American Multinationals in Control:
Power Relations between Competing Stakeholders in the American
Pharmaceutical Intellectual Property Rights Debate
I hereby declare that this thesis is my own work and my own effort and that it has not been accepted anywhere else for the award of any other degree or diploma. When sources of information have been used, they have been acknowledged.
Student Name: Kitty Maria Verduin Student Number: S1698311
Professor: Dr. H.H.Voogsgeerd
Course: Master Thesis
Table of Contents
List of Abbreviations 3
Introduction 4
Chapter 1: Theoretical Framework 9
1.1 Fuchs’ Notion of Power 9
1.2 Framing 11
1.3 Political Discourse Analysis 12
Chapter 2: Intellectual Property Rights 16
2.1 America’s Quest for Intellectual Property Rights 16 2.2 The Agreement on Trade Related Aspects of Intellectual Property 21 2.2.1 General Agreement on Tariffs and Trade & World Trade Organization 21
2.2.2 Features of the TRIPS Agreement 24
2.2.3 Intellectual Property Protection and Enforcement 26
2.3 The Debate in the Pharmaceutical Sector 30
Chapter 3: Power Relations among Stakeholders 35
3.1 Multinational Corporations: Pharmaceutical Research and Manufactures of
America 35
3.2 Non-Governmental Organizations 40
3.2.1 United Lobby 40
3.2.2 Consumer Project on Technology 44
3.2.3 Health Action International 47
3.2.4 Médecins Sans Frontières 49
3.2.5 Oxfam International 53
Chapter 4: American Government as Arena 58
4.1 The Clinton Administration: 1995 - 2001 59
4.2 The Bush Administration: 2001-2004 64
Chapter 5: Conclusion 67
List of Abbreviations
ACTN Advisory Committee for Trade Negotiations CPT Consumer Project on Technology
GATT General Agreement on Tariffs and Trade GDP Gross Domestic Product
HAI Health Action International
IACC International Anti-Counterfeiting Coalition IIPA International Intellectual Property Alliance IPC Intellectual Property Committee
IPEC Intellectual Property Enforcement Coordinator IPRs intellectual property rights
ITO International Trade Organization MNC Multinational Corporation
MSF Médecins Sans Frontières NGO nongovernmental organization PCT Patent Cooperation Treaty PDA political discourse analysis
PhRMA Pharmaceutical Research and Manufactures of America R&D Research and Development
TRIPS Agreement on Trade-Related Intellectual Property Rights
US United States
USPTO United States Patent and Trademark Office USTR United States Trade Representative
WIPO World Intellectual Property Organization WHO World Health Organization
Introduction
“Patents = Profits = Research = Cure” versus “Copy = Life” (Sell and Prakash, 2004, p. 153). These normative slogans stand at the center of one of the most controversial and important political economy debates. This debate is the result of increased attention to intellectual property and its rights in the pharmaceutical sector due to changes in the structure of the world economy. Since the 1980s, this structure has changed and is still subjected to change as globalization is progressing. The increasing interconnectedness of countries and the intensification of selling commodities around the globe caused global trade to become more liberalized. International institutions have followed this shift and adapted to it. Consequently, integration of the global economy advanced (Hoekman and Kostecki, 2012). Since the global economy was extensively altered, the framework of the supervising organization, the General Agreement on Tariffs and Trade (GATT), was in need of change as well. The GATT was established in 1947, but the framework and its covering areas were no longer sufficient. As a result, on January 1, 1995 the World Trade Organization (WTO) replaced the GATT (Hoekman and Kostecki, 2012). The WTO covers areas beyond the framework of the GATT, as during the path to the establishment of the WTO an increase of attention arose to the role of intellectual property and the protection of its rights on a global stage. During the process of establishing the WTO, developed countries felt the need to create an agreement based on the protection of intellectual property rights (IPRs) now that liberalized trade in goods and services was expanding on a global scale. This development resulted in the active lobbying of the United States (US) for stricter enforcement of the IPRs in the 1980s. The lobbying resulted in the establishment of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which is administered by the WTO. The TRIPS agreement offers minimum standards on the protection of IPRs, which are equally applied to all the member states of the WTO. Throughout different conventions and negotiating rounds, the standards for the protection of IPRs have been determined. These standards are diverse, as for instance the Paris Convention sets the standards on patents and the Berne Convention covers the standards on copyrights (Hoekman and Kostecki, 2012).1 One of the main aims of the TRIPS
1 The Paris Convention was held in 1883 and the Berne Convention in 1886
agreement is to create an international trading system that is not subjective to distortions and impediments (World Trade Organization [WTO], 1994). Thus, the TRIPS agreement is supposed to contribute to growth of the global economy.
(MSF) and the Consumer Project on Technology (CPT). Besides the united lobby of these NGOs they also lobbied individualistic, where they also found support of Oxfam International. Through the debate these different groups have framed their view on IPRs and the consequences for the pharmaceutical sector. Ultimately, the debate is important, since the ‘winner’ of the debate has proven to have the political power to persuade the government of the US to follow their line of thought and reasoning. Consequently, this means that the ‘winner’ is determining the policy on IPRs in the pharmaceutical sector in the US as well as on a global stage through for instance the WTO.
of US medication that could be sold for a lower price. Therefore, they have framed their position in the debate as “Copy = Life” (Sell and Prakash, 2004, p. 153).
A question still remains: what is the role of the American government in this debate? This is an important question, since the government of the US is influential as it has the power to implement national legislation and can also lobby for implementation of international regulations. Official committees on intellectual property, such as Intellectual Property Committee (IPC) and Advisory Committee for Trade Negotiations (ACTN), advise the government. These committees are in practice Public-Private Partnerships, as CEOs of mayor American corporations are part of these committees.2 Therefore, the question becomes: is the American government an arena where the debate will be determined or are they biased and take a stance? Through answering this question the political power of the stakeholders will become clear. The extent of the power will also become evident by analyzing the political stance of the government on intellectual property policies after the establishment of WTO and the TRIPS Agreement.
