to highlight. There is a bigger political commitment now than there was in 2004. At the G8 meetings in 2005, the world, including Canada, made a commitment that by 2010 everyone who needs access to HIV/AIDS treatment will have it. That was called the universal access commitment. It was bold. It was then reinforced at the United Nations, where all countries in the world endorsed it in June 2006.

There has been a change in terms of the financing, the money that is needed. The Global Fund, which is the main mechanism for disbursing funds for AIDS, TB, and malaria programs, was just getting started in 2004. But funding has been ramped up. The Global Fund has $7.1 billion worth of funding for AIDS, TB and malaria programs in 136 countries. By 2010, they will probably have about $8 billion for funds, the majority of which is going to drugs and other health consumables. The money is there.

That piece of the puzzle needs to be reaffirmed every year. Canada has made a reasonable contribution to the global fund of about 4%, and we are hoping it will continue with that level of commitment.

There was talk of bottlenecks. There is always a concern about bottlenecks, but they are being addressed very aggressively. As you know, at the G8 meeting last year, Prime Minister Harper made a very bold commitment of $450 million over 10 years, which is being spent on strengthening health systems.

This program is being rolled out by CIDA over the next few years. It is the kind of program that will address not only the infrastructure problems that exist in some countries but some of the health professional shortages, by providing enhanced environments and training.

There is a clear need. I think that has been underlined by what Stephen and my colleagues have said. People are going to be on treatment forever. Right now, as Stephen mentioned, there should be five million people on treatment. By 2010, there should be eight million to ten million people on treatment. That means treatment for HIV for life. Bigger numbers will need the second-line treatments.

There is also a need for the complex treatments related to TB. Increasing numbers of people are not able to have treatment with the off-patent TB drugs. We need much more of the fancy drugs that Canada can produce.

In conclusion, I believe the suggestions that the HIV/AIDS Legal Network and the University of Toronto are putting forward concerning fixing this legislation should be taken into consideration.

I am convinced, more than ever, that the legislation is worth fixing. As you look at these things, you wonder if this effort is worth it. Well, it is. You're damn right it is. You are going to save a lot of people's lives. This is an important piece of work that can have an impact not only in the short term, but also in the long term, and I think Canadians can be justifiably proud if it is fixed properly and we make this important step to a comprehensive response.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. O'Connor.

We'll go to Ms. Devine.

[Carol Devine, Access to Essential Medicines Advisor, Doctors Without Borders]

Thank you, Mr. Chair, honourable members, for giving Médecins Sans Frontières the opportunity to appear here today.

I thank you for allowing us to appear before your committee today.

I am here representing MSF as a humanitarian. I'm not an intellectual property lawyer or a patent specialist. I've worked in Rwanda, Sudan, East Timor, and Peru with MSF, and I've witnessed the devastation of AIDS and other untreated infectious diseases firsthand. I've also seen the consequences of monopoly pricing of medicines. I was involved in the early consultations of Bill C-9, or the JCPA, in 2006.

Today MSF is working in 70 countries worldwide, providing independent medical assistance. In 30 of those countries, we're treating 80,000 people with antiretroviral medicines, as well as providing integrated HIV treatment, prevention, and care programs, so we also see firsthand the reality of drug procurement and the need for reliable access to affordable drugs. Every year we're spending many millions of dollars on drug procurement, some of which comes from the $22 million donated by the Canadian public last year.

The Doha declaration on TRIPS and public health by the World Trade Organization in 2001 recognized the problems many countries experience with accessing newer medicines. While Doha clarified countries' rights to take measures to overcome patent barriers to access medicines for all, it left the issue of exporting medicines produced under compulsory licence unresolved, which is what we're discussing today.

When the solution was announced in 2003, MSF and others said that the August 30 decision was too onerous and cumbersome. It was wrapped in red tape. Still, MSF committed to seeing if it could somehow be workable and urged: “Countries must act now to use the Doha Declaration to access the best priced medicines for their populations. The experience they gain by doing so will test the limits of the WTO rules and be invaluable to revising WTO patent rules after Cancun.” And we still have that opportunity.

Laudably, Canada was the first country to try to implement the solution. I worked very closely on this process, urging Canada to set a workable precedent, and many others here today did--and internationally.

