IGF 2021 WS #268 Right to safe medicines: Managing competing interests online

Thursday, 9th December, 2021 (14:05 UTC) - Thursday, 9th December, 2021 (15:35 UTC)
Conference Room 4

Organizer 1: Private Sector, Latin American and Caribbean Group (GRULAC)
Organizer 2: Private Sector, Western European and Others Group (WEOG)

Speaker 1: Aria Ilyad Ahmad, Civil Society, Western European and Others Group (WEOG)
Speaker 2: Dr. Olga Kyryliuk, Civil Society, Eastern European Group
Speaker 3: Zina Hany, Intergovernmental Organization, African Group
Speaker 4: Mark Datysgeld, Private Sector, Latin American and Caribbean Group (GRULAC)

Additional Speakers

Elizabeth Behsudi, Director of the Domains & Jurisdiction Program at the Internet & Jurisdiction Policy


Round Table - Circle - 90 Min

Policy Question(s)

Assessing Internet governance approaches and mechanisms and fostering inclusiveness: What are the main strengths and weaknesses of existing Internet governance approaches and mechanisms? What can be done, and by whom, to foster more inclusive Internet governance at the national, regional and international levels?
Governance and cooperation for an evolving Internet: How does Internet governance need to change in order to meet the changing nature and role of the Internet? What tools, mechanisms, and capacity building instruments are needed for stakeholders to effectively cooperate, and engage in Internet governance?

Additional Policy Questions Information: A. What are the next steps the Internet Governance community should take to facilitate solutions to issues that depend on the balancing of competing interests, such as is the case of the sale of medicines online? B. What ought to be the role of Internet Intermediaries (registries, registrars, hosts, content platforms) in increasing trust online, considering their unique position of being able to mediate relations between competing actors, and what checks and balances should be in place to simplify this role?


An estimated 8 million individuals die each year from preventable causes, which roughly corresponds to one out of five or six deaths in the world. (Blake C. Alkire, Alexander W. Peters, Mark G. Shrime, John G. Meara, 2018)


A.Progress has been made in the handling of malicious actors online and discussions are being advanced around specific critical issues such as DNS Abuse, but without a broader plan on how to assert legitimacy and quickly deal with threats, solutions will remain flawed. More tangible conversations need to be had on this subject to understand what are the next steps, instead of taking a reactive position that gives the advantage to malicious actors.

B.It has become increasingly clear that Internet intermediaries have the capability of generating greater trust online with their decisions, having a real impact on cybercrime and slowing down malicious actors. The question moving forward is how legitimate actors can be consistently identified and incentivized to engage with the intermediaries in a constructive way, within a system that has the proper guardrails to increase trust.




Targets: The guiding principle for our actions has been Goal 3: “Ensure healthy lives and promote well-being for all at all ages”, in particular 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. We are also attentive of Goal 10: “Reduce inequality within and among countries”, particularly 10.3: “Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard”, seeing as the ones most affected by the lack of access to medicines are the poor, who cannot afford treatment or have to resort to unsafe black markets. Finally, 17.7 speaks to the specific theme of this session and its intent of advancing stakeholder cooperation: “Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships Data, monitoring and accountability”.


The pursuit of responsible global governance mechanisms that balance the interests of different stakeholders has proven challenging, with the added burden of strained political relations and disruption of activities caused by the global pandemic. Like most critical moments in history, this inflexion point can be a setback to the progress of public interest pursuits, but it can also be used as an opportunity to reflect on the current state of matters and how find the best way forward to the furthering of humanitarian objectives.

Drug supply problems are a critical constraint for making progress in health outcomes within the spectrum of treatable diseases globally. According to the World Health Organization (WHO) about one-third of the global population does not have regular access to medicines, so the advent of Internet pharmacy is creating opportunities for better access to medicines; at the same time, the global expansion of falsified/substandard medicines, if sufficient controls are not in place. The WHO estimates that about 25 percent of drugs consumed in poor countries are falsified or substandard.

In continuation to IGF 2019’s WS #92 “Public Health Online: Shadow Regulation-Access to Medicines” and IGF 2020’s WS #116 “Pandemics & Access to Medicines: A 2020 Assessment”, this Workshop intends to once more bring together diverse voices from the internet Governance community to advance discussions around the subject of access to medicines, building upon the knowledge gained during previous events and pursuing the formation of a formal group interested in the long-term implications of this issue, preferably in the form of a Dynamic Coalition.