In this research the political discourse of the different influential stakeholders will be analyzed in order to study and determine which actor is most influential in framing the debate. In order to determine who the most powerful stakeholder is, it is important to analyze how power relations frame the debate on the enforcement of IPR, as well as how political discourse is being used. Hence, this research will be set against the background of Doris Fuchs’ (2005) notion of power, as the aim of this research is to determine the discursive power of the different stakeholders in order to see which actor is the most successful in framing the debate to their wishes, ideas and interests. Furthermore, Teun van Dijk’s (1997) analysis of political discourse will offer the guidelines through which the most influential actor will be determined. After the implementation of the TRIPS agreement the consequences for global health became noticeable, which in turn caused American NGOs to start their lobby (Sell and Prakash, 2004). Therefore, this research is limited in time, as it will start with analyzing the stakeholders after 1995 until 2004. As this research will focus on the debate in the US and will determine the power of the stakeholders in the debate along
2 Public-Private Partnerships are arrangements between the public and private sector.
The public sector holds certain responsibilities in such an arrangement, but through the partnership these responsibilities are administered by the private sector.
the way, the main question of this research is: ‘To what extent are the different American MNCs and NGOs stakeholders influential in framing the pharmaceutical intellectual property protection debate in the United States between the years 1995 and 2004?’
Chapter 1: Theoretical Framework 1.1 Fuchs’ Notion of Power
Every political actor has a certain amount of power through which it hopes to achieve certain outcomes in a political process. The greater the ability to successfully achieve these goals, the more power an actor has. These actors can be governmental as well as nongovernmental actors. Fuchs (2005) improved the understanding of this political power in her work: ‘Commanding Heights? The Strength and Fragility of Business Power in Global Politics’. She divided the political power of an actor into three different types of power: instrumental, structural and discursive (Fuchs, 2005). The understanding and assessing of the different types of power is key in order to determine the general power of an actor in a political process or debate.
In order to assess the first power Fuchs describes, the instrumental power of an actor, it is important to analyze the output side of the political process.3 This type of power focuses on the ability of an actor to influence other actor’s decision-making options. Actively lobbying and the ability to greatly finance campaigns to publicize the actor’s preferred outcome are tools that are being used by actors to enhance their instrumental power (Fuchs, 2005). Fuchs describes this type of power as “the notion of ‘A’s power over B’” (Fuchs, 2005, p. 774). The actor’s instrumental power can be increased when its resources, in terms of financial, organization and human resources are increased as well as by increasing the access to decision-makers (Fuchs, 2005).
The second type of power that Fuchs distinguishes is structural power. This power lies at the input side of the political process. It focuses on the behavioral options of actors and on the influence one actor has on the other actors. Actors influence through the use of existing material structures that assign indirect and direct power on decision-making (Fuchs, 2005). The indirect power takes the form of agenda-setting power, whereas the direct power is described as rule-setting power. In the case of agenda-setting power, this means that actors can pose the question why a certain issue has never reached the agenda in the hope that it will reach the agenda in the future (Porter and Ronit, 2010). Thus, the wish and attempt to bring a certain issue
3 The output side of a political process focuses on deriving legitimacy from the
to the agenda is key in agenda-setting power. By influencing the agenda, the actor is influence the to be discussed topic. An actor can also affect other actors through rule-setting power. Actors can adopt, implement and also enforce quasi-binding rules through the access to and control over fundamental networks and essential resources (Porter and Ronit, 2010). Since this actor also has the capacity to enforce these ‘new’ rules, other actors will have to follow these. This gives the implementing actor the direct power to influence and manage the other actors. In practice this means that, for instance, a MNC creates and adopts a best practice and this best practices results in becoming the standard for the entire branch in which the MNC operates.
Discursive power is the last type of power Fuchs describes. Fuchs describes that instrumental and structural power are lacking a dimension, as the analysis of those powers is neglecting “the systemic sources of power that pre-exist decisions and non-decisions by actors” (Porter and Ronit, 2010, p. 67). Therefore, there is a need for a third type of power, one that “adds a sociological perspective to the analysis of power” (Porter and Ronit 2010, p. 67). This type of power is called discursive power. Discursive power is derived from ideas and norms. It can be found in the used language of an actor. When an actor uses discursive power, it connects norms, values and ideas to the discourse that are being used in a public political debate. Therefore, actors try to shape the ideas and norms of other actors or the public by the use of a certain discourse (Fuchs, 2005). Thus, discursive power has the ability to influence the way in which another actor perceives the discussed policy, political process or debate.
enhance itself. This happens through the shaping of the fundamental norms of social organizations by using discourse (Fuchs, 2005). Not only can the different types of power enhance each other, they can also decrease each other. A decrease in discursive power can result in a decrease of structural and instrumental power, which consequently harms the legitimacy of the actor (Fuchs, 2005). Although the different types of power enforce each other and are most powerful together, this research will focus mostly on the discursive power relations between the different actors within the intellectual property debate. The ideas and interests of the stakeholders will be analyzed in order to determine which actor is most influential within the intellectual property debate and has been able to influence the policy makers to choose their preferred outcome.
1.2 Framing
In order to determine the discursive power of the stakeholders it is important to discuss the concept of framing in more detail. Framing is closely related to the discursive power of an actor. By using a certain type of language for their discursive power they are framing the perception of their message to other actors and/or to the public. Susan Sell (2004) describes the concept of framing by an actor as an actor who wants to “persuade others to redefine their interests, and inject normative commitments that shape prescriptions and seek to persuade others that ‘compliance is morally right’” (p. 336). In other words, framing is used to inform and suggest alternative methods and approaches to other actors who do not share the viewpoint of the actor using framing (McAdam, McCarthy and Zald, 1996). Thus, through the use of framing an actor wants to change the behavior and interests of others to consequently convince them of the viewpoint of the framing actor.
can be traced through the used language. The political discourse used by an actor to achieve a certain outcome by framing an issue is also important, as this links framing to discursive power. Through using political discourse as a method, the discursive power of an actor can be enhanced. This describes why framing is important for actors in successfully achieving the preferred outcome in a debate. In sum, framing advances the actor’s specific interests and preferred policy outcome in a debate (Edelman, 1988).
1.3 Political Discourse Analysis
The aim of this research is to determine the discursive power and consequently their level of success in framing the IPRs debate of the American MNCS and the NGOs, by analyzing their language in written texts. These texts can take different forms, such as statements, interviews, policies or papers. PDA will serve as a method throughout this research. By searching for and analyzing the different elements of PDA in these texts, the discursive power and the level of successful framing of the debate will be determined. According to van Dijk (1997) political discourse is in itself a form of political action, as it can determine public opinion and it holds the ability to alter public policies. Therefore, it is a highly powerful tool and analyzing political discourse is important. In his work, What is Political Discourse Analysis?, van Dijk analyzes the six different elements of PDA as well as the way in which political discourse should be analyzed.
determined how powerful the actor’s political discourse is. The discursive power is considered to be strong if the text contains four to six elements of PDA.