My colleague Michael O'Connor mentioned that in February 2004 MSF testified before this committee. We stated that we foresaw that the Canadian bill in its existing state could not work unless fundamental flaws, indeed some fatal limitations beyond what TRIPS required, were removed. Some were removed and some remain.

In good faith, we tried to place a drug order under the Canadian access to medicines regime. We have spent over two years with other stakeholders holding in the Canadian government, trying to make it work. In short, we've liaised with a Canadian generic pharmaceutical company that rather quickly developed a fixed-dose combination--FDC--antiretroviral medicine that at the time did not exist in an approved state. We have received notification from both Health Canada and the World Health Organization that this drug is approved. They've approved the quality of the drug, but not a single developing country has notified the TRIPS of its desire to use this regime.

It's been mentioned by Stephen that it's a drug-by-drug, country-by-country solution with so many bureaucratic hurdles. In the meantime, the same FDC has come out by Indian generic companies. These products have also been pre-qualified by the WHO.

To purchase these products, no additional procedures exist, no notification to the WTO is demanded, and logically, countries are preferring to take this route. Recent developments in Thailand and India illustrate painfully why this is, and we've heard a few points on that already.

So I wish to make two main points.

For the past three years, MSF has tried in earnest to deliver medicines using the Canadian access to medicines regime. Not a single pill has left Canada or any other countries that have implemented the August 30 decision. We've concluded, therefore, that the WTO decision is not expedient and is therefore not a solution, but we also think that it can be changed.

Today, sources of generic medicines still exist in India, but in the years to come these sources will dry up as India starts granting pharmaceutical product patents. At that point it will be crucial that production for export under compulsory licence becomes as easy as it is now.

We urge Canada to implement TRIPS-compliant, workable solutions in Canada--some examples have been given--to improve the legislation and make a better model to the world, and also to remind us here today that it's to take it back to the WTO. We have commitments that we've made to the Canadian public, but we have commitments that we made at Doha as one of the WTO members, this idea of medicines for all that was adopted.

So secondly and lastly, access to medicines is a continued serious daily concern to MSF. People must be prioritized over patents, as in this poster that was referred to earlier, both in the Canadian legislation and at WTO. In our experience, generic competition has been one key way to provide access to medicines for millions. Over 80% of the patients we're treating are on Indian generic medicines, and those medicines risk drying up because of TRIPS compliance and global patenting. Since Doha we've seen that commercial interests are able to trump facilitating access to medicines.

I would just mention to you that we have talked about second-line medicines, and the urgent need for second-line medicines. Canada can play a part in making second-line medicines in pediatric formulations.

We encourage you to take the logical next steps to fulfil your promises.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much, Ms. Devine.

We'll go finally to Mr. Kelsall.

[John Kelsall, President, Health Partners International of Canada]

Thank you, Mr. Chairman, for this opportunity to address the committee about a topic that's very close to my heart.

My name is John Kelsall, and I'm president of Health Partners International of Canada. HPIC is a Canadian non-profit medical aid agency that is having a significant impact by providing needed essential medicines, medical supplies, and vaccines to people in many of the poorest countries of the world.

We are pleased that the Government of Canada is taking a closer look at the workings of the access to medicines regime to help prevent death and alleviate suffering related, in particular, to the shocking effects of the HIV/AIDS pandemic. We unequivocally support the aim of the regime, namely, to get aid to the people who so desperately need it.

Since the International AIDS Conference in Toronto last August, most Canadians have come to know about the HIV/AIDS situation, particularly as it affects sub-Saharan Africa. Many have seen, through the media, the devastation caused by this affliction. Anyone with eyes to see their desperate plight, ears to hear their horrifying stories, and a heart to feel compassion must be moved to help in whatever way they can. I personally have seen the devastation and heard the cries for help.

According to UNAIDS, every minute of every day a child under the age of 15 becomes infected. Ninety percent of the more than five million children who have been infected were born in Africa. In sub-Saharan Africa, women make up 57% of people living with the disease. Three-quarters of young people infected on the continent are young women aged 15 to 24.

