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South Africa’s coronavirus lockdown measures, some of the strictest in the world, have earned praise from groups including the World Health Organization [WHO] for saving lives – but at the same time, recent data could prove some analysts’ claims that its economy has been largely “destroyed.” (

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The Challenge of Access to Safe Internet Pharmacies and Medicines During Pandemics

Co-authored by Ron Andruff & Mark W. Datysgeld.

With 300+ sessions and over 7,800 participants from 158 countries across every time zone, RightsCon Online 2020 (July 27-31) demonstrated the importance of convening people worldwide to bring about positive changes in a time of crisis. The Dahdaleh Institute for Global Health Research (York University, Canada) organized a panel of diverse experts and academics (please see the Panel List at the end of this article) to discuss: Promoting human rights and access to safe medicines during pandemics: The critical role of Internet pharmacies.

Over the last four years, we have been working within ICANN, RightsCon and the United Nations Internet Governance Forums to build out a set of standards and norms on the foundation established by the Brussels Principles. We're seeking to clarify the governance and jurisdictional issues in a human rights context that promotes the good actors while rooting out the rogues, using a balanced approach to global access to safe medicines purchased from Internet pharmacies. This is consistent with the 2017 U.N. Human Rights Council Resolution for "[...] the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, including access to essential medicines". The Brussels Principles on the Sale of Medicines over the Internet" were developed by a coalition of stakeholders, Internet experts, and civil society at RightsCon Brussels 2017; and subsequently adopted at RightsCon Toronto 2018. At this most extraordinary time, we were happy to be back working with Access Now and the global rights community to continue this critical conversation.

Our main question is whether standards and norms should be advanced at the inter-governmental level through the arduous process of harmonization of trans-national laws, or whether they are best achieved at the Internet governance level, such as through ICANN policy development. What lessons can be drawn from other industry sectors? And, notably, who is the convener of such important work? Should this issue be raised to the agenda of international institutions such as the World Health Organization?

As panelist Dr. Jillian Clare Kohler rightfully stated, before the pandemic, the question of fair pricing of medicines was already a complex issue, and now that issue has been exponentially compounded. Corruption, Dr. Kohler noted, is the abuse of trusted power for private gain, and it finds its way into these situations. The proliferation of fake medicines has been strongly linked with disturbances such as supply disruption and fear-mongering, which could escalate matters in the context of a poorly coordinated, unfair distribution of potential vaccines and medicines against COVID-19.

Panelist Dr. Aria Ilyad Ahmad, who presented his seminal paper "Digital Governance of Public Health: Towards a Regulatory Framework for Internet Pharmacies” at IGF Berlin 2019, invited stakeholders to consider what are the applicable international human rights norms; where do moral and jurisdictional interests intersect (and clash); and, in particular, which institutions have the mandate and legitimacy to set standards and guidelines.

Exploring legal and regulatory approaches that advance the right to health while confronting the risks posed by rogue Internet marketplaces, further exposed vulnerable communities being disproportionately impacted by the virus, and the surging demand on health systems, which has contributed to critical shortages in access to care.

Dr. Oki Olufuye brought the Global South perspective, focused on Nigeria, asking if there is really justification for medicine price discrepancies between different countries. Africa not only suffers from a lack of access to the Internet (just 47% of Nigeria's population of 200 million are online), it also lacks access to a safe, public health infrastructure — both off- and online. She noted that medicine can be bought by the pill without prescription, sometimes in settings as informal as on a bus. Long queues in hospitals force people to go to pharmacies for their general care instead. As Dr. Olufuye puts it: "Accessibility — in every way you think of it — is the challenge in the Global South." It is not difficult to see how fair access to the Internet, combined with safe Internet pharmacies, could advance progress in public health and basic human rights.