The first structure through which political discourse can be analyzed is the use of the topic. Different forms of topic use contribute to the power of the political discourse. According to van Dijk, the topic that is at the center of the political discourse can be combined with a topic from a different societal domain (Van Dijk, 1997). By interlinking it with a different subject, the central topic could get a more severe and alarming nature, which could influence the other actors in revising their viewpoint. Van Dijk gives the following example; a discussion about migration policy not only focuses on the governmental policy, but it can also include topics from the societal domain, such as minorities (Van Dijk, 1997). Another element of the structure topic is the use of references to the past, the present and the future situation of that subject. When political discourse is used, an actor will claim that the past and current situation is negative or ambiguous, but the future will be positive if and when the future plan and actions of the actor is being implemented or followed. Therefore, actors will orientate their texts towards the future, as they believe that they hold the right solution. Another element is evaluations, which include evaluations of politicians, organizations and their actions in the form of descriptions and reference to these groups. These evaluations portray certain political and ideological opinions of the actor towards the subject (Van Dijk, 1997). This is best explained by the ‘we versus they’ and ‘our versus others’. Referring to the different parties involved, evaluation is an effective and functional way in which the actor can influence the political process. Especially in the field of political legitimation and survival, this element of political discourse can influence the competition with regards to votes and support for the actor (Van Dijk, 1997). Through the structure of topics an actor can use political discourse to reveal characteristic constraints on the participants in the debate. Political discourse not only reflects the political actors themselves, as well as their actions in the past, the present and the future, but also evaluates the self in a positive manner and the other in a negative way (Van Dijk, 1997).
this means that an actor can conceal the importance of an issue that is important but will harm their vision. Consequently, this means that an issue of non-importance can be emphasized, as it may be able to distract from any negative impact of the truly important issues. It can also be the case that an issue is eliminated from the debate in its entirety, which is mostly the case when it will harm the actor’s strong political position and legitimacy. Van Dijk believes that this is an important element as “persuasion by argumentation has sometimes been described as the hallmark of democracy” (Van Dijk, 1997, p. 29). In sum, every time an actor uses an argumentative move, the self-presentation that will follow will be positive, whereas the other-presentation will hold a negative character (Van Dijk, 1997).
Local semantics is the following aspect of PDA. It entails different forms, such as indirectness and implicitness, and strategies of description and representation (Van Dijk, 1997). In local semantics, contrastive meanings stand central. This means that an actor will explicitly describe its own organization or actions and they will implicitly talk about the other. Also, if the actor did a good deed, it will be described in detail and when the subject is focused on its bad deeds, the actors tend to be vague. The reversal of this is true for the other group, since their positive contribution to the discussed or debated subject will be described in a vague manner, whereas their negative impact will be described in detail. This is closely related to the concept of generalization and specification, or also called contrast and example. Through the use of this concept the actor can express their biased opinion and views of political events related to the topic, as well as discuss the state of affairs in a biased manner (Van Dijk, 1997). In practice this means that when the actor has done something wrong, it is treated as an exception and can therefore not be generalized. However, when the other actor or actors were responsible for a negative impact to the discussed topic, it is portrayed as typical and will consequently be generalized. Actors can also use disclaimers, which serve as a way in which an actor can bring a negative point about the other actor to the center of attention, while at the same time avoiding a bad impression themselves. Local semantics is also based upon contrast: ‘us versus them’. Every aspect of the actor will be emphasized in a positive way and the other group will be portrayed as negative.
will be described in a more negative way. When the actor holds bad habits or is guilty of producing bad products or when the actor has initiated wrong actions, these will be hardly described, but if they are these will be described by euphemisms. Van Dijk tries to describe this by using the following example: “our bombs are called ‘Peacemaker’ and our killings of civilians among the Others as ‘collateral damage’” (Van Dijk, 1997, p. 33). By using euphemism, words will be used that will make it seem as if the deeds or actions of the actor are less negative than they are in reality. This can influence the public and the other actors in their way of thinking, making them believe that these bad habits, products or actions are not as wrong as they would initially believe. Consequently it can ensure that the supporters of this actor still trust the actor and will be trusting of the actor in the future.
The following element of political discourse is syntax. This is described as manipulation of the syntactic style of discourse and it can be used through different forms. These forms are certain pronouns, active and passive constructions and a certain word order. Pronouns in the form of ‘we’ are popular as it can influence the debate. The receiver of the written information can feel the urge to become part of the ‘we’ instead of being part of them. The receiver does not want to feel left out, especially when this receiver can consciously choose to be part of we or be part of them. Another element of syntax is the use of active versus passive sentence constructions. The difference between these two is that “[a]ctive sentences will associate responsible agency with (topical) syntactic subjects, whereas passive sentences will focus on objects (e.g. victims) of such actions and defocus responsible agency by putting agents last in prepositional phrases” (Van Dijk, 197, p. 34). As a result, when the actor is responsible for a harmful situation it can change the importance of this situation by altering the sentence from active to passive. The last aspect is word order. According to van Dijk placing words or phrases in a more or less prominent place results in an emphasis or mitigation of the underlying message (Van Dijk, 1997). Thus, syntax can be used to alter the way in which the message is received by changing the sentence structure.
rhetoric is additions. Irrelevant additions to the written texts can be found when the actor wants to emphasize their own positive actions and the negative acts of the other actors by using additional words. The use of deletion is a well-known concept, as an actor is consciously not mentioning information that would be expected in a certain context. The actor can choose to delete this information from the debate, as it might hurt their credibility or legitimacy. This could result in a decrease of support for the actor. Substitution is the last element and it is being portrayed through irony and metaphors, as an actor uses this form of political discourse to describe a concept different from the expected concept in the present context (Van Dijk, 1997). Rhetoric is a powerful tool in political discourse as it works through subtle ways and can easily influence the debate.
Chapter 2: Intellectual Property Rights
2.1 America’s Quest for Intellectual Property Rights
forms of rights will prevent others from using the knowledge or ideas without the inventor’s permission and/or without payment. When the property is granted with rights, the owner of these rights can profit from it as he or she can start R&D to improve the idea or even to create a product, such as medication. The produced product can be brought to the market to be sold to others. Consequently, this means that the owner of the rights can profit from the invention. Thus, economic incentives are central in the proponents wish to enforce the rights of intellectual property (Hoekman and Kostecki, 2012). The opposition is arguing that monopolies will lead to high prices of the commodity, as competition is not allowed. In turn, this could mean that the commodity is no longer available for everyone, because prices may be higher than their budget.
institutions stimulated globalization, since they all created a more intertwined and interconnected global economy. Velásquez and Boulet (1997), as representatives of the WHO, define globalization as follows:
Increased interconnectedness and interdependence of peoples and countries, is generally understood to include two interrelated elements: the opening of border to increasingly fast flows of goods, services, finance, people and ideas across international borders; and the changes in institutional and policy regimes at the international and national levels that facilitate or promote such flows. (Velásquez and Boulet, 1997, p. 45).
