Scholar’s Corner: Recent Scholarly Works in Global Health Law

Flu Shots, Work Absences and Hospitalizations: Is an Ounce of Prevention Worth a Pound of Cure?

Courtney Ward
University of Toronto

November 11, 2008


Available at SSRN

In this study, I evaluate the health and economic consequences of a broad-based flu vaccination program. The Ontario Influenza Immunization Campaign was introduced in 2001 and delivers free flu shots to healthy children and adults. This program was novel; historically the flu shot had been recommended only for the elderly or infirm and policy expansion outside these groups continues to be controversial. The Ontario campaign offers a useful policy experiment to address this controversy by evaluating the impact of vaccinating children and younger adults against flu. Given that a simple before and after comparison of Ontario and other provinces may incorrectly attribute all changes in outcomes to the flu shot campaign, I instead develop a triple difference identification strategy that exploits variation in the match of the flu shot to the flu. I find that when the flu shot was a good match against circulating strains of flu, Ontario had substantially greater decreases in illness and lost work-time than other provinces after the introduction of the flu shot campaign. Further, based on the results for hospitalizations alone, an ounce of prevention saves a pound of cure; the program expansion costs approximately $33 million per year while, in an average match season, the program saves $102 million in respiratory hospitalization costs and $64 million in work absence costs. While the results are strongest for children and younger adults, hospitalization rates for those older than 65 fell significantly even though this group experienced no relative change in vaccination. This suggests that increased vaccination of the young has positive externality effects for the elderly.


Insurance Company Covers International Health Tourism

According to the N.Y. Times, health insurer Wellpoint is testing a new program that permits those insured to go to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.  The pilot program arranges for patients to be picked up at the airport and provides special meals to prevent food-borne illnesses. The program complies with the American Medical Association guidelines on medical tourism and uses hospitals accredited by the Joint Commission International.

By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation.

Indonesia Introduces Legislation to Microchip “Sexually Aggressive” HIV/AIDS Patients

Lawmakers in the Papua province of Indonesia support upcoming legislation that requires “sexually aggressive” HIV/AIDS patients to be implanted with microchips in order to identify, track and ultimately punish those who deliberately infect others with up to six months in jail or a $5,000 fine.

The proposed legislation has received full support from the provincial parliament and, if it passes as expected, the legislation will be enacted next month.  The government has not said how it would determine which patients should be considered “sexually aggressive.” 

Human rights workers are understandably troubled.  “People with AIDS aren’t animals; we have to respect their rights,” said Tahi Ganyang Butarbutar, a prominent Papuan activist.  Local health workers and AIDS activists called the plan “abhorrent.”

Given that much of Indonesia’s HIV/AIDS problem stems from lack of knowledge about how HIV/AIDS is spread, health workers suggest that the best way to tackle the epidemic is through increased spending on sexual education and condom use. Continue reading

Scholar’s Corner: Recent Scholarly Works in Global Health Law

Rethinking Trips: Adequate Remuneration for Non-Voluntary Patent Licensing

Antony Taubman
Australian National University – ANU College of Law

Journal of International Economic Law, Vol. 11, Issue 4, pp. 927-970, 2008

Driven by concerns about access to medicines, the World Trade Organization (WTO) Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health and ensuing negotiations to amend the TRIPS Agreement, clarified and extended the international law governing compulsory licenses and government use for pharmaceutical patents. But this process left open the question of how to determine the adequate remuneration payable when these measures are used. This article reviews this question in the light of guidance provided by the law and practice of WTO dispute settlement, and a broader legal and policy context, including the law of human rights and the law of investment. But this narrow issue also sheds light on the general character of WTO/TRIPS as a trade law regime within the broader context of international law. If the essential objective of trade law is to settle trade disputes guided by agreed standards on what constitutes a reasonable opportunity for legitimate competition, the law governing adequate remuneration for compulsory licensing shows how specific IP rules can be reconciled with trade law at the level of basic principle.

Available at SSRN

U.S. Food and Drug Administration opens office in China

The US Food and Drug Administration on Wednesday opened an inspection office in Beijing to help China export safer products to America and the world an to boost consumer confidence in products imported from China, reports the LA Times.


The new FDA field office, one of three to be opened in China, is the first outside the U.S. and comes during a dip in U.S. consumer confidence in Chinese-made products after reports of counterfeit drugs, melamine-laced milk and toys covered in potentially lethal lead paint.

Chinese officials urged the U.S. to lift new restrictions on imported foods from China, insisting that Beijing has taken effective measures to improve food safety standards since the recent tainted-milk scandal that killed four children and sickened tens of thousands of people.


Last year, the U.S. imported $321.5 billion in Chinese products, establishing China as America’s second-largest trading partner after Canada.

FDA Commissioner Dr. Andrew C. von Eschenbach said: We’re not here to superimpose our system on China…We’re here to be partners and collaborators, and offer our expertise as they request it. But consumers want to know the products they use are safe and are subjected to rigorous scrutiny. This will help ensure that.” James Rice, head of the China operations of Tyson Foods Inc said, “These FDA officials here are not going to inspect everything coming from China into the U.S. But it’s better than nothing.”

The U.S. hopes to work with China as part of a global product safety strategy that would eventually involve opening similar inspection offices in India, South America, Europe and the Middle East, U.S. Health and Human Services Secretary Mike Leavitt told a gathering of Chinese manufacturers.

News Brief: Recent Events in Global Health Law


The UN has banned smoking at “all United Nations indoors premises, including regional and country offices throughout the United Nations system”, and that tobacco sales be banned at “all United Nations premises”. WHO 

About 300 people have died in Zimbabwe in recent weeks in a cholera outbreak which has hit about 6,000 people. The World Health Organization reports that the outbreak is likely to continue as the water and sanitation situation is worsening, with severe shortages of potable water, sewage and waste disposal problems reported in most of the populated areas. BBC

Two years after the US federal government recommended that patients in emergency rooms and doctors’ offices be routinely tested for HIV, the advice is generally not being followed, according to a large number of studies presented this week at a conference in Arlington. Washington Post

Uganda‘s health ministry has began the drafting the national Medical Male Circumcision (MMC) policy for HIV prevention. The policy is as a result clinical trials carried out in Uganda in 2005 and 2007 which found that male circumcision reduced the risk of HIV by 60%. New Vision 


Banning tv ads could reduce childhood obesity- study

A study published in this month’s issue of the Journal of Law and Economics found that viewing more fast food television commercials raises the risk of obesity in children.

The economists in the study estimated that if the US was to ban fast food adverts from televiosion programs, the number of overweight children in the country would reduce by 18 percent and decrease the number of overwieght teenagers by 14 percent.

The U.S. Centers for Disease Control and Prevention estimates that 13.9 percent of children aged 2 to 5 are overweight, 18.8 percent of those aged 6 to 11 are and more than 17 percent of those 12 to 19.

 To date only Sweden, Norway and Finland have banned commercial sponsorship of children’s television programs.