Susan George, Baba Aye, Mark Heywood, Kajal Bhardwaj and David Legge
5 August 2020
Our webinar Taking Health back from Corporations: pandemics, big pharma and privatized health brought together international activists and healthcare experts at the forefront of struggles for equitable universal public health. What needs to change in terms of access to medicine, the pharmaceutical industry, and the global governance of health?
Susan George author and President of TNI, opened the discussion with background on the strength of the pharmaceutical lobby. The ten biggest pharma companies in the world amass a total sum in capital of US$1.8 trillion. Using the US as an example, the health industry including various chains of profit-making hospitals, clinics and nursing homes as well as pharma companies, is at the center of the world’s financial lobbying. In Brussels, there are around 30,000 lobbyists pushing for deregulation, lower taxes for the rich, and privatization. Tied up with the neoliberal economic framework, the ‘just in time’ structure of the health system leaves no reserves of supplies to deal with epidemics and is the blueprint of what lobbyists want for global health. A system clearly not aimed at helping people but rather at maximizing profit. We are struggling to fight this pandemic because we have allowed our health systems to become neoliberalized. However, progress can be made by paying attention politically to legislation influenced by the health lobby and putting pressure on creating laws that will serve the people. Healthcare workers are underpaid and under-equipped but wealthier countries can rectify this through proper taxation to have social security systems worth the name.
Baba Aye Health Officer at Public Services International, explained how we got where we are today. The 1978 international conference on primary healthcare organized by the World Health Organization (WHO) and UNICEF proclaimed healthcare for all by the year 2000. The conference attempted to capture and build on that spirit of the factors that led to the emergence of the WHO, giving public health the same importance as healthcare delivery. What followed was the corporatization and marketization of health, starting in the 80s with private finance initiatives (PFIs) in countries like Britain and in developing countries, specifically in Africa, after the World Bank Report of 1981 and the introduction of user fees. The argument essentially centered around involving corporations to address the problem of lack of money for the public healthcare system. PFIs and public-private partnerships amount to subsidizing private interests with public money that could be used to provide universal public healthcare.
An unholy trinity has now emerged between big pharma, health companies and private health demands due to the emergence of so-called innovative means of financing health that in fact only enable these companies to make more money. With big money comes big influence internationally and in governments that help to entrench the power and control of corporate bodies on healthcare delivery. Some 15 years back the British Medical Journal drew attention to the fact that more than half of medical programs in the UK were funded by big pharma.
Most of these corporate bodies are also involved in tax avoidance. Collaborative research by Public Services International and the Centre for Corporate Tax Accountability has shown that these corporations have around $36 trillion in tax havens around the world. A year ago in California, there was a referendum to limit the amount of profit that was hidden to not more than 115 per cent of total costs. The companies involved raised over $130 million for a campaign to oppose this limit against barely $18 million raised by trade unions and civil society organizations in support of it. Unsurprisingly the corporations won with 59 per cent of the votes.
In 2016, following the Ebola outbreak, The Coalition for Epidemic Preparedness Innovations (CEPI) was established. Médecins Sans Frontières (MSF) pushed for combining such an effort with suspending intellectual property rights on vaccines to ensure their availability to more people. Companies including Johnson and Johnson stood against this and CEPI bent to them resulting in a projected $61 billion profit from vaccines this year. This shows how public money is used to subsidize private interest. Since the 1930s, over $900 billion has been spent by governments on developing pharmaceutical products that are ultimately patented as a source of profit by big pharma companies.
To fight against this Public Services International has been organizing a right to health campaign for the last four years, focusing on these arguments that affiliates in 154 countries have been pushing to their governments as well as organizing civil society support to demand universal public healthcare. Due to this pandemic governments have been forced to take over hospitals, and convert factories to manufacture PPE gear and medical supplies. We must insist that there is no going back, our health is not for sale.
Mark Heywood, of Treatment Action Campaign, Section27 and editor at the Daily Maverick,followed on from Baba by taking us back to 1994, the year that South Africa was liberated after 350 years of colonialism and racism under apartheid. Access to life-saving and disease-preventing medicines was a major priority. But the World Tade Organization (WTO) was established shortly after and with it the TRIPS agreement on Trade-Related Aspects of Intellectual Property Rights, which extended an extremely rigid standard of intellectual property around the world, strengthening the hold of big pharma.
As South Africa attempted to amend legislation to make medicines more affordable, the HIV pandemic took hold of the country. Thirty-nine big pharma companies took the government to court as it tried to gain access to medicines and the impacts of TRIPS and the WTO became clear, leaving those medications accessible only to the rich. In the last 20 years, 3 million people have died from AIDS related illnesses in South Africa due to unaffordable medication.