This definition matches the establishment of the three institutions neatly. Furthermore, Velásquez and Boulet (1997) state that “globalization [is] the result of technological and economic evolution” (p. 45). As a result, globalization played a significant role in arousing the debate regarding intellectual property and its protection levels. Intellectual property can be defined as an idea or commodity, which is both subjected to globalization and the increasing pace through which it can travel the world and reach every person on the globe. Consequently, globalization and “freedom of trade […] were facilitating imitation of branded products, resulting in significant losses for MNCs” (Velásquez and Boulet, 1997, p. 40). Therefore, the MNCs in the US changed their attitude towards negotiating intellectual property protection at the end of the 1980s. The different companies in diverse branches started to lobby for stricter enforcement of IPRs within the US. These companies lobbied in an individualistic manner and only after several key persons noticed this trend, they joined forces. Edmund Pratt of Pfizer, John Opel of IBM and industry lobbyist Jacques Gorlin were responsible for combining the companies in their IPRs lobbies. They did so by successfully creating the awareness of the fact that these companies were in search of the same goal: increasing the protection of IPRs on an international level. After this moment of awareness, they became a powerful corporatist’s network of lobbyist within the US (Sell and Prakash, 2004).
president with information and advice about the private sector (United States Trade Representatives [USTR], n.d.a). The ACTN is since its establishment administered by the United States Trade Representative (USTR) and its purpose is to “ensure that U.S. trade policy and trade negotiating objectives adequately reflect U.S. public and private sector interests” (USTR, n.d.a, ¶ 1). The committee works in cooperation with different US departments, such as that of Commerce, Agriculture, Defense and Labor (Sell, 2003). This means that the committee became influential through the access to these departments and at the same time gained a lot of knowledge through their cooperation. Under the Chairing of Pratt, the company Opel was also member of the committee. Due to their close position to the executive branch, the committee was influential in setting the US trade agenda through their structural power. Consequently, they became successful in changing the US trade policy agenda to their preferences. During negotiations on bilateral trade between the US and countries as Taiwan, Korea, Singapore and Mexico, Pratt and his ACTN brought the enforcement of protection of IPRs in the form of patents and copyrights to the table (Sell, 2003).
In addition to the influence that Pratt and Opel had on US trade policies, they were also highly successful in mobilizing other companies and organizations to join their lobby for stricter IPRs (Ryan, 1998). The lobbying companies found support in the US’ International Anti-Counterfeiting Coalition (IACC) and the Copyright Alliance, which enlarged the lobbying group significantly (Sell and Prakash, 2004). The IACC describes itself as a non-profit organization that is “devoted solely to combating product counterfeiting and piracy” (International Anti-Counterfeiting Coalition [IACC], n.d., ¶ 7). The member driven IACC was created in 1979 and consists of different types of members, such as law firms, government agencies and IP associations (IACC, n.d.). The other organization, the Copyright Alliance, is also a non-profit organization that represents different groups “across the spectrum of copyright disciplines” (Copyright Alliance, n.d., ¶ 1). These groups can entail artists, innovators, unions, companies and even individuals (Copyright Alliance, n.d.). The mobilizing of IACC and Copyright Alliance by Pratt and Opel caused the already existing pressure, which the IPRs lobby could exert on US government, to increase.
government could take action when a foreign government violates or acts in inconsistence with an international trade agreement signed with the US, or when an act or policy by a foreign country is unjustifiable and restricts or burdens the commerce of the US. This action could take the form of retaliation or the removal of the US from any act or policy with that foreign country. Amongst the unreasonable acts or policies that the US sanctioned, is the inadequate and ineffective protection of IPRs by a foreign country (United States House of Representatives [USHR], 1974). The Trade Agreements Act of 1979 describes that the amendment serves as a way in which the US can approve and implement the agreements that it negotiated under the Trade Act of 1974 (United States Congress, 1979, §2502). The lobbyists have fought to enforce this amendment for a while, and under the 1979 Act the enforcement of IPRs came in effect under US trading law. In 1984, the Trade and Tariff Act was implemented, which clarified Section 301 of the Trade Act of 1974. According to the new Act, ‘unreasonable acts’ are defined as: “any practice which denies fair or equitable market opportunities, opportunities for the establishment of an enterprise, or provision of adequate and effective protection of intellectual property rights” (United States Government Printing Office [USGPO], 1984, §2411dBII). Thus, it is now explicitly stated that IPRs should be effectively protected or otherwise it is determined to be an unreasonable act. Through the different amendments to the 1974 Act, the lobbying companies were gradually granted with the rights they were actively lobbying for.
PhRMA is to establish and achieve strong intellectual property incentives in the US and around the world (Pharmaceutical Research and Manufactures of America [PhRMA], n.d.a). This goal is in perfect alignment with the goals of IIPA. Therefore, in 1986, PhRMA joined forced with the IIPA and they lobbied together to suspend a foreign country’s trade privileges when the protection of intellectual property was deemed to be inadequate (Sell and Prakash, 2004). This specific lobbying turned out to be effective when the 1988 Trade Act was ratified, which enables the USTR to act against the foreign countries failing the adequate protection of intellectual property of US origin (Sell, 2003).
Since pressuring the US government in changing US law was effective, the lobbyists wanted to achieve even higher protection levels on an international scale. Therefore, in 1986, twelve CEOs of the biggest American MNCs established the IPC. Amongst its members are Pratt and Opel. The members of the IPC worked around the US government as they reached out to their counterparts in Europe and Japan. Their goal was to develop “a transnational private sector consensus” (Sell and Prakash, 2004, p. 157). They wanted to establish an agreement that is internationally binding, which was intended to be part of an international organization such as the GATT (Sell and Prakash, 2004). As most international organizations work throughout the majority principle, the Americans needed the support of their counterparts in Europe and Japan. The IPC convinced Europe and Japan of the importance of IPRs, as well as that it should be implemented on an international level during the Uruguay Round. The GATT organized the Uruguay Round in 1986, which served as a discussion round between all its members that focused on international trade. Europe and Japan agreed that IPRs should be placed on the agenda during the Uruguay Round and lobbied their governments, which as a result eliminated a challenge for the US in its quest to implement IPRs on an international level (Sell and Prakash, 2004). Without opposition of Europe and Japan, the American lobbyists were one step closer again to their goal of establishing IPRs under GATT, which could make IPRs binding to all the members of that organization.
