Green Talking Heads

Equitable access to medicines
#02

Gaëlle Krikorian

Researcher and Activist on Public Health Issues

09October
2021
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Equitable access to medicines

EGP Committee Member Mélanie Vogel is in conversation with Gaëlle Krikorian, a researcher and activist on public health. They discuss the fault lines of our healthcare system, and the role of patents play in the issue of unequal access to pharmaceutical goods and treatment.

Since the outbreak of the COVID-19 pandemic, public health has become part of the public agenda as never before. Aspects such as the research, funding, production, distribution and access to vaccines are now of interest to millions of citizens across the globe. However, this increasing interest has also shown that the current system is much more based on big companies maximising private interest than a consistent public policy approach from the authorities to ensure universal access to health.

Understanding the patent system and its constraints

In order to understand how access to pharmaceuticals works in the current system, it is essential to understand what a patent is. According to the World Intellectual Property Organization, a patent “is an exclusive right granted for an invention, which is a product or a process that provides, in general, a new way of doing something, or offers a new technical solution to a problem; to get a patent, technical information about the invention must be disclosed to the public in a patent application”.

The patent system intended to make sure that someone who invested a lot of resources such as money, time, and energy in research and innovation would be compensated. However, nowadays and in many cases, patents are submitted by big companies that are able to convince patent offices of their legitimacy even though they often do not give clear information about their discovery. Furthermore, since many governments consider patents as a tool to promote innovation, they grant these big companies benefits such as advantageous regulations, public money in the form of subsidies in research or partnerships with public universities, or even tax cuts.

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The patent system intended to make sure that someone who invested a lot of resources such as money, time, and energy in research and innovation would be compensated.

However, nowadays and in many cases, patents are submitted by big companies that are able to convince patent offices of their legitimacy even though they often do not give clear information about their discovery.

Furthermore, since many governments consider patents as a tool to promote innovation, they grant these big companies benefits such as advantageous regulations, public money in the form of subsidies in research or partnerships with public universities, or even tax cuts.

The pharmaceutical industry has changed a lot in the last several decades – although it is in charge of providing health products, it is also one of the sectors with the largest profit margin as their products are considered a commodity rather than an essential good. One of the biggest problems with the pharmaceutical system is that it is, as Gaëlle stated, a “black box with many layers of opacity at every level.” The COVID-19 vaccine case is a clear example, and this is not a new phenomenon.

A few years ago, the World Health Organisation (WHO) adopted a Resolution on ‘Improving the transparency of markets for medicines, vaccines and other health products’. EU member states were particularly concerned about the high prices of pharmaceutical goods as well as the inequitable access to these products among member states.

The so-called “rich countries” were starting to face what countries from the Global South have systematically suffered from – the difficulty of affording essential treatments (such as for cancer or hepatitis C). The resolution urged EU member states and the WHO to take measures to make the net prices of health products public. However, there has not been any advancement on this issue since it was adopted. Gaëlle Krikorian illustrates this issue in the podcast:

“We need to be clear about what the ratio is between the public resources injected and what the private companies are putting in (…) We need to understand what kind of advantages we’re giving to the companies, what kind of control and whether it’s legitimate or not, because all this is supposed to be for innovation, but it’s like we’re paying 10 times for the same thing!”

How we can address the fault lines of our global health system

Gaëlle Krikorian raises three key questions about the management of COVID-19 vaccines:

  1. Why are governments giving pharmaceutical companies the absolute monopoly over vaccine innovation despite the huge amount of public money that has been injected into the industry to find the cure?
  2. Why are governments facing a pandemic that is affecting the whole planet population relying on the capacity of only a handful of companies to be able to produce what is needed to save lives?
  3. Why are governments able to sign secret contracts with pharmaceutical companies producing vaccines and preventing the terms and conditions of these contracts to become public knowledge?

The answer to all these questions lies in the long-standing unhealthy relationship that governments have with the pharmaceutical industry.

A fair return on research should be established among public institutions and the private companies that make use of their knowledge

COVID-19 vaccines with messenger RNA are using a technology that was investigated with public money four decades ago. Since the outbreak of the coronavirus, European institutions and national governments have also injected a lot of money into vaccine companies to accelerate the delivery of a cure.

But despite taxpayer money having been invested in the vaccine, the public still doesn’t know how much the production of a vaccine costs and how much the European Commission is paying for each dose. Transparency is crucial in order to have democratic control over where public money goes.

Patents should not stand in the way of the production and distribution of life-saving vaccines

Companies should be forced to share the technology in order to scale up the production and make it accessible to all. The argument that the technology is too sophisticated for others to produce it has been disproved – RNA technology has for example shown to be very easy and fast to transfer. There are many countries – from India to Cuba – with the capacity, expertise and knowledge to produce these health products. The TRIPS Agreement (the Agreement on Trade-Related Aspects of Intellectual Property Rights) does contain some exceptions – mainly in Article 30 – which could allow states to temporarily waive patents on COVID-19 products for instance. 

This measure is also a matter of political will. It is also possible to stop allowing big pharmaceutical companies to have a monopoly on the production of essential health products. In many cases, these pharmaceutical multinationals externalise various stages of the production to medium and small enterprises (SME) – from basic research to clinical trials – which governments could contract directly.

COVID-19 vaccines and other essential health products could also be granted it the status of ‘public good’ in order to ensure their accessibility

The term comes from economic theory and refers to “a good that no consumer can be excluded from using if it is supplied, and for which consumption by one consumer does not reduce the quantity available for consumption by any other”. Another concept that has a similar approach is ‘common good‘; which means “those facilities – whether material, cultural or institutional – that the members of a community provide to all members in order to fulfill a relational obligation they all have to care for certain interests that they have in common”. The key aspect here is the governance mechanism – how people can control the governance over medicine to make sure that is transparent, accessible and available for everyone.

Building a transparent and accountable health system as part of a better, greener and fairer world

The pandemic has shed light on the fault lines of our global health system. It has brought forth health, socioeconomic and financial crises that have hit vulnerable communities the most. This pandemic has shown us how difficult it is to tackle such a challenge without the cooperation of all global actors. It is also showing us how unsustainable, unfair and unequal access to healthcare currently is. It has illustrated how economic profit is prioritised above citizen rights. Nevertheless, it has also shown us that there are many alternatives that we can rally behind. We can have a more transparent and accountable healthcare system, if only we dare to raise our voices, rethink our systems, and rebuild a fairer and greener world.

The European Green Party adopted a Resolution in the last Council (May 2021) calling for a fair distribution and global access to COVID-19 vaccines – you can find out more about our demands here.

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