By: Tim Bierley
Date: 22 February 2023
Campaigns: Pharma

Governments could take a major step towards a fairer and more effective way of handling pandemics next week, when they discuss a draft global agreement at the World Health Organisation. The new pandemic accord aims to learn the lessons from the catastrophe of Covid-19, build global cooperation to prevent another pandemic from happening and put the world in a better place to respond, should such a disaster hit again. One clear lesson, which an early draft of the accord seems to incorporate, is the need to take on the unchecked power of pharmaceutical corporations.

Rarely has a small group of companies held the world to ransom quite like big pharma have since the rapid spread of Covid-19 in 2020. Despite hoovering up billions in public funding, these firms acted as if they were accountable to no one, moving decisively to secure monopolies over the vaccines and put the pursuit of profit above all else. Governments, desperate to get their hands on limited vaccine supplies, were unable or unwilling to stop them.

After the early euphoria of successful vaccine trials, it was always clear there would be an initial global shortage. But by locking its vaccines behind a fortress of intellectual property, putting artificial limits on production and preventing countries in the global south from manufacturing their own, big pharma made the shortage longer and deeper than it would have been under a more cooperative approach. This helped these corporate giants to amass record revenues but prolonged the pandemic needlessly and contributed to hundreds of thousands of unnecessary deaths, especially in lower-income countries.

Signs of lessons learned

It is encouraging, then, to see that the ‘zero draft’ of the pandemic accord takes on some of the building blocks of big pharma’s deadly monopolies. In fact, this draft often reads as a direct retort to the way the pharma industry has been allowed to put its financial interests above the lives of millions.

First, the draft calls for key industry technology to be transferred to manufacturers in the global south, a necessary action that would dilute the deadly corporate concentration we’ve seen during the pandemic. It would allow lower-income countries to become more self-sufficient, less reliant on performative charity from the global north – and not just during pandemics. More research and production in the global south will also mean more focus on diseases which affect people living in those countries, as shown by a breakthrough mRNA lab in South Africa, which has already started work on a new TB vaccine.

The draft also calls for more public investment in research and development, which makes obvious sense, especially given that the pharmaceutical industry is even now failing to investigate the diseases most likely to cause the next pandemic, once again because they don’t consider these diseases profitable enough.

The draft calls for “transparency in cost and pricing” of pandemic medicines, a clear lesson learnt after companies like Pfizer and Moderna charged mark-ups of up to 2,500% on their vaccines.

Perhaps most significantly, the draft also suggests “waivers of intellectual property rights” during a pandemic, a clear acknowledgement that big pharma’s monopoly patents were a deadly barrier during Covid-19.

The pharma lobby

Clearly, the memory of big pharma’s unchecked power was sharp in the minds of those writing this draft, but big pharma’s disaster capitalists and those who continue to back failed market models are already sharpening their elbows to secure the same privileged position during the next health crisis.

A crucial lesson from Covid-19 is that leaving charitable initiatives to mop up the failures of the market falls woefully short. Covax, a voluntary scheme designed to distribute available vaccine doses equitably around the worlddo this, failed to do so but it fell woefully short after pharma companies largely ignored it and rich countries paid above the odds to buy up vaccine contracts outside of the scheme. However, one of the brains behind this failed distribution model is now labelling the institution as a blueprint for future crises.

Meanwhile, briefing from the sidelines, bBig pharma’s lobbyists continue to insist, against all evidence and in defiance of the piles of public funding that brought Covid-19 vaccines into being, that rigid intellectual property rules are the primary reason for medical innovation. Rich countries like the UK nod their heads in solemn agreement and join the ranks of the deluded, calling for nothing significant to change.

Like a team of mechanics eagerly trying to book you in for another service, moments after returning your car with jammed doors, sound system sold off and a blown up engine, it’s hard to see why we should rely on them to guide us again.

Could the pandemic accord offer us a way to avoid a repeat? Perhaps, but worryingly the pharmaceutical lobby and its client states in the global north have already appeared on the scene, industrial file at the ready in case the accord grows any teeth. Its tone of gentle cajoling means even the best bits of the text are likely to be hard to implement.

The line on intellectual property, for example, is better than we might have expected, but is still shrouded in caveats: any use of an IP waiver will be “appropriate” and “to the extent necessary”. Certainly, after the disaster of leaving IP matters to the World Trade Organisation during Covid-19, the accord must say something about it. But it’s hard not to worry that caveats like this make the text a can waiting to be kicked down the road, no matter how refreshing and unexpectedly fizzy it looks at first sight.

Health policy experts have also pointed out that while the draft’s call for technology transfer is important, the heavy emphasis on ‘voluntary’ agreements means those decisions are left with big pharma. Will they cooperate? And on what terms? During this pandemic, big pharma firms have roundly refused to share their technology, even when it became clear that dozens of global south manufacturers were capable of joining the production effort. Worse, when companies in the global south have tried to build domestic capacity and share technology collaboratively, big pharma has actively lobbied against them. If hundreds of thousands of lives lost wasn’t enough for big pharma to open up its trade secrets, it’s unlikely that gentle coaxing will be.

Public return on public investment

This draft does, however, nudge governments towards a compromise: countries should put firm conditions on any publicly funded research and development. This could see governments demanding medicines be priced reasonably, research made available to scientists who want to improve and build upon it, and technology transferred to countries that want to collaborate. Pharma companies would enter any deal with governments voluntarily, just as they did when profiting from publicly-funded vaccines during Covid-19. The difference is, this time there would be some strings attached.

Even if this early draft is short on obligations, it is encouraging to see an account written in the tone of a witness to catastrophe, rather than the slippery excuses of a culprit trying to avoid liability. Many of the demands of health activists have clearly been considered, even if enforcement mechanisms appear weak. With another round of negotiations coming at the end of this month, we know that the best bits of this draft will come under an onslaught from the pharmaceutical lobby, so it is vital that we push hard in the other direction. Whatever the vested interests of big pharma say, we cannot end up beholden to corporate monopolies again.

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