2.2 The Agreement on Trade Related Aspects of Intellectual Property
n.d.e). Since the early 1930s, protectionist measures were put in place and these still remained binding after the war. The fifteen countries wanted to replace and correct these measures by heading towards the direction of trade liberalization. On October 30, 1947, twenty-three countries, called contracting parties, signed the proposed tariffs concessions that were the result of the trade liberalization talks.4 This
agreement was called the GATT and came into effect on June 30, 1948 (WTO, n.d.e). Although these contracting parties had achieved great success by establishing the GATT, the original intention of the talks about the establishment of a new institution was to create an International Trade Organization (ITO) (Hoekman and Kostecki, 2012). More than fifty countries were discussing the creation of this new institution, which was supposed to “handle the trade side of international economic cooperation, joining the two ‘Bretton Woods’ institutions, the World Bank and the International Monetary Fund” (WTO, n.d.e, ¶ 4).5 The ITO was supposed to be ratified under the United Nations. However, it was never established, since the US Congress refused to ratify the agreement (WTO, n.d.e). Consequently, this means that the GATT was the only international agreement that governed trade on a global level. Therefore, when a country believed a change in the global trading system or its policy was important the GATT was the only institution with the power to actually alter the system.
In the 1970s changes in the world economy were noticed. This called for change in the framework of the GATT. The problems with economic and trade reform were discussed during the Tokyo Round that started in 1973, but the limited achievements resulted in high unemployment rates as well as a crisis for the factory industry as the number of closing factory started to rise rapidly. Since the GATT did not tackle these problems, the governments in North American and Western Europe were forced to implement bilateral agreements with competitors. As a result of this trend, the credibility and effectiveness of the GATT was challenged. Throughout the years, the world economic system kept on changing rapidly and it showed that the
4 The founding countries of the GATT were Australia, Belgium, Brazil, Burma,
Canada, Ceylon, Chili, China, Cuba, Czechoslovakia, France, India, Lebanon, Luxembourg, the Netherlands, New Zealand, Norway, Pakistan, Southern Rhodesia, Syria, South Africa, the United Kingdom and the US (Hoekman and Kostecki, 2012).
5 At a 1944 conference in Bretton Woods, New Hampshire, the modern international
sense possible. The main problem remained: the developing countries were still skeptical. However, as the negotiations progressed, many of them started to link IPRs to foreign direct investment and access to knowledge. These could benefit the developing countries in the longer run, as it was a move towards a market economy. The decisive factor for the developing countries to agree with the implementation of minimum standards on IPRs was the compromise that when they would agree to this, they would obtain better market access for clothing, agricultural and textile exports. Due to this compromise the TRIPS agreement was implemented and the talks during the Uruguay Round resulted in an extension of the trading system into new areas, more specifically into trade in services and trade in intellectual property (WTO, n.d.f). In the 1990s, these talks were translated into practices by creating a new international organization called the WTO, which replaced the GATT on January 1, 1995. The GATT still remained part of the WTO, as it serves as a treaty focusing on trade in goods, but it was updated during the Uruguay Rounds to fit the current world economy.
In purpose the GATT and the WTO serve the same goal. However, there are also significant differences between the two frameworks. Whereas the GATT served as an intergovernmental treaty, the WTO is classified as an international organization, which “administers multilateral agreements pertaining to trade in goods, trade in services and TRIPS” (Hoekman and Kostecki, 2012, p. 47). Another difference between the frameworks is that the GATT consisted out of contracting parties and the WTO consists out of members (Hoekman and Kostecki, 2012). In practice this means that the WTO has the authority to sign agreements with states. The purpose of both the GATT and the WTO is the same, as both hold a regulatory role. The objective is to regulate “regulatory actions taken by governments that affect trade and the conditions of competition facing imported products on domestic markets” (Hoekman and Kostecki, 2012, p. 47). Another important similarity is that nowhere under the GATT or under the WTO free trade as the ultimate goal is mentioned (Hoekman and Kostecki, 2012). When regarding intellectual property, the WTO is very different as it does include, cover and protect IPRs.
2.2.2 Features of the TRIPS Agreement
WTO, since the non-discrimination principle is in effect (Hoekman and Kostecki, 2012). The purpose of the agreement is to not only protect intellectual property in an effective and adequate manner, but also to ensure that these manners and measures will not result in barriers to international legitimate trade (WTO, n.d.b). The TRIPS agreement is based upon the principal international conventions as they are administrated by the WIPO (Hoekman and Kostecki, 2012). These conventions are the Berne Convention and the Paris Convention and therefore some refer to the TRIPS agreement as the Berne and Paris Plus agreement (WTO, n.d.d). The TRIPS agreement obliges the members of the WTO to include provisions in their domestic law in order to ensure that IPRs are being effectively enforced within every member state (Hoekman and Kostecki, 2012).
The TRIPS agreement consists out of three main features, followed by additional general provisions. These features are standards, enforcement and dispute settlement. The first feature, standards, covers minimum standards of protection of intellectual property. The agreement states that each member needs to provide these standards. Furthermore, it also added obligations about issues where the other organizations or conventions were silent about (WTO, n.d.d).
The second feature is enforcement. As the name already implies, this feature is based upon the enforcement of IPRs. More specifically, it “deals with domestic procedures and remedies” (WTO, n.d.d, ¶ 3). Furthermore, this feature contains the procedures and remedies, in a certain detail, that must be available in the member countries. Through these procedures and remedies the holders of the IPRs can enforce their rights in an effective manner. They are based on several aspects, such as civil, administrative and provisional measures as well as requirements in regards to borders and criminal measures and procedures (WTO, n.d.d).
The last main feature is dispute settlement. Any disputes between members of the WTO about intellectual property, its rights and obligations are subject to the procedures of the WTO’s dispute settlement system. Through the dispute settlement body the rules of the WTO are being enforced. The body works with a clear defined set of rules as well as timetables, which serves as guidelines for countries when they want to subject a case to the body (WTO, n.d.d).
prohibited. When a member country is granting another member with a favor, for instance the lowering of customs rates for one of their produced medicines, this member has to do the same for all the other members. Another provision discusses who can apply for a patent. This should be a natural or legal entity, such as companies and persons (WTO, n.d.c).
