Big pharma rules, okay? No, it’s not okay

Life saving antiretroviral medicines (ARVs) were available but not affordable. This led to a global human rights movement that exposed excessive prices and abuse of market dominance by the handful of companies that manufactured antiretroviral medicines - many of them the same companies that have hijacked the market for Covid-19 vaccines. (Photo: Siphiwe Sibeko/Reuters/nature.com/Wikipedia)

By Mark Heywood

19 Oct 2021

The Covid-19 pandemic has exposed big pharma once more engaged in the worst kind of profiteering. They do this because they know that they can hold the world to ransom over access to life-protecting vaccines they didn’t invent but whose manufacture and distribution they monopolise.

This week one of the films showing at the European Film Festival is Save Sandra, a beautiful but tragic story of Sandra, then the six-year-old daughter of William and Olga Massart, and her battle against the rare disease metachromatic leukodystrophy (MLD). Sadly, instead of being a battle against the disease itself, it also became a battle against a British pharmaceutical company, Shire, that had acquired the experimental drug, Metazym (called Matoxym in the film), raised expectations about its efficacy, but priced it out of reach of the young children who most needed it.

In the film, Sandra and her dad describe it as a “magic potion” that can take away her crippling pain and growing paralysis. But despite raising €1-million from a public campaign the company refused to provide it to them (see this local newspaper report from the time).

Sadly, Sandra’s story is not unique.

It is the story of millions of people across the globe with debilitating or life-threatening illnesses that are treatable thanks to the wonders of modern medicine, but are unaffordable (no) thanks to the modern patent system.

In South Africa, for example, the incidence of cancer is projected to double to 160,000 cases per year by 2030 and cost an additional R50-billion. People are dying today, and will die in even greater numbers in future, despite the existence of South African Health Products Regulatory Authority-registered medicines that can prolong their lives.

As an example, Salomé Meyer of the Cancer Alliance cites immunotherapies such as pembrolizumab (Keytruda) that are used for treatments of metastatic disease such as melanomas, non-small cell lung cancers and colon cancers that cost R92,908 a dose and a patient requires a course costing R500,671.

It's been almost six months since May 2021 when the Independent Panel on Pandemic Preparedness and Response issued a report to the WHO that recommended that if greater vaccine equity wasn’t achieved in three months 'a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately'. (Photo: Facebook)

Meyer says that even in the private sector, “most patients cannot afford co-payments and therefore will go into debt if they want to live. Naturally these medicines are not even thought of for public-sector patients as they are unaffordable.” (See the Cancer Alliance report on pricing of cancer medicines here).

Cheaper and effective generic equivalents of many of these drugs do exist but it is illegal to import them. SAHPRA does not take price and affordability into account when it registers medicines – neither will it permit section 21 authorisations or compassionate use of generics because a patented medicine is too expensive.

In the early 2000s, the world faced a similar situation during the AIDS epidemic. Life-saving antiretroviral medicines (ARVs) were available but not affordable. This led to a global human rights movement that exposed excessive prices and abuse of market dominance by the handful of companies that manufactured ARVs – many of them the same companies that have hijacked the market for Covid-19 vaccines.

Big pharma and their bosses were morally shamed. Through protest, research and litigation they were forced to change their approach, reduce prices and issue voluntary licences to generic companies.

One of the frontlines of that battle was South Africa where, for a few brief years, our government showed a will to challenge patent monopolies and excessive pricing.

As a result, today 27.5 million people all over the world, but mostly in poor countries, benefit from access to ARVs.

Pandemic profiteers

Unfortunately, the Covid-19 pandemic has exposed big pharma once more engaged in the worst kind of profiteering. They get away with it because they know that they can hold the world to ransom over access to Covid-19 vaccines they monopolise.

And they are doing just that.

According to a media statement by the British charity ActionAid, Covid-19 vaccine development has been supported by $100-billion in public funding from taxpayers in the US, Germany and other countries. However, just three corporations (Pfizer, Moderna and BioNtech) have earned more than $26-billion in revenue in the first half of 2021, “at least two-thirds of it as pure profit in the case of Moderna and BioNTech”.

The People’s Vaccine Alliance, a global coalition of more than 75 organisations, estimate that the three corporations are overcharging “by as much as $41-billion above the estimated cost of production”. They say that “Moderna has brought in more than $6-billion in revenue this year, $4.3-billion of which is profit – an astronomical 69% profit margin on its vaccines. Moderna expects total vaccine sales of $20-billion in 2021. At the same time, Moderna is paying single-digit tax rates – it has paid only $322-million in tax in 2021 despite earning billions in profit.”

