A/HRC/23/42 I. Introduction 1. In its resolution 17/14, the Human Rights Council requested the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health to prepare a study on existing challenges and good practices with regard to access to medicines in the context of the right to health, ways to overcome them and good practices. Taking into account previous reports of the Special Rapporteur and his predecessor on various aspects of access to medicines,1 he deemed it appropriate not to deal with issues related to intellectual property in the present report. This report therefore focuses on other important issues that determine access to medicines, including essential medicines,2 local production of medicines, procurement, distribution, quality control and appropriate use of medicines. 2. In the preparation of this report, the Special Rapporteur carried out consultations with a variety of stakeholders, including Member States, international organizations, civil society, pharmaceutical companies and other experts. He considered responses generated from consultative questionnaires, which were distributed to the stakeholders and also made publicly available on the Internet. The Special Rapporteur is grateful for the overwhelming interest shown by States, international organizations and civil society in responding to the questionnaires. It is however regrettable that only a few responses were received from the 40 pharmaceutical companies to which the questionnaire was sent. The Special Rapporteur also held consultations in Belgium (Brussels), the United Kingdom (London, through his assistants), Brazil (Brasilia and Sao Paolo), Uganda (Kampala) and the United States (Washington, DC), where he met with government agencies, pharmaceutical companies and associations, civil society representatives and other experts. Information from these visits also fed into the report. II. International legal framework 3. Access to medicines is an integral component of the right to health, as enunciated under article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR).3 The Committee on Economic, Social and Cultural Rights in its interpretation of the normative content of article 12 issued its general comment No. 14 (2000) on the right to the highest attainable standard of health, which provides that all health services, goods and facilities, including medicines, should be made available, accessible, acceptable and of good quality.4 While several aspects of the right to health are understood to be progressively realizable, certain core obligations cast immediate obligations on States, including the provision of essential medicines to all persons in a non-discriminatory manner.5 4. The right-to-health framework sets out key elements that should be fulfilled by States to ensure access to medicines. First, medicines should be made available in sufficient 1 2 3 4 5 A/HRC/17/43, A/65/255, A/HRC/11/12 and A/63/263. While essential medicines are selected nationally, internationally they are defined within the framework of the World Health Organization (WHO) Model Lists of Essential Medicines. The 2001 Declaration of Commitment on HIV/AIDS and the Doha Declaration on the TRIPS agreement and public health also recognize access to medicines as instrumental to the full realization of the right to health. E/C.12/2000/4, para. 12. Ibid., para. 43(d). 3