Health For All
Before going forward in this essay it is important to understand what is intellectual property and how it operates within the capitalist economical system. Intellectual property refers to the claim of ownership to any kind of intellectual work or findings by an entity. When discussing health specifically this intellectual property takes the form of patents that a company obtains through the research and development of new drugs. According to the United States International Trade Commission “ A patent is a grant issued by a national government conferring the right to exclude others from making, using, or selling the invention within the national territory. (USITC)” Even tough they are subject to external factors “most patents expire after 20 years from the date of filling (US Food and Drug Administration)“. These patents are regulated worldwide with the help of the World Trade Organization (WTO) who have created an international agreement on intellectual property that is called Trade-Related Aspects of Intellectual Property Rights (TRIPS). This means that every nation that is associated with the WTO is under legal liability to follow the pharmaceutical patents that are mostly initiated by a few corporations that dominate the global market of drug manufacturing and distribution.
It is also very important to make the distinction between patented drugs and generic drugs when discussing the issues with intellectual property of pharmaceuticals. The first one is self-explanatory and refers to drugs under the legislation of patented laws. Generic drugs are comparable to their patented counterparts since they have the same active chemicals and they are subject to the legislation of the nation in which the drug is dispensed. However, they are different in that they are not under a specific brand and they are usually sold for a lot less than the branded equivalent. This is essential for the auto-regulation of the global drugs market since it creates competition between the manufacturers. This competition is beneficial for society since it should in theory bring most of the prices down and creates a more fair and all-inclusive playing field for entrepreneurs and chemist worldwide.
To grasp the complexity of the issue with intellectual property in pharmaceuticals it is imperative to observe the problems with the economics involved in selling drugs. When looking at the ten largest pharmaceutical companies it is possible to notice that they make very large amounts of profits ranging from 20-70 billions in US currency every year1. This is a massively profitable industry that is mostly centralized in Western Europe and in the United States. This is a problem because even though those companies distribute their products all over the world they only represent a very small portion of the world, which leads to question their ability to represent an unbiased international agenda. The ideal that is health as a universal human right seems to be at risk when it is only represented by a very small percentage of the geographic world.
The results of the economical domination of the few pharmaceutical corporations are multidimensional. First, their massive capital lets them dominate the research and development of new drugs to claim the patents that provide the exclusivity of manufacture and distribution. This makes it hard to create incentive for competition in the drug research field since it is impossible for other companies to match the resources and the salary of researchers. The exclusivity of patents holders makes it even more difficult to create a fair market because of compulsory license. “A compulsory license is an authorization which is granted by the government without the permission of the patent holder (WHO, 2000)”. This means that companies who do not own a patent have the ability to sell a specific drug. However, there are regulations under the TRIPS agreement to have a negotiation for a certain percentage of the revenue to go directly to the company who holds the patent2. This dissuades many potential companies from investing in the pharmaceutical industry.
The many inequalities enumerated above create a very restricted market in which there is almost no limitation to the control these corporations can exert over the governments as well as the pricing of their medical supplies. There have been speculations of companies giving monetary solicitations to doctors to recommend branded drugs over their generic counterparts to patients. This is only happening in certain parts of the world and there have been initiatives to fight the lobbying process of big brands. For example, the Food and Drug Administration FDA bars companies from promoting their own drugs in a medical environment3. The inequalities also lead to monopoly pricing for drugs that are under patents. Having this monopoly provides the ability for the corporation to have complete market power, which usually results in higher costs for the consumers.
Even when drugs have passed the twenty-year period of their patents it is still hard for generic drug companies to compete with big pharmaceutical companies such as Jonhson and Jonhson or Pfizer. This is simply because the big corporations have the ability to distribute their products worldwide easily because their international presence. Smaller industries that create generic drugs do not have the networks required for worldwide distribution. This is why some of the most successful generic drug interventions have required an intermediary for distribution. For example, Médecins sans Frontières MSF has bought over 80% of their AIDS medication from a generic drug provider in India, which is a country that has a significant source of affordable drugs. These HAART’s used by MSF led to the successful treatment of over sixty thousand patients in over thirty different countries4. This explicitly shows that the use of generic drugs was made possible only through the intervention of a third party that took care of distribution.
Using what this essay showed concerning the market of pharmaceuticals has given us a basis to speculate on the eventuality of new drugs to face the Ebola epidemic. The drug that would seem to be able to fight Ebola the best at this point in the research process is Zmapp. ZmappTM is a drug that is privately owned by the company Mapp Biopharmaceutical that is based in San Diego, United States. If the company would obtain the patent for the creation and distribution it would be hard for them to start by subsidizing their prices for the low-income countries affected. Also since most of the funding for ZmappTM comes from the Defense Advanced Research Projects Agency (DARPA), an American military agency, it is possible to assume that the agenda put forward will be one that favours the western world instead of a global approach5. This is especially true since the DOHA declaration stops having its effect on impoverished countries in 20166, a time where Ebola might still be a prevalent public health concern.
