Global health. The current scenario and future perspectives

267 World Health Assembly in 1999. Here it was stated that the WHO should analyze and inform member states about public health problems related to international trade agreements as public health interests prevail when formulating pharmaceuticals policies and healthcare policies (WHO, 1999). Finally, as a result of actions like the South African amendment followed by Brazil’s threat to implement compulsory licenses for the delivery of antiretrovirals to HIV patients in 2001, the proposal by the African Group to include discussion on access to medicines in TRIPS Council Agenda and a specific request from Zimbabwe to WTO for issuing a special declaration on Public Health supported by WHO (WTO, 2001b) at the 4 th WTO Ministerial Conference held in Doha, Qatar (2001), apart from main agreements (WTO, 2001a) a specific agreement was established for Public Health: The Declaration on the TRIPS Agreement and Public Health (WTO, n. d.). Although it did not incorporate new topics or flexibilities, it basically marked a before and after in terms of security given to States to use these flexibilities in health matters and it has served as a tool to curb pressures and accusations of illegality from industry without any foundation. The declaration states that TRIPS should not prevent members from adopting measures to protect public health but that it should support the right of States to protect public health and particularly promote access to medicines for all people (WTO, 2001a). It recognizes the right of granting compulsory licenses and the freedom to determine conditions under which such licenses are granted. Each country has the right to determine what constitutes a national emergency or other circumstances of extreme urgency with the understanding that public health crises can represent national emergencies or other circumstances of extreme urgency (Correa, 2002). This healthcare tool within international trade was developed with certain difficulties while public health needs still exist. A few successful examples of implementing compulsory licenses are Malaysia, Indonesia, Mozambique, Zimbabwe, Zambia, Eritrea and Thailand. In our region, we only have Brazil in 2007 and Ecuador in 2010. However, implementation has not been easy as we saw during the Canada-Rwanda process which lasted about five years (Correa, 2002). Many factors can influence the success of implementing compulsory licensing such as political will, lack of knowledge, fear among responsible government officials, industry pressure, threats from developed countries, incorporation of the tool into national legislation, development of regulations and the functions and powers of different institutions in economic or health areas and their relationship with each other.