171. As Canada has previously said, while the Paragraph 6 System is a useful tool, it should not be regarded as a panacea for the complex problem of access to medicines. Indeed, medicines are one of the many components of health systems, the price of medicines is one of the many factors affecting access to those medicines, and intellectual property is one of the numerous factors influencing the price of medicines. The impact of intellectual property rights on access to medicines, on the price of those medicines and on health care in general is proportionate to the role played by intellectual property in relation to other factors affecting the price and availability of medicines, including infrastructure, health systems, regulations, distribution and administration of medicines, in addition to customs tariffs and other taxes applicable to them.
172. Indeed, it is our understanding that a quarter of Members eligible for the Paragraph 6 System without notification under paragraph 1(b) of the Decision of 30 August 2003 continue to impose import tariffs on medicines at rates of up to 15%, or even 25%. The situation is comparable for other eligible Members. Moreover, a 2011 study by the WHO and the Dutch NGO Health Action International shows that many Members that are eligible for the Paragraph 6 System apply different taxes on medicines in addition to port, customs clearance, transport and/or inspection charges, at rates ranging from 5 to 34%, on top of customs tariffs where they exist. Another study by the same two organizations, published in 2014, reveals that increased distribution charges can push up the price of medicines by another 17 to 84% in relation to the manufacturer's price in low- and middle-income countries, regardless of the patent status.
173. In other words, we think that tariffs, taxes and charges on medicines can neutralize, at least in part, the beneficial effects of the flexibilities we have given ourselves, which is tantamount to lifting a barrier to exportation and availability on the one hand while erecting barriers to access to medicines on the other.
174. This being the case, we cannot examine either the Paragraph 6 System or intellectual property in isolation from the other issues affecting access to medicines. Canada would like to note that according to a United Nations report published in 2014, even essential generic medicines are available in only 55% of public sector health facilities in low- and middle income countries. In other words, the absence of a patent on a particular medicine is no guarantee of its availability; hence the need to examine all of the factors that impact access to medicines, as well as all of the supply mechanisms. In this connection, Canada would like to underscore the importance of voluntary licences, including those obtained through the Medicines Patent Pool, as well as pooled supply systems such as those used by the East African Community. We would be happy to discuss the experiences of importing Members eligible for the Paragraph 6 System in this respect, and more generally, the supply mechanisms they advocate and the challenges those mechanisms would involve.
175. We reiterate that Canada's Access to Medicines Regime that implements the Paragraph 6 System, clearly functions well in its current form, and meets the requirements and parameters laid down in the Doha Declaration on the TRIPS Agreement and Public Health. The Canadian Access to Medicines Regime is just one of many aspects of Canada's firm commitment and leadership when it comes to access to medicines and public health for the least developed and developing countries.
176. Let me conclude by calling upon all Members that have not already done so to deposit their instruments of acceptance of the Protocol Amending the TRIPS Agreement.