Relative to the nature of the complex jurisdictional challenges, panelist Bertrand de la Chapelle declared that important lessons can be gleaned from the earlier free-for-alls around multimedia distribution over the Internet, with the industry initially fighting costly battles against file-sharing software such as Napster and its users. Only through cooperation and the creation of fairly priced services for film and music streaming was an appropriate compromise achieved.

Mr. de la Chapelle noted that any action taken at the Domain Name System (DNS) level acts as a very blunt tool, so it needs to be scoped with precision to be effective. Medicines are naturally regulated due to their risk of harm, often at the national/regional level. The jurisdictional challenge arises when a pharmacy is legal in one jurisdiction, but accessible and necessary in another; blocking it at the DNS level creates problems for all involved parties.

That notwithstanding, there are thousands of illegitimate rogue actors gaming the DNS, and all panelists agreed that they must be shut down. Current measures appear to be solely focused on denouncing all Internet pharmacies irrespective of those safe, licensed pharmacies, rather than establishing a set of multi-stakeholder-developed safety standards and norms to enable appropriate trans-national access. Reaching that precise balance is a mission that the global governance community needs to undertake.

These questions, taken together, are fundamentally a human rights issue, which brings with it questions of licensing, distribution channels, and trans-national recognition. There is a need for a multi-stakeholder initiative to discuss the possible ways to enable access to legitimate medicines across borders, in a transparent manner that avoids corruption. This is particularly important considering potential future pandemics or other situations of global health vulnerability.

Invited to intervene from the audience, Tim Smith, Executive Director of the Canadian International Pharmacy Association, explained that despite their extensive membership criteria and safety and privacy protocols, as well as a policy of not selling controlled substances such as narcotics or opioids, the Internet pharmacy association continues to face barriers. Not from patients, but barriers imposed by search engines to organic searches and online advertising, and even access to the top level domain ".pharmacy," which is controlled by a U.S. trade association. To this last point, Mr. de la Chapelle added that the ".pharmacy" Registry Operator is subject to U.S. law; bringing in to question whether or not that TLD could potentially be considered an appropriate Internet pharmacy accreditation mechanism.

A recurring multi-stakeholder model challenge is actors pointing to each other's deficiencies, rather than acknowledging the common problems they share. In this case, all of the legitimate actors face the same challenge of dealing with the thousands of rogue actors who exacerbate the problems of access to safe medicines. With COVID-19 casting a long shadow on the shrinking global economy, all of the panelists agreed that the time to engage the multi-stakeholder model to make real the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, including access to essential medicines, is now; so this discussion will continue at the IGF Online 2020 in the session "Pandemics & Access to Medicines Over the Internet: A 2020 Assessment." If this topic has captured your interest, please watch for future announcements. We welcome broad multi-stakeholder participation.

Finally, when we asked the 275 participants who attended our RightsCon panel discussion: "Are standards and norms best accomplished at the inter-governmental level or rather at the Internet governance level?" the poll reported 65% believe that this is an Internet governance issue, relative to 35% who felt it is a trans-national governmental issue.

Good food for thought.

RightsCon 2020 Panel List

Aria Ilyad Ahmad: Global Health Foresighting Research Fellow, Dahdaleh Institute for Global Health Research

Jillian Clare Kohler: Professor, Munk School of Global Affairs and Public Policy; Director, WHO CC for Governance, Transparency and Accountability in the Pharmaceutical Sector

Bertrand de la Chapelle: Executive Director, Internet & Jurisdiction Policy Network

Oki Olufuye: Health Manager, Consultant; Teraputik Konsulting

Pat Kane: Senior Vice President, Verisign Naming and Registry Services [Unable to participate]

Ron Andruff: President, ONR Consulting, Inc. [Moderator]

Mark W. Datysgeld: Internet Governance and Policies consultant, Governance Primer [Online Coordinator]

Written by Ronald N. Andruff, President at ONR Consulting, Inc.


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2020's New Internet Success

CircleID has taken the rare exception to publish this essay anonymously at the request of the author. The reason for anonymity is not to avoid personal or professional harm, says the author, but to drive a point regarding the critical subject matter discussed.