Despite the resources, money and lobbying that these companies command people are powerful when we organize. In 1999, just 10 people started the Treatment Action Campaign to fight for affordable HIV/AIDS medicines. The campaign combined on-the-ground social mobilization of poor and working-class people who needed access to medicines and using the law and constitution to assert that health is a basic human right. Media coverage of the campaign shone a light on big pharma and brought in to question the morality of the industry.
Although South Africa was on the frontline, this was a global struggle, fought with activists in Brazil, India and many other countries resulting in pressure on the WTO to instate the Doha Declaration on the TRIPS Agreement that reaffirmed flexibility of TRIPS member states in circumventing patent rights for better access to essential medicines. Particularly important in the context of COVID-19 is the section of this agreement that enables state governments to issue compulsory licenses in the case of public health emergencies that require access to life-saving medicines. Although we need affordable medicines not only in emergency cases, this was an important victory. However, in the mid 2000s we as global activists fell back to our individual fights, allowing pharma companies to regroup and reorganize. In the years following 2006 they once again managed to reassert their power.
Today, while HIV/AIDS drugs and medicines are very affordable in developing countries, people die of preventable illnesses because diagnostics are patented and therefore unaffordable. Mark believes we have found ourselves back in much the same situation as in the late 1990s and it is time to regroup and rebuild our arguments around the critical importance of access to medicines. We must reassert health as a human right, as stated in our constitutions. Governments, therefore, have a duty to guarantee people the fruits of science, medical development, and modern technology and act against profiteering and private interests when they impede the rights of access to healthcare.
With the development of the vaccine and therapies against COVID-19 the question of access, affordability and patents will become the defining issue of the pandemic. We cannot afford to wait until a vaccine is developed to start raising these questions and demanding universal access not only to the vaccine but to the knowledge and understanding behind it. As with HIV/AIDS and cancer drugs and almost all medicines, breakthroughs come from public investments and research that is then taken over for private benefit and profiteering. What we must reassert, once we overcome the immediate COVID-19 crisis, is that healthcare is a basic human right and not for private profit or benefit.
Kajal Bhardwaj continued to elaborate on the impacts of the intellectual property rights regime on health in the context of COVID-19. As was the case during the HIV/AIDS pandemic, we see global attention once again acutely focussed on intellectual property rights that in most countries are now being enforced by international trade rules. Unlike 20 years ago we now have a massive expansion of these regimes in our own national and regional legal systems and we see just how deeply entrenched these intellectual property protections are across all aspects of health products we might need to fight COVID-19 including PPE, diagnosis, medicines and vaccines. During the peak of the outbreak in Italy many 3D printing enthusiasts who printed parts of ventilators were immediately threatened with legal action by companies with patents on the parts.
Currently, there are 145 studies and over 30 potential treatments for COVID-19. Drugs hoping to stop viral entry include Hydroxychloroquine and Chloroquine, the two Malaria drugs that have had an alarming and controversial push in the US despite lack of evidence of their effectiveness. There is also hope that treatments currently used to treat HIV and Hepatitis C could prevent the virus from replicating within the cell. These are a few examples of what the potential drug targets are. All are existing heavily patented medicines attempting to be repurposed to treat a new illness. Many have expired patents but this has not stopped the companies holding them from applying for new intellectual property protection.
The above image is a snapshot of the patents and applications for Remdesimir and Tocilizumab in China. When multiple patents are filed on the same drugs for new forms and uses this extends the time of exclusivity that companies have over the drug and stops generic companies stepping in to manufacture them at affordable costs.
The tactics pharma typically falls back on to deflect criticism include donations, price cuts, and voluntary licenses. These strategies actually allow pharma to maintain control since they decide who gets the medicines, when, how, and at what cost.
Many believe that in the face of the current emergency, pharma will not behave the way they have over the past 15 years, but we would be fools not to learn from history. Government action or a threat of government action forces good behaviour from companies. We have also seen positive developments from the governments of Germany, Canada, Chile, Columbia and Ecuador who have all put forward measures for issuing compulsory licenses. In Brazil, a proposed bill to warrant automatically granting compulsory licensing on any products or technologies needed during a declared international emergency is being considered. This would remove many of the procedural difficulties of issuing compulsory licenses in the current system. We also know there is a significant generic capacity in many countries. For vaccines, capacity is much more limited but there is at least the possibility to ramp up production of chemical medicines if they are approved.
Thanks to the work of public interest minded academics, a study has been published [link] on the minimum costs of production of a number of treatments currently being trialed. For some, the estimated costs per day is a dollar or less, confirming that these treatments can be made at affordable prices.