But even this is not enough to slate their greed.

In August, The Guardian reported how Pfizer and Moderna had unilaterally “raised the prices of their Covid-19 vaccines after data from clinical trials showed their mRNA formula was more effective than cheaper vaccines from Britain’s AstraZeneca and the American drugmaker Johnson & Johnson”.

Price gouging on public goods

In South Africa there has been justifiable outrage over price gouging by PPE suppliers, among others, yet a veil of secrecy is being drawn across the contracts our government has entered with the big pharma companies.

Unlawful non-disclosure agreements have been signed that make it impossible for citizens to assess the terms and prices of the vaccines we are buying. Requests by the Health Justice Initiative citing the Promotion of Access to Information Act to access the contracts have come to nothing so far. The government’s response has been to “invite the vaccine manufacturers and distributors to make written or oral representations as to whether the request for access should be granted or refused (in whole or in part)”.

We know what they will say. So does the government.

Vaccines are vitally necessary, but that does not mean we should not question the prices and terms on which they are sold.

According to the National Treasury Covid-19 dashboard (here), the largest payment made by any government department during the Covid pandemic so far has been R1.27-billion to Pfizer Laboratories. Treasury has not updated this figure for several months. It is likely to be much higher.

This is everyone’s business and everyone should be worried.

It is clear now that Covid-19 is not going to present a one-off windfall to these companies. With the need for booster vaccinations, modifications for variants, and the likelihood that Covid-19 will become an endemic virus circulating for the foreseeable future, their profit line is more than secure. But for developing countries the cost of Covid vaccines will be at the expense of other areas of health and socioeconomic rights.

How can these unwarranted costs be curtailed?

Six months have almost passed since May 2021 when the Independent Panel for Pandemic Preparedness and Response issued a report to the World Health Organisation that recommended that if greater vaccine equity wasn’t achieved within three months “a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) should come into force immediately”.

If anything, vaccine inequality has widened since then: 47.6% of the world’s population have received at least one dose of a Covid-19 vaccine, but only 2.7% of those are people in low-income countries.

In late November the World Trade Organization’s Ministerial Conference must take a final resolution on the TRIPS waiver that has been proposed by India and South Africa. We hope that South Africa will advance the cause of public health and human rights aggressively. It should not give in, like it has done over the health promotion levy (“sugar tax”).

Life-saving antiretroviral medicines were available but not affordable. This led to a global human rights movement that exposed excessive prices and abuse of market dominance by the handful of companies that manufactured these medicines – many of them the same companies that have hijacked the market for Covid-19 vaccines. (Photo: Siphiwe Sibeko/Reuters/nature.com/Wikipedia)

It should wage a global campaign for the human right of access to medicines and medical technologies, as the Treatment Action Campaign did around access to AIDS medicines.

Profiteering from medicines is immoral. It’s a crime against humanity to trade people’s lives for profit.

This is the worst type of capitalism, practised by profit junkies whose behaviours violate international human rights standards and national constitutions. It is the type of extremist capitalism that the Biden administration sought to rein in with its proposal (now adopted) for a minimum corporate tax. It puts big pharma in the same league as those exposed in the Pandora papers.

Profits on this scale make pharmaceutical companies more powerful than most democracies in the world, with a power akin to that of big finance.

They behave like modern-day monarchs who wield the power of life and death with impunity – which is not good for democracy and wealth inequality. The private control of research, development and production of medicine is not good for global public health.

It’s time we reclaimed our sovereignty and health and said that the rule of big pharma is not okay. DM/MC

Join the webinar discussion: A Film about Life, Death and Money! Jan Verheyen and Lien Willaert’s film Save Sandra, is showing free online at the European Film Festival until 24 October. Willaert wrote the screenplay based on the true story of the Massart family, a story that deeply touched media and public opinion in Belgium, and far beyond, 10 years ago. The film forms the basis for a Live Zoom discussion as part of the festival’s Special Event programme where Verheyen and Willaert will be in conversation with Maverick Citizen Editor Mark Heywood about the story, and its far-reaching implications, on Wednesday, 20 October at 6pm. To access the discussion visit the www.eurofilmfest.co.za Special Event page.

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