Furthermore, the agreement defines the seven types of intellectual property. These are copyrights, related rights, trademarks, geographical indications, industrial designs, patents, layout-designs of integrate circuits, protection of undisclosed information and control of anti-competitive practices in contractual licenses. In regards to the pharmaceutical sector, patents are the most important form of intellectual property protection. Article 27.1 of the TRIPS agreement requires that all the member countries have to make patents available for any type of invention in the field of technology, whether it is a product or a process, without discrimination. The patents are subject to “the normal tests of novelty, inventiveness and industrial applicability” (WTO, 1994, Article 27.1). Furthermore, discrimination between imported or locally produced, or place of invention is prohibited (WTO, 1994, Article 27.1). Article 33 states that a patent is available for twenty years and this period starts at the filing date of the patent (WTO, 1994, Article 33). When a patent is obtained, the patent holder can use their protected intellectual property as they see fit. In the pharmaceutical sector this means that they can start the process of R&D and consequently manufacture new medication. In sum, the TRIPS agreement protects intellectual property in a broad sense.
2.2.3 Intellectual Property Protection and Enforcement
The government of the US grants patents and registers trademarks through the USPTO. It is important to understand what is patentable and what is not. There are three different types of patents in the US available: utility, design and plant patents. Utility patents are the most common form, as it can be granted over the following inventions: “new and useful process, machine, article of manufacture, or composition of matter, or any new and useful improvement thereof” (USPTO, n.d.b, ¶ 2). Design patents are granted over the design of a manufacturing article, and it is required that the design has to be innovative (USPTO, n.d.b). The last form, plant, concerns patents that can be granted to a person who discovers, invent or asexually reproduces a variety of plant that is new and distinct (USPTO, n.d.b). In the pharmaceutical sector utility patents are most likely to be granted, as ideas and processes lay at the basis of most pharmaceutical patents. Besides the patentable aspects, it is also important to repeat that these aspects can only be patented when they are new, nonobvious and useful (USPTO, n.d.c). Aspects that are not patentable are “laws of nature, physical phenomena, abstract ideas, literary, dramatic, musical and artistic works, and inventions that are not useful or offensive to public morality” (USPTO, n.d.c, ¶ 4).
international patent application can be filed at the national patent office, which can be done at the USPTO in the case of the US, or directly at the WIPO. The national office in which the patent is filed will remain in control of the actual granting of the patent, which is called the ‘national phase’ (WIPO, n.d.). The PCT patent process offers a great solution for inventors that have the incentive to protect their intellectual property on a global scale. The positive aspects of PCT are that the process of applying for a patent is simplified through the PCT system and it also decreases any expenses since the filer only has to pay an international fee. It does not have to pay the fees for every country separately. In addition, it allows more time for the inventor to assess the viability on commercial ground of his or her invention or creation (WIPO, n.d.).
2.3 The Debate in the Pharmaceutical Sector
The Uruguay Round concluded to be successful in establishing an intellectual property regime, but the link between public health and intellectual property caused a debate to arouse in the WTO’s Doha Round as well as simultaneously in the US itself.6 After the completion of the Uruguay Round, the American intellectual property lobbies were still aiming to strengthen the rights on intellectual property on a global scale, which includes the protection of pharmaceutical research and medication. The developing countries and the supporting NGOs rigorously started to oppose the WTO legislation after the implementation in 1994. They were afraid that new WTO legislation would result in even higher numbers of HIV prevalence in their regions. Therefore, several NGOs launched an anti-WTO message in which they expressed their concerns about the TRIPS agreement regarding the access to medication. Through this anti-WTO message the NGOs generated a debate and became an important stakeholder in this intellectual property debate.
Although the TRIPS agreement already took the public health problem into account concerning developing countries, especially Africa, the access to essential medicines still remained a problem, as Hoekman and Kostecki (2012) analyze:
The TRIPS agreement (article 31:f) recognizes that IPRs should not come in the way of action by governments to address pressing public policy needs. Thus, in a case of an important public health emergency, if local drug manufactures are unable to produce enough to satisfy the demand for the medicines protected by patents, a WTO member government can require the producer to licence the medicine to other firms to address any (expected) shortage. The TRIPS rules negotiated in the Uruguay Round stipulated that production under compulsory licensing must be predominantly for the domestic market. This created a problem for developing countries with no production capacity as they would need to import the drugs. (Hoekman and Kostecki, 2012, p. 391).
Thus, the developing countries remained viewing the TRIPS agreement as an obstacle in their combat against public health emergencies, since patented medicines were now restricted in availability. Although the WTO included Article 31:f, through which the countries have the ability to manufacture drugs themselves, many developing
countries did not have the resources or knowledge to do so. Therefore, the problem of access to essential medication still remained problematic.
In order to analyze the severity of the problem raised by the developing countries, which serves as the start of the American pharmaceutical IPRs debate, it is important to research the actual consequences of life threatening diseases in these countries. Since the prevalence of the diseases HIV and AIDS is considered to be the most affected by the implementation of the TRIPS agreement, the analysis will focus on these diseases. After the implementation of the TRIPS agreement the HIV prevalence increased tremendously in several Sub Saharan African countries. The HIV prevalence in 1994 in Lesotho was determined at 7.9, in South Africa at 3.3, and in Swaziland at 10 (World Bank, n.d.b).7 After the implemented increased levels of IPRs protection in the pharmaceutical sector, the HIV prevalence rose in 2001 to 22.1 in Lesotho, 16.2 in South Africa and 25.5 in Swaziland (World Bank, n.d.c). It becomes clear that the prevalence of HIV amongst adults in the Sub Saharan Africa region was not only increasing rapidly, but also spread throughout the region in a fast pace. The NGOs claims that this increase in HIV prevalence is the result of the increase in prices after the implementation of the TRIPS agreement. The high prices of medication caused them to become too expensive for developing countries and as a result the medicines became unavailable for the citizens. For instance, a brand name antiretroviral drug that is fabricated in the US and is available in Africa costs $10,400 per patient per year in 2000 (Médecins Sans Frontières [MSF], 2001).8 The highest HIV prevalence countries do not have the resources to pay for these expensive medicines. The examination of their Gross Domestic Product (GDP) per capita will prove this.9 In 2000, the GDP per capita in Lesotho was 425 US dollars, in South
Africa it was 3,020 US dollars and 1,433 US dollars was the GDP per capita in Swaziland (World Bank, n.d.a). Thus, the GDP per capita of developing Sub Saharan
7 The HIV prevalence percentage is based on percentages of the total population in
the ages 15-49.
8 A brand name drug is a drug that is originally subjected to R&D by a
pharmaceutical company. This drug entered the market because it was granted with a patent and could be manufactured as a result. Generic drugs are copies of brand name drugs.
