The Right to Health and Access
to Medicines
Anand Grover
United Nations Special Rapporteur on
the Right to Health
Geneva, 11th October 2010
ACCESS TO MEDICINES AND THE RIGHT TO
HEALTH
 Nearly
two billion (1/3 of the world’s population)
people lack access to essential medicines. [“WHO
Medicines Strategy: Countries at the Core, 20042007”, (2004)].
 Unlike in high income countries, in low and middle
income countries about 50% to 90% of the cost of
medicines are paid by the patient out of pocket.
ACCESS TO MEDICINES AND THE RIGHT TO
 The median coverage of HEALTH
health insurance is 35% in Latin
America, 10% in Asia, and less than 8% in Africa. As a result,
cost of medicines is one of the key
 Many factors affect access to medicines. In low and middle
income countries, medicines account for 20-60% of the
healthcare cost. [The World Medicines Situation, WHO,
2004]. [“Equitable Access to Essential Medicines: A Framework
for Collective Action”, No. 8, WHO, 2004]
 In the case of HIV, it is presently estimated that around 15
million people living with HIV (PLHIV) need ARV treatment
(based on the revised WHO Guidelines). However, as of the
end of 2009, only 5.2 million PLHIV were receiving treatment.
ACCESS TO MEDICINES AND THE RIGHT TO
HEALTH

Recently published studies show that many people would be
pushed into poverty on account of the prices of medicines, in
particular branded medicines as they usually cost much more
than their generic counterparts. [Niëns LM, et al, “Quantifying the
Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the
Affordability of Medicines in the Developing World”, PLoS Med 7(8) e1000333 (2010)]

The world post-TRIPS continues to experience great problems
with respect to access to medicines as the above numbers
make clear. TRIPS is still very much an impediment to
increased access, however many new access-limiting
instruments should be of concern to advocates.
ICESCR – Article 12
1. The States Parties to the present Covenant recognize the right
of everyone to the enjoyment of the highest attainable
standard of physical and mental health.
2. The steps to be taken by the States Parties to the present
Covenant to achieve the full realization of this right shall
include those necessary for:
• (a) The provision for the reduction of the stillbirth-rate and of
infant mortality and for the healthy development of the child;
• (b) The improvement of all aspects of environmental and
industrial hygiene;
• (c) The prevention, treatment and control of epidemic,
endemic, occupational and other diseases;
• (d) The creation of conditions which would assure to all
medical service and medical attention in the event of
sickness.
• Access to medicines is an integral part of the right to health.
Core obligation of the right to health. (General Comment 14)
Human rights inextricably linked
• Traditionally, Civil and Political Rights are
immediately enforceable
• Economic, Social And Cultural Rights are
progressively realizable  not enforceable
immediately
• Domestic courts in Latin America, Southern Africa
and South Asia have abolished that distinction
• Progressive realization implies
–
–
–
–
Non-retrogression
Bench marks
Monitoring; and
Acc0untability
ACCESS TO MEDICINES AND THE RIGHT TO
HEALTH
1. AAAQ (Availability, Accessibility,
Acceptability, Quality)
1. Respect, Protect and Fulfill
2. Equality and Non-discrimination: Gender
perspective, women,
children/adolescents; marginalized
groups
ACCESS TO MEDICINES: BARRIERS
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IPR issues
Inability of States to use TRIPS flexibilities
Pressure to introduce TRIPS plus measures:
India – EU FTA
Anti-counterfeiting
Border measures
Investment
Drug
regulations
Palliative
care
drug/controlled meds
Reduction of Funding
Lack of technology transfer