Kajal ended by emphasizing the importance of this work in fighting corporate control over health. Histories are carried across generations, countries, and written in blood and stone. Whether it is for this pandemic or indeed the everyday pandemics that we see in the struggle for health.
David Legge of People’s Health Movement, detailed the role of the WHO in the governance of global health, beginning by underlining the importance of understanding the two sides of the organization. The governing bodies, particularly the World Health Assembly are where the member states come together to govern. The secretariat is the staff, led by the director-general.
Working over the last 30 years under increasing donor control, the program funding of the WHO is now essentially entirely dependent on tied voluntary contributions from wealthy countries, the World Bank, and big philanthropies. The World Health Assembly adopts a notional budget but the work that can then be implemented is completely dependent on what the donors are willing to fund. In addition to restrictive funding conditions, donors – the US in particular – also use the threat of defunding as a means to control the secretariat.
The US has advanced the interests of big pharma through bullying and donor control, including by trying to block the essential medicines list providing advice to countries on the minimal medicines needed in the face of marketing efforts of corporations. Fortunately, this list is now standard. A further example concerns the WHO’s attempt to adopt a binding code on the ethical promotion of pharmaceuticals. The US and a number of wealthy countries used their power in the assembly and capacity to refuse donor funding to prevent any action on the rational use of medicines, effectively leaving the marketing strategies of big pharma unchallenged.
The most relevant case is the use of bullying to prevent the WHO from advising countries on how they pass into law the principles of the TRIPS agreement and how they accept propositions on intellectual property in various free trade agreements. Although the assembly passed resolutions on giving such advice, the secretariat faced severe pushbacks from donors, particularly the US, when implementing it. Proposals for publicly funding the research and development of pharmaceuticals to allow lower costs have been supported in various ways by member states in the assembly but prevented from them being enacted.
Also important to note is the scaremongering carried out in direct cooperation between wealthy countries and big pharma, arguing that any medicines not tightly controlled by intellectual property are likely counterfeit and therefore dangerous. These false allegations encourage states to adopt medicines legislation which in effect helps to police pharma’s severe intellectual property claims.
Fundamentally, the way in which the WHO is controlled is critical to setting the conditions for effective action on COVID-19. Past failure to continue research following the epidemics of the other two coronaviruses, SARS and MERS, will result in a delay in developing a COVID-19 vaccine. Barriers to low and middle-income countries establishing their own manufacturing capacity will be created by the extreme intellectual property laws and associations with trade liberalization. The WHO’s lack of skepticism regarding early Chinese advice on person-to-person transmissibility contributed to delays in implementing initial more-targeted travel restrictions resulting in the rapid spread of the virus and consequent need for harsher restrictions with deeper economic consequences.
The issue of travel and trade restrictions has been fiercely debated between public health and trade officials since 1851. The debate centers around concerns of whether travel restrictions are sufficiently effective in disease control to justify the economic effects, if health protection is being used to justify protectionism, and trade aggression and whether the economic damage from travel and trade restrictions impacts the resilience of the affected countries in coping with epidemics. International health regulations forbid restrictions on trade and travel unless approved by the emergency committee. In the context of ebola in 2014, many wealthy countries were challenged by the WHO for implementing unapproved travel and trade restrictions. The implementation of severe travel restrictions in relation to COVID-19 has had a devastating impact, particularly on those countries least able to draw on their own resources to confront the virus. Earlier sharing of evidence from Wuhan about transmissibility and the implementation of targeted trade and travel restrictions could have limited some of the harm.
Panellists and participants identified further ways forward:
Learning from the lessons of previous pandemics we need to strengthen work on the ground. A convergence of people’s movements around the world is vital to drive not only progress on COVID-19 and the WHO but fundamental structural and systemic change. This pandemic has shown the interconnectedness of public health with the social-economic system. A human-made crisis created by policies that enforce underlying inequities and place economic interests above health and environmental concerns. We need to organize internationally and consider our collective networks and capabilities as well as the issues we can draw on to affect a new global consensus that covers health issues and puts people over profit.
Fearful individualism and insecurity is driving a new form of fascism in many countries during this crisis. Promoting a sense of solidarity instead will be important. We need to reframe corporate control in terms of the transnational capitalist class, including corporate and political leaders of wealthy, imperialist countries. Considering their control, tied into neoliberalism as a strategy to defend such elites against instabilities of their own making, must be a way to help us build a consolidated global movement.
ABOUT THE AUTHOR
Kirstie Crail is an Amsterdam based writer and editor freelancing in the nonprofit and cultural sectors.