This essay, on the dysfunctional pharmaceutical market, was my Observer column this week. It was published on 7 June 2020, under the headline ‘If drug firms take public funds they must make their finds available to all’.
Hotez is director of the Center for Vaccine Development at the Texas Children’s Hospital. In 2016, he and his team developed a vaccine for Sars-1, the virus that first appeared in China in 2003. Today’s coronavirus, Sars-Cov-2, Hotez observes, is ‘about 80% similar [to Sars-1]’. But by the time he developed the vaccine, Sars was no longer a public health issue and nobody was interested in funding the work. Hotez is now working to ‘repurpose our Sars-1 vaccine to fight Sars-2’. But had ‘investments been made previously, we potentially could have [had] a vaccine ready to go now’.
We could, of course, have prepared for many things better with hindsight. But Hotez’s point is not simply about Sars or Covid-19. It speaks to a broader problem with the production of medicines. Pharmaceutical companies only make products that are profitable, not socially necessary or scientifically possible. ‘Before I took this role,’ says Anna Mouser, policy and advocacy lead for vaccines at the medical research charity Wellcome Trust, ‘I would not have imagined that there would be diseases where there is scientific potential to advance vaccines but that this doesn’t progress due to the lack of economic incentives.’
Last week, London hosted a summit of Gavi, the global vaccine alliance supported by the World Health Organization (WHO) and the Gates Foundation, among others, to raise funds for immunisation programmes and the fight against Covid-19. It’s one of many organisations, including Cepi, the Coalition for Epidemic Preparedness Innovations, launched in 2017 to finance and coordinate the development of new vaccines, which seek to fill the gaps created by the dysfunctional pharmaceutical market.
The work of such organisations is of enormous importance, especially for people in low-income countries. Yet filling the gaps often also means propping up a rotten system. As Médecins Sans Frontières (MSF) notes, governments and philanthropic organisations have so far ‘given over $4.4bn to pharmaceutical corporations for research and development for Covid-19 vaccines. However, by and large, no conditions for access or affordability have been included as a precondition to any of that funding.’
The much-acclaimed deal between Oxford University’s Jenner Institute and the pharmaceutical company AstraZeneca to manufacture, if successful, the Covid-19 vaccine being pioneered at the university, has been greased by government funding to the tune of £84m. Despite this, and the research being carried out at a university, as the campaigning group Just Treatment points out, AstraZeneca ‘now owns the intellectual property rights and can therefore dictate the price’. The company has refused to share the research or trial data with a WHO initiative to pool Covid-19 knowledge.
This is not unusual. A decade ago, Gavi helped set up a fund providing $1.5bn in subsidies to Pfizer and GlaxoSmithKline to supply pneumonia vaccines for low-income countries. Nevertheless, MSF argues, many such countries were still unable to afford the prices that the companies charged.
Medicines are a public good, but they are manufactured and traded like common commodities, as if they were apples or cars. The policies pursued by organisations such as Gavi and Cepi are largely attempts to circumvent this fundamental conflict between public goods and private profits.
Perhaps, many argue, rather than find ways around the problem, we should tackle it head on, by nationalising pharmaceutical production. Even the former Conservative minister Jim O’Neill has made the case for partial nationalisation. After all, the key reason Britain established the National Health Service was to ensure that all citizens should have access to free decent health provision. If health services can be socialised, why not the production of medicines, too?
The problem is that, even if such a policy were politically viable, the dysfunction of the pharmaceutical market cannot be resolved at a national level. The problem is global and requires a global solution. Indeed, attempts to find a solution at the national level may exacerbate what many call ‘vaccine nationalism’ – attempts by richer countries to grab medicines for themselves.
There are no easy answers to this conundrum. At the minimum, pharmaceutical companies should, in return for public funding, be forced to set affordable prices and be more transparent, for instance by opening their books so we can see the actual costs of drug production. Medicines are a human necessity, not a profit-making machine.
The image is from a University of Oxford press release.