Putting Access to Medicine ahead of Pharmaceutical Monopolies
The gross inequalities that characterized the global rollout of first-generation COVID vaccines are being replicated again today when it comes to the distribution of promising new COVID outpatient treatments and diagnostic tools. As a result, “test and treat” strategies designed to prevent the worst outcomes due to COVID-19 are only widely available in affluent nations, leaving billions of people around the globe without access to not only the most effective vaccines, which leaves them at higher risk, but also to simple tests and effective therapeutics. This ongoing inequality continues to cause huge numbers of avoidable severe disease, hospitalizations, and deaths each day and greater-and-greater incidents of “long COVID,” while compounding the economic, societal and political harm of a needlessly-prolonged pandemic.
Just as with mRNA vaccines, COVID treatments’ supply is being kept artificially low and prices are being kept artificially high by pharmaceutical monopoly rules that put so-called “intellectual property rights” ahead of public health.
According to ACT-Accelerator global health consortium set up in response to COVID-19, no significant doses of any outpatient COVID antivirals have been purchased by low- and middle-income countries. This is in part because high-income countries, led by the United States, have together bought up 30 million courses of treatment at inflated prices for the most-promising COVID treatment regimen called Paxlovid. This number represents the entire first six months of Pfizer’s supply of the drug, meaning it has almost none immediately for sale for the rest of the world. The U.S. has also purchased the lion’s share of less promising treatments like molnupiravir, remdesivir, and monoclonal antibodies.
In addition, the price quoted by Pfizer to middle-income countries whenever more doses eventually become available is $250 per treatment — literally ten times the $25 per course price generic medicine makers have indicated they can profitably manufacture and sell Paxlovid for in the limited number of countries where generic competition has been allowed by the company.
The solution to inadequate supplies and high prices is simple: allow generic COVID tests and treatments to be produced in as many places as possible as quickly as possible.
Already, efforts are underway in countries like Colombia, Chile, Peru, the Dominican Republic and potentially elsewhere to issue “compulsory licenses” that would allow Paxlovid’s component drugs to be produced without waiting around for Pfizer’s approval. The Biden administration can support these and related efforts in two easy ways:
- Signaling Support for Compulsory Licensing. The quickest and easiest action the Biden administration can take is to publicly state that it supports efforts by other governments to issue compulsory licenses for COVID vaccines, tests and treatments and that it will not challenge their right to do so under the World Trade Organization (WTO), U.S. Free Trade Agreements or otherwise. Historically, the United States government has sided with Big Pharma in strongly discouraging countries from issuing compulsory licenses. An Executive Order or even a brief press statement indicating that the President sides with countries that prioritize access to COVID medicines would go a long way to easing other governments’ anxieties about provoking U.S. hostility by issuing compulsory licenses. The U.S. should likewise withdraw consent for “Investor-State Dispute Settlement” cases by private companies that are related to COVID-19 medicine access.
- Addressing Tests and Treatments at the WTO. After more two years of debate, the World Trade Organization approved a face-saving text in June 2022 purported to address access to COVID vaccines. While public health advocates argue the recent text left too many intellectual property barriers in place to expand vaccine access, most say it could be helpful if expanded to include comparatively easy to produce treatments and diagnostics — specifically by allowing medical goods produced under compulsory licenses to be more-easily exported to additional countries. South Africa, India and numerous other countries have called on the WTO to do exactly that, and many believe that the United States’ ultimate decision on the matter will be the deciding factor on whether the proposal moves forward. The Biden administration should immediately back countries calling for expanded test and treatment access and should not wait until the end of the six-month window to do so.
The abovementioned bullets are things the administration can do on its own in very short order without waiting for Congressional approval. Beyond these steps, the United States could also play a meaningful role in expanding global access to COVID vaccines, tests and treatments by providing funding for globally-distributed production and by incentivizing and compelling pharmaceutical companies to share their technology with additional qualified producers.