In 2016, the World Health Organization (WHO) released a report highlighting sixteen pathogens that pose a serious threat to global health and that are desperately underfunded when it comes to research. One of the sixteen pathogens was, of course, coronavirus – that is, not the new coronavirus (SARS-CoV-2), which did not yet exist; but the class of coronaviruses in general, which include the viruses that cause SARS and MERS.
The prophetic report was intended as a call for the largest pharmaceutical companies in the world, who collectively invest billions in R&D annually for pathogens that are already threatening humanity or that will happen soon. Despite the WHO warning, Big Pharma did not listen. Two years later, in 2018, the pharmaceutical giants had no research projects to fight coronaviruses.
It is clear that the WHO was right; and it is understandable that by 2020, pharmaceutical companies had spent money on studying coronavirus. Yet they still do little to heed the WHO’s warnings about the other sixteen pathogens: a report released by the Access to Medicine Foundation last month shows that at 6 only 16 of the 16 pathogens have any research into the pipelines had. Of the research projects, the vast majority – 63 out of 76 – were for COVID-19. Because the other pathogens did not kill enough people in the west (although the mosquito-borne chikungunya virus, one of the sixteen pathogens, swept through Africa and India), Big Pharma was reluctant to cough up money for the R&D.
It may be strange from where the world is now sitting and thinking that the pharmaceutical industry ever thought it had nothing to do with coronavirus research. After all, COVID-19 is the gift that will give Big Pharma for years to come. There are booster shots to be delivered and many profitable monoclonal antibodies to be made. Given how profitable COVID-19 was for the industry, one would think it would pay more attention to smart businesses that are profitable for the next pandemic.
Why can the pharmaceutical giants not heed the warnings of the WHO? To understand why Big Pharma ignored coronavirus until it became a global pandemic, one must understand the twisted business model.
Pharmaceutical companies make money by discovering medicine and then protecting medicine through artificial monopolies. Without competition, drug companies can then turn around and charge the price they want for the new medicine. It makes sense for pharmaceutical companies to prioritize disease research with the richest patients – while paying little attention to diseases that kill poorer patients. This means that diseases such as cancer and diabetes receive a lot of research funding, and diseases such as Ebola, Zika virus and malaria do not. Unless the industry is sure that there are great benefits in the future, no pharmaceutical company is going to take the risk of finding a cure. In other words, Big Pharma is not interested in drugs for deadly diseases if there is no guarantee of high rewards. An example is antimicrobial resistance (AMR). If you are one of the unfortunate souls who gets gonorrhea, your doctor will probably prescribe you a series of antibiotics. The problem with gonorrhea (besides the physical discomfort and uncomfortable calls to former lovers) is that these diseases are becoming increasingly difficult to treat due to the growing resistance to antibiotics. A 2014 Chatham House study predicted that by 2050, AMR would kill 10 million people and cost the world economy an estimated $ 100 billion. Although these are incredible numbers, an antibiotic other than, for example, a cancer remedy makes doctors not want to prescribe it; over-prescription is what creates more resistance. It creates a deterrent for these lucrative ventures to make new kinds of medicines that can help fight antimicrobial resistant pathogens. As a lawyer from a Big Pharma company told me once a year, “think of AMRs like fire hydrants. You need them, but you never want to use them.”
The problem is that the disease eventually becomes resistant by using it – and then you need a new range of antibiotics. And medicine companies do not want to invest in medicine if doctors are reluctant to prescribe it. A report by the Pew Charitable Trusts showed that only 42 new antibiotics are being developed, while there are more than 1,100 treatments for cancer. It makes more sense to spend money on cancer for the growing number of sick westerners, than for an antibiotic you will not be sure of. The underlying problem here is that we as a society have entrusted private enterprises with the incredible task of finding medicines for sick people. It is a well-established fact that the price of medicines is not based on R&D costs, but on the maximum amount that pharmaceutical companies think they can charge. The old line is that Big Pharma has to charge such high prices to cover the cost of drug research and reinvest in new drugs. To begin with, this argument is unfounded. A 2017 report looked at the simple price differences between the US and Europe for the top 20 best-selling medicines. In 2015, the net price difference between the two regions was $ 116 billion, while global R&D costs were only $ 76 billion. Pfizer, the manufacturer of one of the COVID vaccines, has recovered more than twice its R&D spending in just one year through US premium prices. The money does not flow back to research pipelines, but rather lies in the pocket of the company’s shareholders.