Our key takeaway from previous years has been that the clearest point of tension lies in the relationship between parties which exert control over Internet resources (such as registries, registrars, hosts, and content platforms) with actors from the Health sector that facilitate or directly sell medicines using the Internet. Without clear protocols in place on how to deal with different actors, the controllers end up at times both blocking legitimate operations, while also allowing illegitimate ones to remain online for too long. This results from a lack of greater collaboration and mediation between the involved parties, and is an issue not exclusive to the Health sector.

Therefore, we seek a broader discussion that is still rooted in our core theme, which is that of managing competing interests in Internet Governance. We see great importance in understanding what are the next steps and how to find avenues forward, as the Internet becomes an increasingly complex space which demands progressively more sophisticated solutions from participating actors to ensure the maintenance of the public interest.


Expected Outcomes

This is a session in preparation for the assembly of a group aimed at generating continuous debate on the subject, and its outcomes will be added to the findings from the Workshops of previous years in order to serve as a guide to the priorities that need to be adopted by said group. Regular publications are being carried out to serve as catalysts for debate and policy generation, and the active understanding of the issues presented here are key in enabling us to generate material that is relevant to the community and helps answer their concerns.


One of the main goals, if not the main goal, of our previous sessions has been to create opportunities for stakeholders to interact organically within a non-judgmental context. This will continue to be strongly emphasized, as it has led to incredible contributions, ranging from personal experiences being shared to dialogue between stakeholders that do not usually talk directly.


Online Participation

Usage of IGF Official Tool.

Key Takeaways (* deadline 2 hours after session)

Conflicting interests vary based on what region of the world is being looked into. However, actors such as operators of the Internet’s critical infrastructure and global pharmacy companies are ever present. Bridges should be built between these actors making use of the Internet Governance ecosystem.

Considering the variety of involved actors, some often only noticed at the local level, more regional research needs to be performed to achieve a better understanding of the challenges of increasing access to medicines in different parts of the world.

Call to Action (* deadline 2 hours after session)

The Internet Governance community needs to pay more attention to matters of health and access to medicines.

Our health is our most important asset, and should be seen as a policy priority, not as a parallel discussion.

Session Report (* deadline 26 October) - click on the ? symbol for instructions

Moderator Ron Andruff (ONR Consulting) set the stage by explaining the group's ongoing mission to bring the subject of access to medicines to the Internet Governance community, in a series of IGF Workshops carried out over the past few years. He emphasized the need for better coordination between actors to achieve the humanitarian goal of improving health outcomes by means of a patient-centric approach.

Speaker Aria Ilyad Ahmad (Dahdaleh Institute for Global Health Research) highlighted the jurisdictional challenges involved in matters of health, and particularly in relation to the importation and exportation of medicines. The need to balance markets and achieve the right amount of regulation was a central point to his intervention, explaining how over and under-regulation can have negative impacts on patients outcomes. A framework that can interoperate matters of Internet Governance and health is an important gap that needs to be addressed.

Speaker Olga Kyryliuk (SEEDIG) approached the subject from the angle of the SEE and EU regions, bringing up examples of how policies have worked or not in the recent past. She gave particular emphasis to the "EU Common Logo", an intiative that has been a successful vector in the combat of rogue actors online who sell medicine wrongfully. This technique is transparent enough that other State actors could pick up on it to improve matters in their own regions.

Speaker Mark Datysgeld (Governance Primer) presented original research on access to health and medicines online in the LAC region, discussing the situation on the top 10 countries by GDP. He presented data outlining how the majority of countries studied didn't have clear regulations on the sale of medicines using the Internet, leaving matters in a troublesome gray area. Most of the telemedicine regulations are also recent and insufficient to address the necessities of the general population.

Speaker Zina Hany (B.Pharm, MPH, MBA, CEPH) brought the MENA region's perspective to the table, pointing out the wild price variance between even neighboring countries of similar economic conditions. She stressed the necessity of this information being made available to patients so that they are better informed of the situation. With pressure built up, gatekeepers and governments would need to pay attention to the quesiton instead of being able to sideline it.

Speaker Elizabeth Behsudi (Internet & Jurisdiction Policy Network) presented I&J's work on domain names, explaining the importance of stopping malicious actors who exploit the DNS to sell medicines wrongfully. She pointed out that I&J's model of bringing all relevant stakeholders to the table and effectively mediating their conversations, helping advance common goals, has been effective in addressing several hot topics, and could be brought to that of access to medicines.