Coronavirus is killing the poor far more than the rich. A vaccine must be free for everyone

19 May 2020

Pneumonia is killing 2,000 people every day. But not because of coronavirus. For nearly twenty years, millions of children have not had access to the patented vaccine manufactured by Pfizer and GlaxoSmithKline due to its high cost, which has generated billions in profit for those corporations. It was only in December 2019 after a long campaign by MSF that a third company, the Serum Institute in India was allowed to launch an affordable version, bringing the price down to just $2 a day.   

In 2009, during the swine flu pandemic, rich nations like Australia, Canada, and the United States made large advanced orders for the vaccine from manufacturers, meaning that the rest of the world received the vaccine in much lower quantities and much slower. They were unable to vaccinate their citizens. 
The risk is extremely high that a coronavirus vaccine, when discovered, will only be available to the lucky few, tailor made for profit, not for the people who need it most. 
Unsurprisingly the battle over the vaccines and treatments for Covid-19 is shaping up to be immense and a huge amount is at stake. Last week Oxfam worked with UNAIDS on the launch of an open letter from over 140 leaders worldwide calling for the ‘People's Vaccine’ to be made free of patents and free for the people who use it. It was signed by Cyril Rhamaposa, President of South Africa, and a number of other sitting presidents, as well as over 60 former heads of state including Gordon Brown. It was also signed by many leading economists including Dani Rodrik and Joe Stiglitz. It is a powerful letter:

Now is not the time to allow the interests of the wealthiest corporations and governments to be placed before the universal need to save lives, or to leave this massive and moral task to market forces. Access to vaccines and treatments as global public goods are in the interests of all humanity. We cannot afford for monopolies, crude competition and near-sighted nationalism to stand in the way.

There is no doubt that our global way of producing new vaccines and medicines is broken. It is driving up the costs of providing healthcare, as new medicines are so expensive that health systems, even in the rich world, are struggling to cope. At the same time, there is a consistent failure to research and develop vaccines and treatments for many diseases, of public health importance that kill millions each year, because they cannot provide a profitable market.  Pharmaceutical firms have said for example that there is simply no money in producing vaccines. 
It may be a broken and indefensible system, but it is a resilient one, not least because so much profit is at stake. The argument is then given this is the system we must work with, that in order to do good in the world, we must ensure that delivering global public health is also profitable. Drawing on the language proposed by the US government to water down a World Health Assembly resolution this week, we need to ‘align incentives’. 

It seems such a benign phrase, ‘align incentives’. It is all very neoliberal; this is not about the competition of the marketplace. It is not about making sure government is a small as possible. Instead it is about legally enshrining enormous monopolies and oligopolies, to the exclusion of competition. It is about governments, and especially the US government, fiercely defending these rights all over the world, at times with outright threats. It is also about governments,  providing generous and unnecessary subsidies on top of their record-breaking profits. This can be through the up-front public investment in research and development. It can be in turning a blind eye to industrial levels of tax avoidance. And in the case of procuring and delivering medicines for poor countries, it can be about using precious aid dollars to ensure that Pharma can ‘make money while doing good’. 
The pernicious paucity of this system, as with so much else in the world, is being thrown into stark relief by coronavirus. The chasm between what needs to happen and our tools for doing it is nakedly apparent. 
There is an argument that this is not the time to go for system change. That once again we should hold our nose and ‘align incentives’ to ensure the quickest possible development and delivery of vaccines and treatments for Covid-19.  
Personally, I think that would be a mistake. I think it will actually delay the day when coronavirus vaccines and treatments are available to all that need them. I also think it would be squandering the greatest opportunity in a generation to break up this ossified system that could not be less fit for purpose.  
We should of course be regulating, not incentivising. We can’t nudge these corporations into good behaviour. They must be made to pay their taxes. They should be stopped from using armies of lobbyists and lawyers to protect their profits. We should end the practice of ever-increasing returns to wealthy shareholders driving all decisions. We should tax their profiteering and prosecute it too. 
But I think it would be wrong to blame Big Pharma completely, and too simplistic to think that regulation alone will suffice. It is a bit like regulating a T-Rex to provide vegetarian food for all (maybe I have been spending too much time home-schooling my seven-year-old). In many ways they are doing exactly what they are supposed to do, make money. Often rapaciously and excessively. Sometimes corruptly and illegally. But their core business is to make money and that is never going to change. 

So whilst a far more regulated and policed pharma sector is essential, I think this can only ever be part of the problem of designing and delivering cheap safe and effective vaccines and medicines for all. To do this we need to go beyond market-based solutions to this fundamental human need. Health is a public good, which underpins everything, not least a functioning market economy. Leaving our health to the vagaries of the market can have an astronomical cost for the rest of the economy. The last few months has demonstrated this clearly. Health is simply too important a human need to be left to the market. 
The polio vaccine was developed by Jonas Salk and he insisted it was made available patent-free. When he was asked who owned the patent, he replied "The people I would say. There is no patent. You might as well ask, could you patent the sun?"
What is needed now is imagination and ambition to build a new and permanent change in the way we develop medicines and vaccines. I think that we need to imagine a far more public system, from the research and development all the way through to the nurse giving you your injection. 
We already have huge public investment in much of the most innovative research and development. We need to have a lot more of this, but we also need to make sure that whatever we set up is actually for public benefit. After the Ebola outbreak in 2014/15, several countries agreed to set up the Coalition for Epidemic Preparedness Innovations (CEPI). This was a great idea but sadly so far CEPI has still given too much opportunity and influence to drug companies. This means despite unprecedented levels of public investment the drug industry gets to keep all the intellectual property and charge high prices to the very governments who paid for the research and development in the first place, as well as many developing countries. We must stop socialising the risk of this research through government funding, only to privatise the reward by enabling private firms to reap the benefits. We need to instead ensure this reward is also shared by the public. We also need the same type of public-first approach to develop new medicines and tests.  
Above all, a new more public system would help break free of the suffocating web of intellectual property and patents that has cost so many lives. No need to tie ourselves in knots to ‘align incentives’. Instead publicly funded R&D delivers safe and effective vaccines and treatments, whose specifications are openly available patent-free and can be rapidly produced by manufacturers all over the world at the lowest possible cost to all governments. For developing countries, aid money can then be used not to subsidise profit, but to ensure that poor country governments are able to deliver vaccines and medicines for free to all who need them. 
Health is desperately unequal. In every country, the poorest can expect to live many years less than the rich. Life expectancy in the richest parts of Sao Paulo, Brazil is 25 years more than in the poor neighbourhoods just a couple of miles away. Coronavirus is feeding on these inequalities and creating new ones. It is killing poor people far more than rich people. 
Yet at the same time it has also exposed the reality of our collective frailty. And as the world rushes to develop new vaccines and treatments to beat this disease, I think it offers a unique opportunity to remake our broken system of medicine and vaccine development. Over the coming months, tens of billions of dollars of taxpayers money will be poured into this system. As the open letter says, providing health for all is a deeply moral task, that cannot be left to market forces. Instead we must use this public money as leverage, to ensure it lays the foundations for a new system. A truly public alternative, where the public good is the primary endeavour, not something that can only be addressed once profit is ensured. 

Photo: Jonas Silk, developer of the polio vaccine. Credit: San Diego Air and Space Museum Archive



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