Chinese technology policy is now more effective even than their naval posture in the South China Sea, and both are playing out in full sunshine. This success is not about the hardware pillar of Chinese tech policy, though: its focus is the structural approach China and, increasingly, other stakeholders are taking to global Internet Governance.

Place and Timing

Late in the Year of the Pig just gone, China's offer of a New Internet Protocol was chewed over in senior-level advisory groups of the International Telecommunication Union (ITU) after which the formal consensus-building process of that UN organization considered the matter in March and again in July of this year. There were a few briefings and workshops to explain the merits of the system in between times, particularly in Africa, where the ground for novelty and inclusion is fertile. From these briefings, it is clear that a timeframe for rolling out an alternative internet protocol is still notional, but that proponents are aiming at 2024. In the meantime, Huawei, at least, is attracting significant interest around the opportunity by announcing that certain features of New IP will be embedded in their networks within the next 10 years, offering all stakeholders time to evaluate and appreciate the new approach.

Many Benefits

The "top-down" New IP system will provide a universally-accessible alternative to the current TCP/IP model that has dominated until now. New IP is proving attractive to governments particularly because it assigns each user of the Internet a unique token for naming and addressing that marks all their activity in cyberspace: an obvious but effective way to limit excessive user privacy and eliminate the wet anonymity that has been characteristic of modern creatives from the authors of the Federalist Papers to JK Rowling. New IP will enable central national authorities to manage the authentication process directly, so that under-resourced governments will now be able totally to deliver on the promise of meting out security among their citizens and anyone they interact with online. In this way, freedom of expression is preserved while creating accountability for that expression to any government that believes it should be punished. As importantly, under this approach e-commerce can also be more effectively surveilled, and web-based innovations or content that build on the work of others can be tracked to their sources and addressed in the way the government of that creator's country deems the most expedient, or effective, or quickest. And finally, there will be a rebalancing of charges within eCommerce as well. With embedded "kill-switch" functionalities the New IP will become a practical tool to enforce new protective tariffs on digital services and for extracting appropriate revenue from multinationals, in time to help answer the call of many governments that are already trying hard to ensure the WTO Moratorium on Electronic Transmission does not get extended.

Growing Consensus

The robust proposals of New IP have currency from more than just the Central Kingdom; in Europe, they enjoy support from Telecom Italia and in Africa by at least eleven governments: Burundi, Côte d'Ivoire, Guinea, Mali, Niger, Nigeria, Senegal, South Sudan, Tanzania, Zambia, Zimbabwe. There is every reason to expect — there's no case being made to the contrary, so consensus can only build — that other European entities and governments, those that enjoy strong partnerships with proponents of New IP, will join their voices to this initiative. The United States, which can be sceptical about Chinese initiatives, is today not engaged here, and it is possible to read from this that the U.S. stakeholders are unconcerned, agree, or just take less interest in Internet Governance.

Root Success

In parallel, Huawei is successfully using its diplomatic and commercial influence to generate further governmental support for the initiative. They have helpfully offered trials of the New IP-enabled applications that are filling actual gaps in many countries: those connected to agriculture, remote education, and artificial intelligence. It is unlikely that such large trials will see a reversion back to use of the old root zone, and so many important industries in the developing world should now become zealous champions of New IP, not just for themselves but in a way that gives them a stake in universalizing the use of the new protocols worldwide.

Give it Time

Over the long run, beneficiaries of the Internet economy may become interested in the possibility of increased compliance costs associated with operating with more than one network. But there'll be time enough to consider the validity of such concerns since any costs will become clear once there are two systems in full operation worldwide. Here too, quiet observation and cautious but patient restraint by those most affected will provide the space necessary for China to demonstrate the benefits of competition in matters of Internet protocols and to allow them to flourish — a thousand such may yet bloom — out in the bright sunshine.

Anonymous, TCP/IP.

Written by CircleID Reporter


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