Pharmaceutical companies often defend their high drug prices by claiming that they have to pay a lot because most drugs do not have clinical trials, and the cost of bringing new drugs to market is becoming more expensive. These are true statements. Most drugs fail, but they fail early in Phase I trials, and much of the early research is funded with public money. A 2018 report showed that the U.S. National Institutes of Health (NIH) contributed money to all 210 new drugs approved by the Food and Drug Administration between 2010 and 2016, and provided $ 100 billion in research funding. U.S. taxpayers cover the cost of medical research and in return receive an increased price of drugs. The pharmacists I talk to are vehemently opposed to changing the system. One thing they tell me is that the public will have very little appetite to pay for all the research that goes into failed medicine. This is a ridiculous argument because we cover all the costs of failed drug research while paying more than billions of drug prices for successful research. The drug companies will also point to the success of the COVID-19 vaccines as an example of their rapid efficacy. They casually ignore the large sums of money they have accepted from governments, which made it possible in the first place. The Modern vaccine was funded entirely with U.S. tax money, and the AstraZeneca vaccine was developed with public funding from the Jenner Institute at the University of Oxford. The Pfizer / BioNTech vaccine was also made possible with almost half a billion dollars from the German government. The private companies would not be able to get a drug on the market as quickly if the public did not even pay for it.
There is an alternative way to discover new medicines that are not patent-pending, to create incentives for drug research. The system is known as delinkage. The idea is that instead of pharmaceutical companies using patents to create monopolies and charge ridiculous drug prices, governments will offer a combination of cash prizes, contracts and tax credits as a reward for access to the market to fund research. This means that the price of drugs is directly linked to the cost of developing the drug, rather than pharmaceutical companies believing that a desperate dying patient should be willing to pay for it.
The delinquency movement is gaining momentum. In 2017, Bernie Sanders enacted legislation to recognize the incentives granted to pharmaceutical companies through the patent system and replace them with public access awards. Sanders’ so-called Medical Innovation Prize Fund would equate to 0.55% of GDP, amounting to $ 102 billion in research funding. Across the dam, former British Labor Party leader Jeremy Corbyn called for a study in demarcation in his 2019 policy proposal ‘Medicines for the Many’.
Delinkage is not an idea on the left. Andrew Witty, former CEO of GlaxoSmithKline, proposed scrapping as a way to fund research for rare diseases; Joseph Stiglitz, the 2001 winner of the Nobel Prize in Economics, also argued for replacing the patent system with reward for market access. One of the many benefits of delinkage is cheaper drugs, but also drugs for a wider range of diseases. Next time the WHO says an investigation into new pathogens is needed, governments could create a cash prize to encourage pharmaceutical companies to put research into the pipelines to help bring a drug to market faster .
Another benefit to unraveling is sharing information. In the current patent system, pharmaceutical companies store their data and research from competitors who can use it to develop their own remedy. Under delinking, all information and data can be made public so that scientists can repeat the mistakes another research team has already made. The open sharing of information is of great importance in COVID-type scenarios when time is of the essence.
But the biggest reason to change the current way we research research is not just about efficiency and pricing, but also about morality. Neo-liberalism has given a price to everything, even human life. Farmers in India will die because a cancer remedy is not talked about patent. Millions of others die unnecessarily from HIV, even though PrEP has been around for decades. And the rollout of vaccines has shown that, despite global movements for racial equality, rich white countries will be relieved of COVID months, if not years, ahead of those in the developing world. If patents were no longer a problem, countries such as India and South Africa would not have to beg the WTO for permission to waive intellectual property rights so that they could make their own COVID vaccinations and therapies. What this means is the idea of justice – the idea that someone’s right to life should never be determined by how much money he earns. Neoliberalism opposes an opposite worldview.
Anthropologist Margret Mead once said that the first sign of civilization was a thigh that was broken and then healed. As she explains, animals in the animal kingdom die when their legs break because they can no longer get water and food and can not protect themselves. That first healed leg is proof that someone in society carried the person to safety and looked after his wound.
If we consider ourselves civilized, we should make sure that we provide medicine to all who need it, regardless of their income, where they live or the disease they suffer from.