It is also possible to look at the effects of intellectual property in a less speculative fashion by looking at the patent laws on AIDS medication and the impacts it had on low-income countries. “In developing countries, which accounts for ninety percent of infected people globally, the overwhelming majority of HIV/AIDS sufferers cannot afford these treatments (Ferreira, 2002, p.2)”. The prices of ARV treatment from about eight years ago seen in Figure 1, which can be found at the end of this essay, shows that although treatment prices vary considerably, it is out of reach of the majority of the population who only makes a few dollars a day. These prices are driven up by the patents laws that are being used in African countries that are not under the jurisdiction of the WTO. Therefore, it seems impossible for the developing governments to provide treatment to their people without the help of a third party such as an NGO or a private donor.
The action plan that I have created is threefold. The first step of the action plan consists of removing all the patent laws that have been established worldwide at all levels of institutions. The main argument that is used to protect the concept of intellectual property is that patent laws are the only way to make the research and development a worthwhile economic decision. According to The Pharmaceutical Research and Manufacturers of America PHRMA it usually takes over 15 years with over 1.2 billions in expenses to create a drug that will be approved by the FDA7. The concern of the private industry leads me directly into my second step.
The second step of the action plan would entail the creation of an international organisation that would be named Global Association for Health in Research and Development GAHRD. GAHRD would be formed of an association between multiple countries. Each country would have to give a fixed percentage of their annual revenue to the organisation, which would lead to the creation of a global fund. This fund would be used to pay and direct the research and development of new drugs that would then hit the global market. This would allow for GAHRD to have a more conscious and international agenda that could promote health as a human right instead of a privatised mind-set of making drugs for the highest bidder. By paying the fee every country in GAHRD would have the ability to take part in the decision making process of the association as well as being part of the emergency policy. The policy would comprise a law stating that any country facing epidemic and or serious threat to the health of their population would receive a complete priority of the research and development department in order to face the global issues.
GAHRD would be a not for profit organization but it would employ many scientists for the purpose of research as well as bureaucratic work that would manage the institution. To reduce the amount of money spent on jobs in research it would be possible to give grants to various educational institutions across the world that would help take a part in the research process of the overall institution. This would relieve stress from the organization as well as involving young minds in global action. GAHRD would also not affect the private market of pharmaceuticals since it would not take care of manufacture and distribution of the new drugs. This means that investing in the drug market would still be a viable economical option for companies that are interested.
The third step of the action plan would reside in the ability of the WTO to regulate the global pharmaceutical market enough so that there is no monopoly from a few corporations. The legislation required is beyond the scope of this essay but it can be assumed that it would be very radical. This would help create a more competitive market, which is the root of a good capitalist system.
The action plan that is shown above used a biosocial approach in that it requires the participation of very different fields of work from a more economical standpoint to a health one. It also involves several levels of institution from universities to national governments and unites them under a global goal. Health for all.
1 List of pharmaceutical companies. (2014, October 18). Retrieved October 20, 2014, from http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies
2 Compulsory license. (2014, June 14). Retrieved October 20, 2014, from http://en.wikipedia.org/wiki/Compulsory_license#cite_note-1
3A New Kind of Free Speech: Drug Reps’ Pitches to Doctors - The New Yorker. (n.d.). Retrieved October 18, 2014, from http://www.newyorker.com/business/currency/a-new-kind-of-free-speech-drug-reps-pitches-to-doctors
4 Mentor, V. (2006, December 1). Intellectual Property and Access to Medicine for the Poor. Retrieved October 20, 2014, from http://virtualmentor.ama-assn.org/2006/12/hlaw1-0612.html
5 We May Have a Way to Stop Ebola in Its Tracks. (2014, September 1). Retrieved October 20, 2014, from http://www.newrepublic.com/article/119376/ebola-drug-zmapp-darpa-program-could-get-it-africa
6 Westerhaus, M. (2006, August 1). How Do Intellectual Property Law and International Trade Agreements Affect Access to Antiretroviral Therapy? Retrieved October 18, 2014, from http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.0030332&representation=PDF
7 Intellectual Property is“ A vital incentive for pharmaceutical innovation. (n.d.). Retrieved October 20, 2014, from http://www.phrma.org/innovation/intellectual-property
WHO: Compulsory Licensing. (2000, May 2). Retrieved October 20, 2014, from http://apps.who.int/medicinedocs/en/d/Jh1459e/6.3.html
U.S. Food and Drug Administration. (n.d.). Retrieved October 18, 2014.
WORLD TRADE ORGANIZATION: Current Issues in Intellectual Property. (n.d.). Retrieved October 18, 2014, from http://www.wto.org/english/tratop_e/trips_e/trips_issues_e.htm
Generic Drug Sector Study. (n.d.). Retrieved October 20, 2014, from http://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/02495.html
Intellectual property. (2014, October 17). Retrieved October 20, 2014, from http://en.wikipedia.org/wiki/Intellectual_property
Canadian Generic Pharmaceutical Association. (n.d.). Retrieved October 20, 2014, from http://www.canadiangenerics.ca/en/resources/market_trends.asp
TRIPS Agreement. (2014, October 18). Retrieved October 20, 2014, from http://en.wikipedia.org/wiki/TRIPS_Agreement
Monopoly price. (2014, August 28). Retrieved October 20, 2014, from http://en.wikipedia.org/wiki/Monopoly_price
Ferreira, L. (2002, January 1). Access to Affordable HIV/AIDS Drugs: The Human Rights Obligations of Multinational Pharmaceutical Corporations. Retrieved October 20, 2014, from http://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=3874&context=flr&sei-redir=1&
Retrieved from http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.0030332&representation=PDF