We need a social enterprise model of drug production
The World Health Assembly, which is meeting in Geneva for the first time since the start of the Covid-19 pandemic, has agreed to set a framework to start preparing for future pandemics. But this decision-making body of the World Health Organization (WHO), with its many delegates from middle- and low-income countries, is facing a difficult reality: even as the world is only beginning to understand the extent of our failures devastating in response to Covid, the rich countries of the world want to get out of the pandemic.
Preparing for the next pandemic will require more than a commitment from delegates to the World Health Assembly. This requires a structural shift towards a fairer global health framework, where power is more evenly distributed through a social enterprise model of vaccine and drug production. Social enterprise is the form of business which is based on the principle of solving human problems in a sustainable business manner, where the owners are not interested in earning profits except for the return of the investment amount initial over a period of time. It’s a non-dividend company aimed at solving social problems, not making personal money.
There are concrete steps that world leaders can take towards this framework. If governments can give billions of dollars in grants to pharmaceutical companies to develop and distribute vaccines, they can invest those funds in social-purpose pharmaceutical companies and pass the benefits on to vaccine users in need.
The global inequalities engendered by the pandemic are evident: more than 20 millions people have died from Covid, with deaths overwhelmingly concentrated in low-income countries. The WHO had set itself the goal of vaccinating 70% of the world’s population by the middle of this year. But as we approach that deadline, 16 percent people in low-income countries have received a single dose. At this rate, it will take another two and a half years for the poorest countries to reach the WHO target.
After low-income countries have been denied vaccines for more than a year, some doses are finally starting to arrive. Supplies arrive unpredictably all at once, in large volumes and often close to their expiration date. When the doses arrive, low-income countries have little say in which vaccines are delivered, in what volume, and in what time frame, making it nearly impossible to plan vaccination campaigns. Production, meanwhile, remains concentrated in the North.
And now that effective treatments such as antiviral pills have been developed, the cycle begins again.
Rich countries have already bought nearly all of Pfizer’s Paxlovid and Merck’s Lagevrio supply for 2022. The companies control which countries can produce the drug, excluding many countries, including almost all of Latin America. Pfizer even outrageously claimed that an attempt to produce Paxlovid in the Dominican Republic would violate the company’s “human rights.”
Wealth is power. And the brutally uneven global deployment of Covid vaccines and treatments is the consequence of an ever-increasing concentration of wealth and an emphasis on maximizing profits. Today’s pharmaceutical industry supplies drugs to the highest bidder for ever-increasing profits. Equity and access are treated as simple public relations issues.
In this context of deep inequalities, immediate funding for the global deployment of Covid vaccines, treatments and tests is essential. It is the wealthy nations, the G10, continuous beneficiaries of the wealth-concentrating economic machine, who have profited from the current pharmaceutical model at everyone’s expense. They have the resources to close the vaccine gap, if they want to. And for starters, I recently called US President Joe Biden will take the lead with a $5 billion pledge to support global immunization efforts.
More and more vaccines are being produced, but they are not reaching the right places and the right people. When new, more effective vaccines are ready, they will once again be sold to the highest bidder, leaving low-income countries to fight today’s virus with yesterday’s tools. It is imperative that this system be changed. We need to have clear decisions about where vaccines and treatments are produced, by whom, for what purpose, and how accessible and affordable they are. And freeing Covid vaccines from profit and patent is the key.
I called for the creation of pharmaceutical companies with a social purpose. These would be companies not looking for dividends that would produce vaccines and medicines to reach places and people that are still missed by the current system, and sell them at cost of production, without markup, also at prices affordable to lower-income earners, through cross-subsidies. It’s the clearest thing the healthcare industry can do to solve one of its most pressing problems, to reach everyone, everywhere, from the bottom up. But this requires removing barriers such as intellectual property rules and social enterprise initiatives. And, although the call to make vaccines patent-free to enable global production has gained traction, it has not been enough to follow through.
Now, in the midst of a crisis of this depth and magnitude, is the best time to undertake this initiative. If we decide to gradually move from a charity model to a social enterprise model, we will lay the foundation for local manufacturing and distribution of vaccines, tests and treatments. Leaders can start with the next generation of coronavirus vaccines, revoking patents and investing in socially-minded generic makers, to ensure countries in the Global South don’t have to fight tomorrow’s variants with the tools of yesterday.
World leaders can remove barriers to the production of generic vaccines and treatments, by backing a full waiver of intellectual property rules on Covid tools at the World Trade Organization (WTO) this month. And they can do everything in their power to compel pharmaceutical companies to share their vaccine, testing and treatment technology with countries in the Global South.
Instead, however, the EU, UK and Switzerland blocked an intellectual property waiver for more than a year. The United States has refused to accept the removal of these barriers for treatments, insisting that a waiver only cover vaccines. They can sense the domestic political pressure on Covid waning. So as the negotiations heat up, the rich countries are closing ranks.
Any meaningful progress will be too late for the millions of people who have died unnecessarily from Covid. But our actions today can correct our trajectory for tomorrow’s variants and set a pattern for future health crises. There is still time for world leaders to say never again, to ensure that the right to health is extended to all and to commit to a fairer global health system that puts lives first. rather than the profits of a handful of pharmaceutical companies.
Doctor Muhammad Yunus is an economist, social entrepreneur and civil society leader. Founder of the Grameen Bank, he received the Nobel Peace Prize in 2006.