9 GDP per capita shows how much a person can spend in a certain year based on
African countries is not sufficient enough to pay for the essential HIV medication. Consequently, the analysis proves that for the developing countries access to essential medicines was a vital and just concern within the Doha Round. NGOs stood by these developing countries with their anti-WTO message and emphasized the need of a change in policy. Within the US they tried to lobby the government to favor the restriction on IPRs, opposing the American MNCs, which created a debate (Hoekman and Kostecki, 2012).
important to link this to the economic growth. The value added per employee will serve as the factor to determine the economic growth, as value added is a rough measure of productivity. Between 2000 and 2004, on an annual average, the value added per employee was $181,417 in the intellectual property intensive sectors and $105,703 in the non-intellectual property intensive sectors. The pharmaceutical sector has a value added of $425,529 per employee (Shapiro and Pham, 2007). In sum, the analysis of this research shows that the use and protection of intellectual property leads to a blooming pharmaceutical sector, especially when it is compared to other sectors. Thus, as is claimed by the American MNCs within the IPRs debate, the American MNCs and the US as a whole are tremendously benefitting from stronger protection of IPRs.
During the first years of the American pharmaceutical IPRS debate the NGOs were receiving a lot of media attention, which was harming the pharmaceutical companies. The public image of the American intellectual property lobby was suffering from the bad press and as a result their legitimacy was being affected. This changed the attitude and the business model of the MNCs. They shifted their lobby from an emphasis on litigation to an emphasis on morals. The MNCs developed plans to donate drugs to the countries in need and to also ensure affordable prices. Regarding their business model, the MNCs decided to go beyond the emphasis on innovation and patent strategy concerning R&D and move towards marketing and advocacy. This translated itself into practice by an increased interest of the MNCs in the production of generic drugs (Hoekman and Kostecki, 2010). Due to the public pressure and the modernization of their business model caused by the American pharmaceutical IPRs debate, the MNCs softened their stance on IPRs regarding public health matters.
Chapter 3: Power Relations among Stakeholders
This chapter will determine the discursive power of the stakeholders by analyzing different texts of the stakeholders. The method of analysis will be van Dijk’s PDA. Van Dijk has determined six different aspect of political discourse. In order to use this method for this specific research, a scale needs to be established. In this research the strength of the discursive power will be determined by the total of aspects a text holds. Only when the actor uses four, five or six aspect the discursive power can be determined as strong. When it uses one, two or three aspects of PDA, the power is considered as weak and has consequently not the ability to influence the opinion of other actors or policy. As described before, the American pharmaceutical MNCs have formed a joined lobby, called PhRMA. Therefore, press releases, statements and research done by PhRMA will be analyzed in the first of this chapter. In the second part, the different NGOs will be the focus of analysis. Since these stakeholders also have created a joined lobby, statements and press releases regarding this united lobby will be analyzed first. After the joined lobby, the NGOs will be separately analyzed through their press releases, researches and statements. The NGOs that will be subjected to analysis are: the CPT, HAI, MSF, and Oxfam International.
3.1 Multinational Corporations: Pharmaceutical Research and Manufactures of America
believes that they should have the ability to do so in the best global circumstances possible. Therefore, the goal of PhRMA “is to conduct effective advocacy for public policies that encourage discovery of important new medicines for patients by pharmaceutical and biotechnology research companies” (PhRMA, n.d.a, ¶ 4). The lobby group has set out three key aspects that are of crucial importance for the public policies PhRMA is lobbying for, within the US and around the world. These aspects contain “a free market, without prices controls, strong intellectual property incentives and transparent, effective regulation and free flow of information to patients” (PhRMA, n.d.a, ¶ 4). Accordingly, intellectual property protection is a highly important part of PhRMA’s advocacy for public policies. Furthermore, according to the group, economic growth and the resulting competitiveness of the US is foundationally driven by continued governmental leadership in the pharmaceutical sector. For PhRMA, this leadership is based upon prioritizing the importance of intellectual property protection, as incentive for the creation of new medication (PhRMA, n.d.a). Strong intellectual property protection incentives are related to American economic growth according to PhRMA. Mark Elliot, Executive Vice President of PhRMA, states that IPRs “provide the backbone for innovative industries” (PhRMA, n.d.c, ¶ 1). He continues his argument by linking IPRs to economic growth by claiming that the American pharmaceutical industry employs “40 million Americans with well-paying jobs and propel 60% of U.S. exports and $5 trillion in gross domestic products” (PhRMA, n.d.c, ¶ 1). The importance of IPRs protection and the positive impact on American economic growth is clear for PhRMA. Consequently, the lobby group emphasizes that the role of the US government in the international negotiations about IPRs should be leading and expanding. High standards of protection should be advocated in international agreements (PhRMA, n.d.c). PhRMA even believes that the US should apply bilaterally pressure in order “to ensure American IP and the resulting jobs and innovations relying on it aren’t undercut by lackluster foreign economic and enforcement practices” (PhRMA, n.d.c, ¶ 6). As a result of this conviction, PhRMA lobbies for stronger global rights and measures of intellectual property protection.
growing HIV infection rates” in 1999 (p. 765). Health Minister Nkosazana Dlamini-Zuma of South Africa started a campaign against international drug pricing. She argued that the prices where discriminatory in nature, since the medication was “based on extremely high levels of market concentration” (Bond, 1999, 766). As a result, these high prices prevented South Africans to access essential drugs at affordable prices. Zuma created a new law, the Medicines and Related Substances Control Amendment Act, also called the Medicines Act, which was passed in parliament in 1997 (Bond, 1999). Clause 15(c) contains two essential points through which essential medication was supposed to be accessed more easily. The first point legalizes parallel importing, through which South Africa could seek the lowest price for a medicine around the world and import this particular drug. Compulsory drug licensing is the second point of Zuma’s Medicines Act. In practice it means that the country could grant rights in order to copy patented medication, without the consent of the holder of the patent of that specific medicine. Granting rights over already patented drugs can only be done if safeguards are being followed by the manufactures and only if the patent owner receives fees (Bond, 1999). Although this law was technically in line with the TRIPS Agreement, the American government believed that South Africa was violating global intellectual property protection and decided to place the country on the USTR’s Special 301 Report (Bond, 1999).
