License to sign

Let's talk about tuberculosis. The first effective therapy for TB, streptomycin, was developed in 1944. Today, TB is a preventable and curable disease, and yet the World Health Organization estimates that it kills up to 5000 people every day. In 2004, 80 percent of the 9 million new TB cases were concentrated in 22 countries, mostly in Africa and Asia.

Or we can talk about HIV/AIDS. The first drug to treat AIDS, AZT (zidovudine), was approved by the FDA in 1987. Since then, a host of antiretroviral agents (ARVs) have significantly improved the survival rate and health outcomes for persons living with HIV in the United States. Yet, in 2006, out of the 39.5 million people living with HIV, 24.7 million of them lived in sub-Saharan Africa, and as of June 2006, a little more than 1.6 million people living with HIV were receiving ARV therapy in low and middle income countries.

You get the point: At the end of a long list of infectious diseases that are preventable, treatable and in many cases curable, there remains a fundamental series of questions that demand intelligent answers. Why are people at this very moment dying of diseases that we are well prepared to treat? Why do global health disparities still exist and whose responsibility is it to eliminate them?

In the age of neoliberalism and free market capitalism, a few answers come to mind. The modern pharmaceutical establishment in the developed world functions as a multi-billion dollar industry that produces many of the life-saving treatments we currently have. However, pharmaceutical research and development is fueled by the ability to generate profits from drugs developed for and sold to wealthy citizens of wealthy nations. Ironically, those who can not afford these medicines are often the ones who need them the most. This has led to devastating inequality in access to life.

For those who believe that health care is a basic human right, restricting access to life-saving medication is unacceptable. Luckily, we as students and faculty at a major American research institution are in a unique position to reject and revolutionize these policies. American universities have long been important in the early stages of the development of life-saving medication. The active ingredients in the drugs that are marketed by pharmaceutical companies are often developed by university-employed scientists. These innovations are then patented and licensed out by the university to pharmaceutical companies who continue to develop the drugs. Unfortunately, the university is pressured to license these medicines on the financial terms of profit-driven companies that are not rewarded for providing for the poor.

Take, for example, the case of Yale University and the HIV drug d4T or stavudine. D4T was invented by a Yale professor and was originally licensed exclusively to Bristol-Meyers Squibb. In February 2001, Doctors Without Borders requested Yale's permission to use a generic version of d4T in South Africa. Yale initially refused to consider the proposal. However, this position quickly elicited protest from a group of outraged Yale Law School students, who believed that a university's humanitarian goals should outweigh any immediate financial earnings. Under intense student pressure, Yale eventually conceded in negotiating with Bristol-Meyers for emergency patent relief and price cuts on the drug throughout Africa.

More recent advances at universities throughout the country have resulted in the public release of a document entitled "In the Public Interest: Nine Points to Consider in Licensing University Technology." Developed by eleven top U.S. research universities and the Association of American Medical Colleges, the document openly commits to policy changes that would make university inventions more widely available in developing nations.

Unfortunately, our own University is not among the signatories. As one of the top research institutions in the country, Duke has incredible potential to contribute to this ever-growing movement of increased access to essential medicines and health technology. As students and faculty, it is our responsibility to ensure that Duke achieves its humanitarian goals by ensuring global access to its innovations. To do this, we must raise our voice and encourage the University to document publicly its commitment to equitable access licensing around the world. Once we have openly rejected exploitative licensing policies we can begin to consider ourselves a global, humanitarian institution.