We applaud the federal government's commitment to ensure the delivery of affordable essential medicines to help alleviate the suffering. We are also very much aware of the need for ARVs, and that these must be delivered in a coordinated framework that includes patient counselling, home-based care, trained medical professionals, blood testing laboratories, and the consistent supply of ARVs, along with other medicines and medical supplies.

It is our belief that government policy should enable Canadian aid organizations such as ours to be the outstretched hand of Canadians in a way that is both reasonable and responsible. We are aware, however, that this review must resolve practical policy and regulatory issues regarding to whom medicines are sold, and in what conditions. And we trust that people with a heart to do so will find workable and equitable solutions.

The comments that we provided for the review are already on the record. For the purpose of this discussion, l'd just like to highlight our key recommendations.

First, take an integrated approach to dealing with HIV/AIDS. HPIC recommends that the government, as well as aid agencies, industry, and civil institutions, ensure that there is a balance in funding and allocation of other resources to all aspects of the battle against HIV/AIDS, including treatment of opportunistic infections, and other public health initiatives that support HIV/AIDS interventions.

Second, simplify the process as much as possible and ensure that information regarding CAMR is clearly communicated to countries that could benefit. HPIC recommends that the government undertake programs to facilitate access to essential medicines through Canada's access to medicines regime by involving developing countries, especially sub-Saharan Africa, by encouraging use of its provisions, and by making adjustments if necessary.

Third, favour practical solutions of manageable scale. HPIC recommends that the government focus on support of suitable facilities with the supply of ARVs and other appropriate medicines from Canadian sources in order to develop a template for the effective treatment of HIV/AIDS, particularly in sub-Saharan Africa.

Last, protect the anti-diversion provisions of the current regime. HPIC recommends that the government take all reasonable steps to ensure that medicines originating from Canadian sources not be diverted from their intended consignee.

What appears evident to us, Mr. Chairman, is that Canada must better understand the reasons why provisions of the regime have not yet been operationalized. The government would profit from hearing the voices of African governments, for example, that have a major stake in the outcome. Many have acted courageously, against daunting odds, to implement bold national strategies that deal with the shocking prevalence of HIV and AIDS. As well, African nations should be encouraged to explore local manufacturing and procurement options, perhaps with the assistance of the Canadian government.

Canada has a brilliant reputation as a land of compassionate people. But the problems associated with AIDS in Africa are too big for compassion alone. They call for the mobilization of all developed countries and all segments of Canadian society. They call for responsible action.

The Canadian access to medicines regime is only one tool designed to deal with a larger set of issues, and it is not even the most important one. Decisions regarding CAMR, therefore, must be both cautious and courageous. They will require goodwill and ingenuity from all political parties, all segments of the Canadian population, as well as all sectors of industry. We are confident this will occur.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much, Mr. Kelsall.

We'll go right to questions from members. I ask members to be as brief as possible, so we can get to as many other members as we can.

We'll go now to Mr. Byrne, please.

[Gerry Byrne, Liberal, Humber—St. Barbe—Baie Verte, NL]

Thank you very much, panellists. It's been very, very informative.

One of the things I think we need to get further information on as a committee is specific recommendations as to what you would collectively, or individually, envision as changes to the legislation. If possible, if not at this forum, could you submit specific recommendations to the chair.

I know the Canadian HIV/AIDS Legal Network has done so in their presentation. If there's anything further, it would be extremely helpful to us, especially if done in an expeditious fashion. If there are specific things you can put forward right now, they would be very helpful to us.

I would like to follow up on Ms. Perkins' advice. Basically, if I remember correctly, Ms. Perkins, you just suggested we should not request or expect importing countries to contravene their own laws. Is there anything specific being recommended here that would put Canada in contravention of WTO TRIPS requirements and the specific provisions within the waivers they have allocated or granted?

[Sarah Perkins]

No, under the WTO rules, it would be permissible and TRIPS compliant for Canada to permit the exporting manufacturer to obtain a compulsory licence prior to entering into a formal agreement with the importing country. So it is TRIPS compliant and something that Canada could do. In doing so, you would allow foreign governments, particularly governments like Ghana with domestic procurement laws, to respect their laws and enter into these international tender agreements, and have companies here come forward in good faith with a licence in hand to say, we can fill that tender and here's our price.