word as ‘building’, but by choosing words that hold a more negative character, Truit used the van Dijk’s aspect lexicon to persuade the reader to share its viewpoint. In addition, the word lifeblood is a metaphor, one that implies that patent protection drives the pharmaceutical industry. Truit makes it seem as if the industry will not survive without the patent protection. The use of this metaphor proves that Truit also used the aspect rhetoric to persuade the reader to believe that South Africa’s policy is wrong. Lastly, by calling the industry ‘our’ the reader will feel the urge to be part of this group. Therefore, Truit also subtly made use of the aspect syntax. He continues his statement: “[t]he South African government’s stand threatens the development of medicines. The average drug costs $300 million to $500 million to develop” (Bond, 1999, p.779). In these sentences Truit implicitly mentions that PhRMA considers the Medicines Act of South Africa a problem regarding the creation of medication. He continues his argument by explicitly mentioning how expensive drug production is for the companies PhRMA represents. Through the use of this type of local semantics Truit is portraying his political opinion again. Moreover, he uses the sematic strategy to describe his own group direct and thus explicitly, namely through mentioning the costs of drug production. In the context of the statement, stating the cost is not relevant, since there cannot be found a direct and explained link between South Africa’s Act and the costs. Therefore, analysis of this statement shows that Truit adds this irrelevant aspect to emphasize that the member corporations of PhRMA are greatly involved in the mission to cure diseases, especially from a financial point of view. In order words, Truit is using the costs to persuade the reader to believe that PhRMA’s members are committed to good work and are consequently the victim of South Africa’s new act. He is implying that PhRMA, its representing pharmaceutical corporations and the American pharmaceutical sector are the actors that should be supported by the reader, the American government and other political actors, as they are the only ‘good’ actors.
PhRMA argues that “patenting levels are miniscule” (PhRMA, 2001, ¶ 3). The representative of American pharmaceutical MNCs is portraying the patent situation as if almost none of the drugs are patented. PhRMA describes that it surveyed in fifty African countries. The research shows that two of twenty-six drugs are patented in approximately a third of the surveyed countries. This part of the research is being concluded by stating: “in more than two thirds of the countries of Africa, no patents exist in relation to any of the drugs to treat opportunistic infections” (PhRMA, 2001, ¶ 3). It would seem as if this means that not many drugs are patented in Africa, but in fact there are still patents granted on essential medication within Africa. By stating that almost no patents have been granted it would seem as if PhRMA is dismissing the claim of the NGOs, which is that PhRMA’s patents are considered an obstacle in accessing medication in African countries. However, it still remains the case that patents exist in Africa and that these patents are causing the drugs to be greatly expensive and thus unavailable for African inhabitants. PhRMA altered the meaning of the research to make it seem as if PhRMA’s policy is not a barrier, which is in reality not true. This is considered a manipulation of superstructure. PhRMA also states that in the case of drugs developed to stop progression of HIV “Africa is a patent desert” (PhRMA, 2001, ¶ 4). By calling Africa a ‘patent desert’ PhRMA is making use of a metaphor, which is part of the substitution element of rhetoric. A desert symbolizes an open area, which is mostly empty. Therefore, PhRMA is using this word to say that medication in Africa is available for anyone as not many drugs are patented. Moreover, PhRMA argues that “[t]hese statistics demonstrate the reality of the African patent situation, which stands in stark contrast to the statements made by a number of organizations advocating drastic reinterpretations of the TRIPS agreement” (PhRMA, 2001, ¶ 5). PhRMA is using the method of evaluation to portray its opinion of its opponent, the NGOs, supported by evidence. The use of this element of topic is used to portray a ‘we versus them’ situation. The evidence provided in this research supports the lobby of PhRMA and consequently opposes the lobby of the NGOs. By using the words ‘stark contrast’ it is implied that the NGOs could not be more wrong in their argument. The reader will be subtly persuaded to doubt any other arguments made by the NGOs as well, as PhRMA is trying to harm
the NGOs’ legitimacy. The following sentence is “they demonstrate what many have
PDA: local semantics and syntax. Local semantics is portrayed through a disclaimer. By stating that ‘many have long believed’, PhRMA is removing their sole responsibility when it depicts the NGOs lobby in a negative manner, as ‘many’ share the arguments of PhRMA’s lobby. The second aspect in this sentence is syntax, more specifically the use of an active sentence to persuade the reader to share PhRMA’s viewpoint. ‘Patents’ is the subject of the sentence and through the verb ‘are’ it becomes clear that the subject is undertaking an action towards the object, namely ‘almost every sub-Saharan African nation’. Since the word ‘not’ is included in the sentence, PhRMA is using this sentence to convince the reader that patents are not interfering with access to essential medication, as the NGOs are arguing. Through analysis of this research five of the six aspects of PDA are found, as PhRMA did not use the aspect lexicon.
In sum, PhRMA has proven to hold a strong discursive power throughout several written aspects of their lobby. The lobby group has implemented the several aspects of van Dijk’s PDA on numerous occasions, which means that it has the power to persuade the reader of their viewpoint and have the power to successfully convince other actors to redefine their interests.
3.2 Non-Governmental Organizations 3.2.1 United Lobby
In 1999, on November 25 and 26, several NGOs came together in Amsterdam, the Netherlands, to discuss the current situation regarding the access to essential medication. In December of that same year, the WTO organized a luncheon in Seattle and the NGOs used their conference to try to put health and intellectual property on the agenda during the WTO luncheon. This conference was called the ‘Increasing Access to Essential Drugs in a Globalised Economy Working Towards Solutions’. The organizing NGOs were HAI, MSF and the CPT. Together they developed the ‘Amsterdam Statement’ in which they lobbied for a working group on access to medicines, which should be implemented under the WTO (“Amsterdam Statement,” 1999).
IPRs have caused. Through stating these facts, the NGOs are urging action on behalf of the developing countries. These statements includes facts such as: “[m]ore than 90% of all death and suffering from infectious diseases occurs in the developing world” and “20% of the world’s population uses 80% of the world-wide production of medicines” (“Amsterdam Statement,” 1999, ¶ 2). By starting with these facts, the NGOs are framing the debate already. Since facts cannot be altered, they are powerful. Through the use of these facts, this particular stakeholder group is trying to persuade the MNCs and the American government to redefine their position within the debate by repeating the consequences of the current policy they have set. According to van Dijk’s PDA this is considered to be manipulation of rhetoric, as these NGOs are portraying the government and the MNCs to be standing on the wrong side in this debate by repeating the negative consequences of their policy. The ‘Amsterdam Statement’ continues with an introduction, describing the consequences of the current policy set by the American MNCs and the US government in more detail. The NGOs believes that through the IPRs the patients in need of medication are no longer able to attain those and this leads to “avoidable human suffering”
(“Amsterdam Statement,” 1999, ¶ 3). Through the use of these words the NGOs are
