THOMAS POGGE| THE HEALTH IMPACT FUND 1. Introduction Part of the WTO Treaty, the TRIPS Agreement entitles pharmaceutical firms to protect their innovations with product patents, 1 which suppress generic competition, and then to sell their patented medicines at prices far above the cost of production. By pressing less-devel­oped countries to institute and enforce stronger patent protections, the wealthier countries enabled their phar­maceutical firms to profit from sales to the more afflu ­ent people in the developing world. As a side effect of this success, poor people are now excluded from many advanced medicines which, without TRIPS, would have been immediately available to them as cheap generics. In order to make sure that affluent people in the devel­oping world contribute to the cost of pharmaceutical research and development(R&D), TRIPS causes grave harms and countless deaths among poor people who cannot afford the large mark-ups charged on patented medicines. Some defenders of the TRIPS regime contend that it is natural and not unfair that affluent people have all kinds of expensive things that poor people cannot afford to buy. But this contention assumes that the existing dis­tribution of income and wealth is fair. This assumption is highly problematic. Today, at least 80 % of global in­come variability is explained by a person's initial country and class. 2 Affecting human beings from the moment of conception, these(dis)advantages are obviously un­deserved. And their magnitude has become extreme in the course of a long history pervaded by massive crimes such as slavery, colonialism, and genocide. Today, the bottom two-thirds of humankind have about four per cent of global private wealth 3 and six per cent of glo­bal household income. Average income in the top 5 per cent of humanity is 9.3 times the global average, while average income in the bottom quarter is 1/32 of the glo­bal average. So one person in the top 5 per cent has as 1. Product patents allow the patent holder to veto the manufacture and sale of a patented molecule regardless of how it is produced. Before TRIPS, India granted only process patents, which allow the patent holder to veto merely a specific way of making a molecule. See World Health Organization:»WTO and the TRIPS Agreement«, available at www.who. int/medicines/areas/policy/wto_trips/en/index.html. 2. Branko Milanovic:»Global Inequality of Opportunity: How much of our income is determined at birth?«, available at http://microdata.world­bank.org/lsms/index.php/citations/904. 3. See Credit Suisse, Global Wealth Report, p. 3, and Global Wealth Databook, both available at https://responsibility.credit-suisse.com/app/ article/index.cfm?fuseaction=OpenArticle&aoid=291405&coid=284071 &lang=EN. much income, on average, as 300 people in the bottom quarter. 4 Poverty strongly affects health: Even in affluent Eu ­ropean countries, the life expectancy of the poorest groups is considerably below that of the richest. Glo­bally, health disparities are vastly greater as avoidable health deficits are highly correlated with poverty. Most of today's morbidity and premature mortality are poverty­related. Those whose right to health is unfulfilled are overwhelmingly poor. This right, enshrined in Article 25 of the Universal Declaration of Human Rights, is a fun­damental human right because health is an important precondition for the realization of most other human rights. Large shortfalls in its realization result in avoid­able suffering, lack of physical and mental functioning and premature death on a massive scale. Most of these avoidable medical conditions cause economic losses that are much larger than what it would have cost to avoid them or to treat them adequately. Realizing the human right to health would thus not merely fulfil a preeminent moral responsibility, but also increase human economic prosperity overall. A second, independent problem with the mentioned defence of TRIPS is that new medicines are not expen­sive to manufacture. Their high prices are»artificial« in the sense that they are enabled by patents. The question is not whether affluent countries should subsidize ad­vanced medicines for the poor. Rather, the question is whether affluent countries may promote the enforce ­ment of temporary monopolies that foreseeably make ad­vanced medicines inaccessible to a majority of humankind. This is what our governments have done in our name by insisting that innovators must be enabled, even in the less-developed countries, to outlaw and suppress the competitive manufacture and sale of generic versions of »their« products. In defence of this practice it has been argued that the manufacture and sale of generic pro­4. The income data used here were kindly supplied by Branko Milanovic, Lead Economist in the World Bank's Research Department, in a personal e-mail communication of 25 April 2010, on file with the author. Milano ­vic is the leading authority on the measurement of economic inequality, and his published work contains similar albeit somewhat less updated in ­formation. See Branko Milanovic:»True World Income Distribution, 1988 and 1993: First Calculation Based on Household Surveys Alone«, The Economic Journal 112(2002), 51-92; Branko Milanovic: Worlds Apart: Measuring International and Global Inequality(Princeton: Princeton Uni­versity Press 2005); Branko Milanovic, The Haves and the Have-Nots: A Brief and Idiosyncratic History of Global Inequality(New York: Basic Books 2011). 2