Also in Seattle were 20,000 to 30,000 protesters, mostly concerned that the WTO is destroying national laws to protect labor and the environment. Medical issues, including treatment access in developing countries, were expected to get less attention.

We asked James Love, of Ralph Nader's Consumer Project on Technology (see "Compulsory Licensing for Bridging the Gap," AIDS Treatment News #314), what could be done now to help overcome economic barriers to access to essential medical care around the world.

ATN: You mentioned the goal of getting a working group within the WTO, on access to medical technologies--a working group of nations, which any interested nation could join.

Love: There are already such groups that work on services, on intellectual property rights, on electronic commerce, for example. Usually they are driven by the agenda of big businesses that have some issues they want addressed by the WTO.

The way decisions are made in the WTO is that people try to control the agenda; they try to control the topics that are talked about, they frame questions. If there were an initiative about access to medicines, that would frame the issue in a positive way.

It would say the issue is how do you get people access to drugs, and bring in public-health people in the various countries, and look through the various international agreements to find out where the problems are. It would be quite helpful.

ATN: Are there any such working groups in the medical area already, or would this be the first in medicine?

Love: I'm not aware of anything like this in the WTO now. There are initiatives to look at labor, and at the environment. Environmental groups have been disappointed at what has emerged. You need to think about how the WTO should be structured, and then you need to lobby to get movement. It's not easy; you have to do lots of different things to make progress happen.

But having a working group on treatment access would be a magnet to address certain concerns, for example the export issue [whether any country can export pharmaceuticals to a country which uses compulsory licensing, but is too small to have a local industry which can manufacture the drug], or the health registration data issue [whether a country can be prohibited from using publicly available data in its approval process, and required to either run new human trials or buy the drug at monopoly prices from the company that developed it originally]. In these and many other issues in implementing the WTO treaty, you have to get agreement among WTO member countries on what is reasonable to do.

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These issues can be challenged in the WTO's dispute-resolution panels. To position yourself for a good result, you try and create a consensus of world opinion, or at least raise the understanding of your position early, so that when the tribunal meets, it is more likely to come out where you want to be.

There are many such nuances of the WTO agreement; each one in itself is hard to campaign on, because it's not the big picture and is hard to explain. But taken together, they are real problems for access to health care. So you need a single vehicle you can use to hammer away at these, to drive home a pro-access, pro-consumer position.

ATN: What resistance would you expect to the idea of adding a working group on access to pharmaceuticals and other medical treatment, much like the working groups that already exist in other areas?

Love: The pharmaceutical companies will be opposed. They don't like you talking about access to drugs; they want to talk about issues like drug counterfeiting.

Their main goal is to eliminate parallel importing, which is permitted Under the WTO agreement; they want to reverse that position. They want to restrict the grounds of compulsory licensing. They are trying to use issues in government procurement at the WTO to attack nations' efforts to control drug prices. It's important to have a power base within the WTO for public- health positions.

ATN: And if we don't get the working group on treatment access in Seattle?

Love: We can get it later. There are ministerial meetings at least every two years, often about every 18 months. And there are many other councils that meet between the ministerial meetings. You could use the meetings at Seattle to raise this as a proposal, and then campaign after that to have it implemented.