Kyoto Style Disease Intervention Credit Trading and Neglected Diseases
by Gregor Wolbring

October 30 , 2006

A fellow presenter at a recent conference in Sweden spoke about carbon trading -- which is seen as one way countries can meet their obligations to reduce carbon emissions under the Kyoto Protocol (1-3). My presentation dealt with problems in a proposed Medical R&D Treaty (4) which envisions Kyoto-style credit “disease intervention trading” whereby “disease intervention” is the commodity to be traded, to address problems associated with neglected diseases (5-8).

One might expect that "disease trading", and “disease intervention trading" would show up in Google in connection with medicine and other medical health technologies, insurance against disease, and other "health" and "health care" products. We have traded these commodities for a long time, using a variety of mechanisms. My recent columns on ableism, enhancement and transhumanism highlighted that the human body is increasingly becoming a commodity for “disease trading” and “disease intervention trading” (see also a new report by ETC). However only 1000 hits show up in Google. None are related to the way I use these terms.

There is no doubt that the situation around neglected diseases has to be rectified, and the proposed Treaty is one attempt to address the problem (9).

In February 2005, a letter to the World Health Assembly Executive Board and the WHO Commission on Intellectual Property Rights, Innovation and Health, asked for an evaluation of the Treaty, which had been developed to deal with neglected diseases in low income countries. The World Health Assembly adopted a resolution last May (WHA59.24) (10) creating a working group to develop a global strategy on intellectual property, health research and development, and new medicines for diseases that especially affect developing countries. NGOs and others think there are opportunities to rectify problems related to neglected diseases within a New Health R&D Framework (11).

It is understandable that the drafters of the Treaty and the resolution want to involve industry and other players .Without these parties the situation cannot be solved. However, current practices of “disease intervention trading” can be seen as one reason why neglected diseases exist.

Where will the language of the Treaty and the resolution lead us?

Medical versus Social Interventions

The Treaty envisions a Kyoto-type credit trading system to rectify the problem:

“Similar to the Kyoto climate treaty, credits would be traded across borders -- and countries that exceed the benchmark obligations can sell excess credits. The credits will be given for a variety of projects including:

• R&D for neglected diseases and other priority research projects
• “Open public goods,” such as free and open source public databases
• Projects that involve the transfer of technology and capacity to developing countries
• The preservation and dissemination of traditional medical knowledge, and exceptionally useful public goods.” (12)

The letter to the World Health Assembly and the WHO Commission envisioned the following interventions:

“At the core of the proposed treaty is an obligation to finance Qualified Medical Research and Development (QMRD). This obligation is tied to country GDP. In Draft 4, two different methods of determining the fraction of GDP for QMRD are presented. Alternative 1 uses different rates for each of four income groups (high, high medium, low medium, and low). Alternative 2 is a graduated rate. QMRD would include (1) basic biomedical research, development of biomedical databases and research tools, (2) development of pharmaceutical drugs, vaccines, medical diagnostic tools, (3) medical evaluations of these products, and (4) preservation and dissemination of traditional medical knowledge.” (4)

The resolution talks about “the need to continue to develop safe and affordable new products,” but specifies in a footnote that products “should be understood to include vaccines, diagnostics and medicines.” Nowhere does it target social determinants. Many of the problems with lack of access to medicine, however, are social, and social determinants are needed to deal with the incidence of neglected diseases. Just providing access to medication cannot be the whole focus. Limiting solutions to just medical interventions will have dire consequences.

From Neglected to Non-Communicable Diseases

If credit trading for medical interventions is approved, the language of the resolution could easily be extended to non-communicable diseases. Unipolar disorder, for example, is projected to be one of the major contributors to the burden of disease in low income countries by 2020.

Will interventions be limited to medical interventions -- ignoring the social roots of many conditions, and required social and psychosocial interventions?

Medicalization and the Transhumanization Dynamic

I have outlined elsewhere that variations in body functioning are increasingly being labelled as "diseases,” generating demand for "medical" products(13). In high-income countries the human body is fast becoming a commodity for “disease trading” and “disease intervention trading.” This dynamic could spill over to middle and low income countries if Kyoto style credit trading or any pure medical determinant solution and focus is applied to non-communicable diseases.

The language of the resolution and the treaty opens the door for such a development.

Personal Disease Prevention and Intervention Trading

Although not currently present in this discourse, one can envision how the concept of personal carbon trading (14-18) could be applied to personal disease prevention and intervention trading.

Personal carbon trading allocates emissions credits to individuals on a per capita basis (16). One would become responsible for one’s own carbon usage. To quote The Guardian:

“The environment minister, David Miliband, today unveiled a radical plan to cut greenhouse gas emissions by charging individuals for the amount of carbon they use. Under the proposals, consumers would carry bank cards that record their personal carbon usage. Those who use more energy - with big cars and foreign holidays - would have to buy more carbon points, while those who consume less - those without cars, or people with solar power - would be able to sell their carbon points.” (17)

A similar approach could apply to “disease intervention trading.” If one eats healthily, has a healthy lifestyle, is not involved in unsafe recreational activities, and takes as many disease prevention measures as possible -- including prebirth genetic and non-genetic diagnostics with accompanying selection and deselection procedures -- one could gain or at least not lose credits. In the same way that personal carbon trading seeks to encourage responsible energy usage, disease intervention trading could be seen as encouraging people to live responsibly with respect to their medical health. One might be able to trade something for this "responsible" style of living. Social determinants are taken out of the equation, however.

Intriguingly -- extending the environmental analogy -- one can envisage a disease generation footprint that is comparable to an ecological footprint – where the percentage of overweight people, for example, is a reflection of how active individuals are within a given social structure, what is advertised and sold, how we eat as individuals, and the activities we cherish. In other words, how a society is structured, and how it functions, leads to choices that create disease generating “footprints.”

The Choice is Yours

There is an urgent need to deal with neglected diseases. However strategies that focus just on medical determinants will have dire consequences, and might not lead to the desired outcomes. A more holistic approach is required.

Gregor Wolbring is a biochemist, bioethicist, science and technology ethicist, disability/vari-ability studies scholar, and health policy and science and technology studies researcher at the University of Calgary. He is a member of the Center for Nanotechnology and Society at Arizona State University; Member CAC/ISO - Canadian Advisory Committees for the International Organization for Standardization section TC229 Nanotechnologies; Member of the editorial team for the Nanotechnology for Development portal of the Development Gateway Foundation; Chair of the Bioethics Taskforce of Disabled People's International; and Member of the Executive of the Canadian Commission for UNESCO. He publishes the Bioethics, Culture and Disability website, moderates a weblog for the International Network for Social Research on Diasbility, and authors a weblog on NBICS and its social implications.

©Gregor Wolbring, All Rights Reserved, 2006. Reprinted with permission.