On 11 March 2020, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO), declared the coronavirus disease (COVID-19) a pandemic. The announcement virtually signalled the starting pistol to a frantic race to find a vaccine or effective treatment and, on the same day, Humanity faced a new global challenge in the form of a pandemic yet to be seen by this generation in terms of severity and scope: “no-one is safe until everyone is safe”. Yet certain overtones of the challenge are related to an unexpected opportunity to transform norms that have been regulating the international system, converting health and technologies into the preservation of market-led assets. Humanity comes face to face with the chance to transform this system and back cooperation and global health. At the time of writing, the world is still toing and froing between these two possibilities.
Perhaps the two newest initiatives endorsed by the WHO are, on one side, the project called “Access to COVID-19 tools accelerator (ACT-accelerator)”; and, on the other, the “COVID-19 Technology Access Pool (C-TAP)”, a pool of public patents and universal access to technologies to combat COVID-19.
The ACT-accelerator aims to speed up the development and production of new medicines, diagnostics products and vaccines against COVID-19, as well as equitable access to them. To finance the project, a pledging marathon was convened jointly by the European Union (EU), Canada, France, Germany, Italy (which will hold the forthcoming G-20 presidency), Japan, the Kingdom of Saudi Arabia (which currently chairs the G-20), Norway, Spain and the United Kingdom.
For its part, the technology access pool involves a major initiative to facilitate free access and the use of technologies to the most impoverished countries. Nevertheless, as a voluntary initiative it is clearly not being backed by all States expected to do so in order to reach its goal. The number of countries involved falls short of forty and are those where COVID-19 technologies are not being developed. In the European sphere, only Netherlands, Belgium, Luxemburg, Norward and Portugal are participating, while the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) stated in relation to C-TAP: “We will participate, but we’re not obliged to”.
In parallel, the WHO has implemented the “Solidarity” international clinical trial to combat COVID-19, an initiative being used to drive forward their capacity for word-wide collaboration and research to study different treatment possibilities. While randomised clinical trials usually take years to be designed and implemented, the “Solidarity” trial will reduce this time by 80% through the coordinated work of hundreds of medical professionals and researchers from across the globe. The European Commission, for its part, has swiftly mobilised since the pandemic was declared to allocate millions of euros to promote COVID-19 research, including via the programme Horizon 2020, the Innovative Medicine Initiative (IMI) and loans from the European Investment Bank (EIB). Furthermore, a number of European governments have mobilised significant resources to support the development of diagnostics, treatments and vaccines.
If we rest our gaze on Europe, particularly noteworthy is the “European Parliament Resolution, of 17 April, of coordinated action to combat the COVID-19 pandemic and its consequences” which, in addition to encouraging Member States to “boost financing for speedy research on a vaccine or treatment”, emphasises “the need to support measures favouring open science in order to accelerate the sharing of data and research results within the scientific community in Europe and beyond”. It also insists that any publicly funded research must stay in the public domain.
In fact, in recent months pressure has been mounting on the pharmaceutical industry to revise the regulations governing biomedical and pharmaceutical R&D in order for public interest to be placed firmly at the core. At the same time, however, governments are not in a strong enough position to confront the pharmaceutical industry and its commercial interests, given their reliance on the sector to address the priorities that stem from COVID-19.
[ Of special interest is the Financial Times editorial at the beginning of April. With the headline “Big drugmakers under pressure to share patents against coronavirus”, the article supported the use of compulsory licences, where applicable, to ensure effective COVID-19 vaccines and treatments were affordable around the world. The editorial was a shock to the industry. Also of note is The Guardian’s opinion piece: “The race to find a coronavirus treatment has one major obstacle: big pharma”. ]
In Europe, no advance has been made in the Union’s common stance with respect to the pool of public patents and instead it is promoting an EU system of jointf vaccine procurement with some developers, similar to the one reached previously in the US. Elsewhere, and of their own accord, a group of four European powers (Germany, France, Italy and Netherlands) have created their own “inclusive vaccine alliance” to bolster their role in negotiating with pharmaceutical laboratories working to develop a coronavirus vaccine. Their aim is to officially ensure an increase in the capacity to manufacture possible vaccines against SARS-Cov-2 and to obtain the largest number of treatment dosages in the shortest possible time. What remains to be seen is whether these types of agreements do not seek an advantageous position in the distribution of future vaccines to populations. One thing is for sure: in the search for a COVID-19 vaccine, when one is discovered production will not be on a scale big enough for everyone.
In terms of world governance, when we are also dealing with global health and the survival of Humanity, the upper hand still lies with the wealthiest countries, and the tension between opposing forces puts international organisations such as the WHO to the test. For now, the biggest powers are demonstrating a knack for having their cake and eating it.
If there was any doubt over new health tools and resources to combat COVID-19 becoming a luxury product, only one name needs to be mentioned: Remdesivir. This anti-viral drug was developed a number of years ago to combat the Ebola disease but as a treatment for COVID-19 it offers a very limited scope and is a far cry from being a definitive cure to end the pandemic. Even so, only a short time before the biopharmaceutical company Gilead launched it onto the market, the US anounced the near-total purchase of its production for the three months that followed (100% of the company’s production in the month of July and 90% in August and September). Nevertheless, the most significant part of the “Remdesivir phenomenon” is the company’s excessive price tag placed on treatments: 2,083 euros per patient.
One month later, the European Commission signed a contract with Gilead to guarantee treatment dosages of Veklury, Remdesivir’s commercial name, from August onwards. Brussels will have paid approximately 63 million euros to supply up to 30,000 patients with severe COVID-19 symptoms with the treatment, with its financing coming through the Emergency Support Instrument set up to foot the bill for the purchase of treatments or vaccines. [ dw.com - consalud.es ]
The example of Veklury (Remdesivir) is a reminder that during the pandemic no change whatsoever has occurred in the way in which intellectual property is managed and pharmaceutical companies can monopolise the future of COVID-19 and condition who has access to it or not.
It is worth highlighting that pharmaceutical companies are receiving millions of euros and dollars through private agreements with certain countries and, above all, through public and philanthropic funds. This public financing, from donors of funds to promote collective initiatives, for example, must give rise to the production of vaccines and treatments that, as well as being effective, are designated as global public assets. The sales price must not be fixed by the laws of monopoly.
As of July, 149 experimental vaccines are being developed, six which are in the advanced stages and with a target of late 2020, with some even becoming available for production. However, certain questions still sit on the table: How effective will these vaccines be? What is the industry’s capacity to produce them on a global scale? And the big one: Who will receive them first and who will never receive them?