Constraints to an equal global healthcare system
Author: Cathy Nguyen | National Affairs Director
Over the past year, COVID-19 has remarkably disrupted our lives and reshaped the systems that surround us. To date, the COVID-19 death toll exceeds a staggering total of 3 million globally. It's a time in history that has been termed as the ‘inequality virus’ and that has left no one untouched. However, after one year of overcoming multiple lockdowns, border closures and the associated turmoil to our economic and social systems, we celebrate and rejoice in the entrance of the COVAX, new learnings and a bigger drive to create a fairer world. And although we either hold high levels of hope or a sense of fatigue from constant shocks, here is a list of facts and projections that could create concern regarding what the world may look like in the years to come - if we don’t raise questions of what did not work in the past and respond effectively.
The pandemic is set to drive nearly 150 million people into extreme poverty by the end of 2021, reversing decades of progress.
It took just nine months for the fortunes of the top 1,000 billionaires to return to pre-pandemic highs, while for the world’s poorest countries, economic recovery will take more than a decade.
In the US, close to 22,000 Latin Americans and Black People would have still been alive as of December 2020 if these communities’ COVID-19 mortality rates were the same as white people’s.
Let’s also think about pre-existing health inequalities challenges as well:
According to the World Health Organisation, at least two billion people (nearly a third of the world’s population) don’t have access to the medicines they need due to a lack of availability or because adequate treatments do not exist. These include limited access to important medicines for some of the world’s most devastating diseases such as malaria and tuberculosis.
These concerning projections and known disparities may come as a shock. Without a doubt, the pandemic has exposed the weaknesses of poorly equipped health systems and the failures of governments across the world.
Spotlighting the Failure of Big Pharma
Access to life-saving medicines and vaccines for COVID-19 and other maladies are at the mercy of some of the world’s largest pharmaceutical firms. These firms directly contribute to the formation of global structural health, economic and social inequalities.
In an attempt to grapple with the issue, governments are deploying COVID-19 vaccines at accelerating rates. For already resource limited health systems around the world, it's saddening that big pharmaceutical companies who deliver the most critical medical supplies to the world, are incentivised to maximise their profits rather than public health. Oxfam terms this as the ‘prescription for poverty’ where research has shown that the largest four pharmaceutical companies Abbott, Johnson & Johnson, Merck and Pfizer, systematically and sophisticatedly allocate their profits to tax havens. Analysis has been conducted to show that these firms appear to deprive the United States of $2.3USD billion annually and developing countries more than $100USD million every year. Potential available capital like this should ideally be spent on healthcare expenses for developing countries and help enable them to achieve higher levels of equal healthcare access and economic productivity instead of expanding profit margins and inflating share prices.
“Prescription for Poverty’ also outlines how the companies undermine poor people’s health by overpricing medicines - putting them out of reach for cash strapped public health services and poor patients…”
The irony with the profits that pharmaceutical companies generate is that they are actually derived from taxpayers and government funding. Think about the existence of large public health research institutes and universities where the most important stages of medical development and vaccines are based on research in these labs. The major source of funding for these research operations comes from the government which ultimately derives from hard working citizens’ tax payments. If you were personally going to invest in a business or stocks, any value created from funding should be paid in return for initial funding otherwise business activity would have not been possible. This should also be the case for funding for drug development and innovation, when taxpayer funding is allocated to research and development and in later stages of drug commercialisation, it should be assumed that whenever an investment is made, the gains from the initial funding should return to benefit the original financiers (society) rather than a few - but this is far from the reality of the contemporary pharmaceutical industry.
Another factor that leads to unrealistic drug prices in the global south are that the rules of trade, patents and in developing drugs are not quite on the fair side either. The price of medicine around the world has been influenced by the World Trade Organisation, a global institution that governs international trade, including drug patents. Various WTO policies have enabled large firms to monopolise the market on life saving drugs for the past 20 years. This has enabled firms to charge prices that maximise their profits and close out the door for less wealthy countries to develop and produce at much more affordable prices. The desire for patent protection stems from firms aiming to protect research and development and argue that it is an essential for continued R&D for the new drugs and technologies. And while it is important to continue fostering innovation to adapt to the constantly changing nature of medicine and human health, historical research and evidence has alluded to the fact that firms are incentivised to employ tactics to prolong a drug’s exclusivity and make deliberate drug modifications in order to develop longer forms of consumption. This is termed as evergreening and thicketing, a term referring to the lucrative practices of firms taking advantage of the gains from research and developing drugs that are ultimately not the most effective cures for diseases, which increases consumer dependence on drugs and leads to higher levels of profits.
This large disconnect from drug innovation and global health disparities highlights both a current tragedy of the commons, but perhaps also an opportunity to redirect needed funds to close existing health gaps.
So what can potentially be done to champion change?
The Drugs for Neglected Diseases initiative (DNDi) is a working, successful model of non-profit, virtual collaboration that researches, tests, gains approval, manufactures and distributes clinically superior medicines at a low cost and for wide access, thus reducing health care disparities. Since the 2000s, the initiative has been working to serve neglected diseases such as leishmaniasis, sleeping sickness (human African trypanosomiasis, HAT), Chagas disease, malaria, filarial diseases, mycetoma, paediatric HIV and hepatitis C. For initiatives like these, they model ways of reducing the cost to drug development, ensuring that research is transparent, open and working consciously to address the largest health problems in the world.
All in all, the pandemic of the century has unwrapped economic, social and health systems - bearing at its absolute worst and people demanding for more equitable and just choices to be made. The much needed development and deployment of COVID-19 vaccine provides us with a spotlight that when pharmaceutical firms have the liberty to maximise profits from health and drug innovation, this could actually be economically counterproductive. However, if governments, policy-makers and taxpayers voice and intervene in the market mechanisms of drug development then we may have the possibility to control drug equity. Meaning that for the future, global public health and reducing disparities should be the utmost priority for global growth and development or we may face far more concerning consequences across the world. It may present itself as an opportunity for us to question our systems with more scrutiny, do more for the world and account key stakeholders to uphold the solutions we need to resume to a far greater normal post COVID-19 world.
Additional Resources:
The Value of Everything by Marianna Mazzucato
The People’s Prescription: Re-imagining health innovation to deliver public value