Global health: public vs private interests in times of pandemics

Modern epidemiology is often traced back to British doctor John Snow, who is not only credited with discovering how cholera spread during London’s Great Stink of 1858, but also as the unofficial founder of public health. The latter concept relies on the idea that hygiene and scientific knowledge can combat contagious diseases and that this task should be in public hands. However, in recent decades, the world of medicines and vaccination has not escaped the trend of privatization and globalization.

In the 19th and 20th centuries National Institutes for Public Health were established around the world to find cures for diseases and to develop vaccines. This task, which was usually attributed to a specific vaccination department or “state vaccination factory” has been abandoned in recent years and replaced by a focus on the implementation of prevention programmes. The decision by countries like Spain, Sweden and the Netherlands to abolish their vaccination factories and sell them to big pharma companies in the 21st century can now have serious consequences. While the Dutch vaccination factory was still able to produce a smallpox vaccine at short notice after 9/11 and the subsequent threat of bioterrorism, this is no longer possible. The closing of such factories was required for budgetary reasons but also because technological improvements and stricter safety norms required vaccine development to be scaled up.

Importantly, the national institutions have not been replaced by cross-country collaborations on the European or global level nor is the private sector always sufficiently interested in filling the void. Still no vaccines have been developed for some of the most deadly diseases in the developing world, including AIDS, tuberculosis and malaria, prompting the WHO to conclude that “the market for vaccines for diseases of developing countries is neither sufficiently big, nor sufficiently predictable, to offer returns on investment in expensive research and product development”. Privitization has also led to excessively expensive prices for some medicines and lower investments in R&D. The Atlantic has found, however, that the private sector invoking high research costs to justify high prices is deceptive and that the revenue from the 20 most popular prescription drugs is more than enough to cover the R&D costs of developing those drugs.

With the pharmaceutical industry being one of the most profitable on earth with an expected worth of $1.4 trillion by the end of 2020, Ellen ’t Hoen, director of Medicines Law & Policy, nonetheless points out that none of the four top vaccine companies has shown significant interest in developing a vaccine for Covid-19. Rather, efforts in that direction have been led by a government and charity-funded initiative – the Coalition for Epidemic Preparedness Innovations.

There is also a legal dimension to medicines and vaccines in the form of patents and intellectual property. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), drafted under the auspices of the WTO, is a key document in this connection. TRIPS, which was lobbied by the pharmaceutical companies, essentially entails a curtailment of countries’ powers to protect the general interest against the negative health consequences of companies’ intellectual property rights. An exception to this is the “compulsory licence”, which can be invoked to force companies to share their patent for a non-excessive price in an emergency situation so that others can also start producing a particular patented product.

As of 2017, an additional provision (article 31bis) was added to TRIPS which allowed countries with their own pharmaceutical industry to use compulsory licencing to allow the export of medicines at an affordable price to countries that were facing a shortage. Quite unexplainably, the EU as well as other high-income countries such as Australia and the US, have opted out of this article. Although they were warned against the negative consequences of opting out, it is speculated that at the time countries could not imagine the high medicines pricing crisis they are facing today. Be that as it may, the effect is that they unilaterally committed to not making use of this system as importers. Christopher Garrison therefore recently called on these countries to “urgently reconsider their decision in the face of the Covid-19 pandemic”. If not, there is a serious risk that drugs and vaccines against the virus will not be universally and cheaply available.

Edited by: Dr. Olivier Vonk