We can beat others out there. It's possible, and it's TRIPS compliant, and it's probably the way that would work best.

[Gerry Byrne, Liberal, Humber—St. Barbe—Baie Verte, NL]

So that is basically the only expression of concern you would have about the one element that puts it in potential contravention with importing countries' own legal requirements?

[Sarah Perkins]

Yes, that's the one that is the most apparent, and from our perspective and our work with Ghana, it has been the biggest obstacle to accessing this legislation. There seems to be a perception, perhaps amongst generic companies and others, that the African countries are going to come to Canada—perhaps sitting down with a company in a room—to talk about specifically what medicines they need.

From the foreign government perspective, from the Ghanaian perspective, that cannot happen, as it's a violation of their domestic laws. So it has to happen the other way around: our companies here have to approach them with the licence in hand.

[Gerry Byrne, Liberal, Humber—St. Barbe—Baie Verte, NL]

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. Byrne.

We'll go to Monsieur Vincent.

[Robert Vincent, Bloc, Shefford, QC]

Thank you, Mr. Chairman.

I want to thank the witnesses for explaining the whole range of problems they are facing. Has any of you ever provided any medecines or other products to another country, which would have allowed through WTO their introduction somewhere else? Have you received any orders in answer to any offers you would have made through any type of process?

[Carol Devine]

We have been discussing this with one country, and they will not do TRIPS notification. We've also brought this, and MSF's potential interest as an organization procuring a lot of drugs, to the attention of other developing countries, and to our knowledge, they have not done any take-up of the Canadian legislation.

[Robert Vincent, Bloc, Shefford, QC]

How should the legislation be changed to allow you to export drugs to other countries? What would be the best solution to help you export drugs?

[Richard Elliott]

I can speak to that.

Our central recommendation, which I think would help answer your question, and it's something that Ms. Perkins has already mentioned, is to simplify this process by letting the generic manufacturer here in Canada get one compulsory licence at the beginning of the process, before there are any particular contracts negotiated with any particular country or countries. With that legal authorization in hand, the generic manufacturer can then bid through transparent international tendering processes that many developing countries will have. They can negotiate with multiple developing countries on the list of eligible countries and achieve a certain degree of economy of scale, because they can actually negotiate larger-sized contracts, which means they can negotiate with suppliers of active pharmaceutical ingredients to get the prices of producing the pill down even further, and they will not be required to go through the process every single time, for every single drug order from each particular country.

So it's a simple process, and all that would be required is that they would then periodically pay royalties based on the formula that is already found in the legislation, which is actually the single best feature of the Canadian regime. The Canadian regime is not all bad. The royalty provisions for calculating the royalties that are payable is actually, I think, a very good model for the world. It's unfortunate that few other jurisdictions have copied that particular provision. But that would be a much simpler way of doing it, in our view.

To follow up on the question that was posed before about TRIPS compliance and to reiterate what Ms. Perkins has said, in fact it would be consistent with Canada's obligations as a WTO member to legislate that kind of process. It would be a different approach from what is currently in the regime and different from what the 2003 WTO decision contemplates, but that doesn't mean that what that decision contemplates is the only game in town. In fact, that decision said, and WTO members said specifically in that decision, that it was without prejudice to the other kinds of flexibilities that countries have under the patent rules of the WTO.

One of those flexibilities that have not yet been explored, but could be by Canada, is to define limited exceptions to patent rights here in Canada that would permit the kind of process that I've just outlined. It would give you the licence at the beginning, and then let you negotiate the contracts and pay the royalties on an ongoing basis.

[Robert Vincent, Bloc, Shefford, QC]

First, one has to get a license to manufacture the drug. However, I believe the problem is to get contracts from other countries. One may get a license and go through the whole process but what is more important than anything else is to get a contract from another country.

Does the legislation help you to obtain contracts from other countries? Whether you have a license or not, if you cannot qualify, that is a major obstacle. How can you sell it if you don't have a contract? Is it difficult for you to qualify and to get contracts?

[Richard Elliott]

It has in fact proven to be a problem, and that's why we're suggesting the simpler, slightly different process that we've outlined.

