Thank you, Mr. Chairman, and good morning.
I'm an anglophone, so I'll speak in English, but I would be more than happy to answer your questions in French.
I'm a professor in the faculties of medicine and law and the Canada research chair for population health and global development policy at the University of Ottawa.
I began my research on access to medicines over a decade ago while employed at Harvard, Yale, and Chatham House in London. I've published on the subject in The Lancet and in the Canadian Medical Association Journal. In full disclosure, I am or have been on the editorial teams of both those medical journals. I've also been unusually privileged to serve on all sides of this debate as a consultant. I have served Médecins Sans Frontières as a consultant at one time and I've served developing country governments such as Brazil and Malawi. I've served drug companies such as Novartis and international organizations like the World Health Organization and the World Bank.
I thank you for calling on me to discuss Bill C-393, and as I sit here I know all of you, all members, all political parties approach this bill with good intentions. This is clear. And you have hopes and prayers that will help the world's poor. This is clear. It is therefore my unhappy job to tell you why I think the bill will probably have zero results for public health and would likely even do harm. Please let me explain.
When CAMR was enacted in 2005, its raison d'être was to make it possible for poor countries to buy cheaper generic medicines manufactured in Canada. To make this possible, CAMR authorized patent overrides of a kind called compulsory licences, and Parliament believed that by overriding patents in cases of acute humanitarian urgency like malaria, like AIDS, poor countries would beat a path to Canada's door for those medicines.
However, as you know, it hasn't worked out that way. Everyone agrees that CAMR has been a one-shot wonder, and only a single country, as Rachel correctly said, Rwanda, bought medicines under CAMR from a Canadian company, Apotex. As Apotex's own spokesperson, Elie Betito, said to the Ottawa Citizen, “We will not be doing this again.” Everyone agrees, this law is a failure.
Well, how come? In a correct diagnosis, CAMR has failed for economic and not legal reasons. The causes of failure are not in the statute of CAMR, which Bill C-393 could amend, but in reality the causes of failure are in global medicine markets, which no conceivable bill can affect. Rachel's correct about this. I'm sorry to say so, but Parliament simply is powerless to make this law work.
Here's the basic problem: for CAMR to succeed and achieve regular exports of Canadian generic medicines to poor countries, it's necessary for those Canadian generic medicines to be priced competitively compared to other generics on the global market. If Canadian generics cost more than foreign generics, poor countries will buy foreign generics, as well they should: that's how free trade works.
Canadian generics, though, and this is unfortunate, are among the most expensive in the world. And let me share with you some data from the federal government's Patented Medicine Prices Review Board. In 2006 this federal agency compared generic medicine prices in Canada and abroad and it found that compared to Canada generics cost 35% less in America, 51% less in Finland, and a whopping 77% less in New Zealand. Now, I emphasize that these are not industry-sponsored data. They are not activist-sponsored data. They are federal government data of a federal government agency and are trustworthy. What they show is that Canadian generics are among the most expensive in the world, and certainly the most expensive in that study. And as you might guess, overpriced medicines don't sell.
So put yourself in the shoes of an African health minister. Why use CAMR to buy generics from Canada when you can buy generics from America, Europe, India, China, New Zealand, and what have you, for less? This economic reality makes it puzzling why certain AIDS activists insist on supplying the world's poor with Canadian medicines manufactured under CAMR. It's patriotic of them. It's definitely well-meaning of them, I don't wish to take that away; it is well-meaning, but it's also naive.
By selling poor countries more expensive Canadian medicines, the corollary is that fewer patients could be treated on a given budget. It could do harm.
Knowing this, the activists support Bill C-393's amendments to amend the Food and Drugs Act and remove generics produced under CAMR from Health Canada's regulations. That aspect of Bill C-393 is, frankly, terrifying. For activists to champion the deregulation of life and death medicines to save a buck, it is not simply vertiginously irresponsible, it's also medically unethical.
If I may have one minute, I'll wrap up.
In closing, my advice is to forget about Bill C-393 and accept the present reality that including Canada, as elsewhere, there are about 30 countries with such laws. Laws such as CAMR don't work.
This is not to say the House should cease caring about public health in poor countries--far from it. Please maintain your interest, but take the energies, the very good, well-intentioned energies you and others have, that are now absorbed in the sinkhole of CAMR and direct them to reforms of other kinds.
Fix the fact that CIDA is a sclerotic agency. Fix the fact that one-third to one-half of malaria medicines, like I'm holding here, are fakes, are counterfeits in developing countries. They kill children. Stop exporting asbestos. These are things Canadians can do that will save lives. Bill C-393 I don't believe will.