A Fair Shot: The Fight for Affordable Medicine – David Zuther, Germany

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It’s a killer. 100 children an hour. 2,500 a day. 922,000 in a year. Pneumonia is a major cause of death among children, accounting for 15 percent of all deaths of children under five years of age in 2015. Pneumonia is not only a deadly disease, it is also a fruitful base for business. The world’s bestselling vaccine is against pneumonia. Every day, the pharmaceutical giant Pfizer rakes in $17 million in sales of the vaccine. The large profits the drug industry makes from this product indicate that the vaccine is prohibitively expensive in many poorer nations.   

When those high prices make potentially life-saving drugs and treatments inaccessible to those who need them most, ethical questions ensue- do pharmaceutical companies have a wider responsibility to the public, or are they only accountable to their shareholders and thus unfairly blamed when the world’s poor cannot afford their medicine?

This is certainly not a new debate, and the battle lines have been well established before: in 1998, 39 international drug companies decided to take the South African government to court because of a law aimed at reducing the cost of HIV/AIDS medication for the country’s population. This law allowed the South African government to import drugs from an Indian medical company that imitated the more expensive brand-name drug (a so-called ‘generic’), thus saving money and enabling more people to access the treatment. However, the pharmaceutical companies saw their profits threatened and sued, arguing that the law violated their patent rights. Facing criticism from the European Union, the World Health Organisation and AIDS activists across the globe, the pharmaceutical companies finally dropped the lawsuit in 2001. The corporate bosses concluded that the damage the suit would do to their image would outweigh any benefits from a potentially favourable ruling.

After 2001, the pharmaceutical industry became more reserved about taking developing nations to court but maintained its determination to defend its profits. A country that recently came to witness that determination is Colombia. After seeing the cost of some drugs increase tenfold in just a few years, the Latin America’s public health system was strained by the staggering price of medication. In order to control the cost of a leukemia drug, the Colombian government threatened the pharmaceutical giant Novartis with a “compulsory license” unless it agreed to lower the price. A compulsory license allows the authorities to break a company’s patent and introduce generic alternatives to the market.

In response, Novartis vowed to fight such a step as well as ruling out any further price cuts because the drug brought in 4.7 billion USD for Novartis last year, making it one of the company’s best-sellers. Leaked memos written by the Colombian embassy in Washington, D.C,  showed the intense pressure Colombia faced from Novartis and its allies in US Congress, who threatened to withhold development assistance for a peace deal with rebels and warned that Colombia’s role in a free trade deal could be at stake if the country chose to revoke Novartis’ patent.

Unaffordable medication is not even a problem that only afflicts so-called developing countries: it is a major issue in the United States, where the price of some cancer drugs has increased a hundredfold in the last fifty years and the growth in prescription drug costs isn’t predicted to slow down any time soon. When faced with criticism over high prices, pharmaceutical companies often point to the high cost of developing new drugs and the complex process to get them approved. To some extent, they are right: it is very expensive to research and develop new drugs (although most pharmaceutical companies actually spend much more on marketing and advertising than on research and development).

Nevertheless, as observers noted, some brand-name drugs are twice as expensive in the U.S. compared to some European markets, which means that the high cost of prescription drugs in the States cannot be blamed on R&D costs. More often than not, the unusually high drug prices in the US when compared to other markets result are not from expensive development, but rather from the industry’s profit interests. A notorious example of such short-term profiteering at the expense of public health is the acquisition of a drug often used for patients with  immune-system deficiencies like HIV by Turing Pharmaceuticals. Turing, a company owned by now-infamous investor Martin Shkreli, jacked up the price of one pill from $13.50 to $750, causing a widespread wave of indignation.

Another case involves a drug so expensive and so inaccessible that it is out of reach for patients, both in the United States and in the developing world. In 2014, a ‘direct-acting-antiviral’ was introduced, a promising treatment for the 130 to 150 million people worldwide fighting chronic hepatitis C. The new type of medication is faster and more effective than previous ones, but it comes with a price tag attached: $84,000 for a 12-week treatment cycle in the United States – or, a shocking $1,000 per pill. Outside of the US, hopes that the new drug will help many hepatitis C patients anytime soon are similarly grim. Gilead, the manufacturer of the antiviral, has allowed limited competition from generic companies in 101 low and middle income countries through licensing agreements. Such agreements will eventually lower the cost but Gilead has excluded some 38 other developing ‘middle-income countries’ from its licensing scheme, meaning that in these countries, patients will still be unable to afford the care they need.

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At the end of the day, this issue turns into a broader debate about what role businesses and corporations should have in our society. If we believe that pharmaceutical companies should only be accountable to themselves and their shareholders, then there is nothing wrong with price regimes that leave poor patients without care. However, if we believe that the drug industry does have a responsibility to society as a whole, then their behavior is entirely unacceptable. If we believe that healthcare should be a universal right, not a privilege reserved for a fortunate few, then we must speak up now. We must tell the pharmaceutical industry it cannot continue putting profits over people. It’s time.

The Doctors Without Borders campaign to lower the price for pneumonia vaccines is at: http://www.afairshot.org/#petition-en

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