As you heard from MSF, despite all of their efforts, because the Canadian legislation requires that there be a tentative contract with a particular country already, and because the process set out at the WTO and in the Canadian legislation requires that the name of a country be disclosed before there's any guarantee that the generic manufacturer can get a licence, there has been a reticence, and unfortunately a fatal reticence, for countries to actually come forward.

We heard Mr. Stephen Lewis say earlier today that there is a history of intimidation here. This is not something to be taken lightly. When we see what the U.S. government has done, when we see the steps that have been taken by the brand name pharmaceutical industry to prevent countries from using compulsory licensing, it's not surprising that developing countries will be reluctant to say yes, we'll sign a contract with you, knowing that what you will then need to do as a generic manufacturer is approach the brand name company in Canada and disclose the fact that we're talking to you, asking for a cheaper medicine, which fact will then get to the U.S. government, who will put pressure on our trade ministry. We have to tell the WTO all of this before we even know whether you're going to get the licence that's going to let you produce the product we're interested in and supply it to us.

This process is backward. It needs to be reversed, and the Canadian legislation could do that if we legislate the kinds of changes that we've proposed to you in our brief.

[The Chair, Conservative, James Rajotte]

Okay, thank you.

We'll go now to Mr. Van Kesteren, please.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Thank you, Mr. Chair, and thank you, everyone, for coming.

This is a very complex file. I hope you appreciate that. We certainly appreciate your coming here.

We heard from the government people yesterday, or two days ago, and they explained their position, the things they're experiencing. We now have the privilege of having you here, and we now are hearing whole new frustrations. We will get a chance to talk to the pharmaceuticals too somewhere along the line.

I think we all realize that Canadians and everybody look at this, and it's a horrible thing to see that the aid is not getting out there. We all really want to come to a solution. It's frustrating for everybody. It has to be frustrating for you. It has to be frustrating for us to be redoing an act now. Mr. Chrétien had a promise to Africa, and this thing is just falling apart. So it's in all our interests, and we really want to find a solution.

I want to talk about CAMR. I think I want to ask Mr. Fox this, from Oxfam. Are you competing with other drug delivery systems used by the Canadian government? Is CAMR competing with other methods we provide to get the money out there, to get the drugs out. Are you competing with others in CAMR?

[Robert Fox]

I would say no. That is to say, there are parallel dynamics here.

First are the various avenues the Canadian government has and the Canadian people have to provide support to people to access drugs. CIDA has funding. We provide funding to support programs of WHO. We provide funding to support various other multilateral channels.

Then the question is how much people are paying for the drugs that are being delivered through those channels. These intersect in terms of their consequence, but they're two different dynamics. What CAMR is doing is affecting the price people are paying for drugs produced in Canada. And because it isn't working, Canadian suppliers are only supplying high-cost drugs to those systems, and as a consequence, they aren't the producers of choice, because there are other countries--Brazil and India, in particular, but others--that are actually meeting the need.

So if you had a million dollars of aid money to spend on drugs, you would not go to one of the brand name drug manufacturers to buy those things. Right? And that's the situation we are in. It isn't that they're completely unrelated, but CAMR is not about avenues for delivering drugs or the effectiveness of delivering drugs; it's about how much we're spending in order to access those drugs.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

I don't have much time, so I'll go quickly. Are any of you promoting CAMR in Africa, specifically?

[Carol Devine]

I mentioned that when Canada announced that it would be the first to implement the legislation, immediately we spoke with our colleagues. As I said, we are in many countries. We decided that we would try to use it, for a couple reasons: first, to see if it's workable, and second.... We don't think Canada is going to solve the access to medicine crisis, but it can contribute. We've seen the effect of generic competition, so another generic is excellent.

We thought Canada could also play a part, as I mentioned, with second-line medicines, with innovation, with new medicines, and with pediatric formulations. So we did see a role for Canada. We spoke about it internationally in our programs. We had a lot of endorsement from our field teams working in these 30 countries.

I think it's so important to reiterate that the changes that can be made can make it less complex and can make it work. But the way it is now, no country wants to take it up. If it's simplified and if it really follows the WTO paragraph 6 idea to allow generic competition, to allow export of generic medicine to developing countries, this can really contribute.

You speak about competition. Well, India right now, we know, is producing many of the generics, but that's at risk. So we need more solutions, and Canada can be in that.