For all the harm that has been caused, and for all the harm that it is still likely to be caused in the near future, the current Ebola pandemic in Western Africa is merely a symptom of a much larger structural injustice concerning the global manufacture of pharmaceuticals – For this, Thomas Pogge has a solution.
A frequently reoccurring and highly fatal virus, since its discovery in 1976 there have been at least 20 separate outbreaks of Ebola prior to the current crisis. And, while the recent death-to-infection rate has been 65%, casualty rates for past outbreaks have been as high as 90%.
This being the case, considering the relatively rudimentary biological composition of the virus, and the almost 40 years in which pharmaceutical companies have had to complete the requisite research and development, it is not unreasonable to expect a vaccine to be in global production by now, if not a cure.
Dr Margaret Chan, the Director-General of the WHO underscored the reason for this failure: “Because Ebola has historically been confined to poor African nations… the R&D [Research & Development] incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay”.
To take a new drug from conception, to research, through various stages of testing, to manufacture, and eventually to market is an extremely onerous process. This is a process that takes, on average, upward of 10 years, and costs over $1 billion per drug. What’s more, pharmaceutical development is a highly uncertain investment. The large commitments of time, resources and capital, provide no guarantee that a marketable drug will be produced.
This is why patents are so important. The patent system, now effectively universalised by the World Trade Organisation (WTO) agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), protects against the development of generic (counterfeit) pharmaceuticals by supplying and enforcing long-term market monopolies for newly developed drugs. During this period, free from competition, pharmaceutical companies can charge inflated mark-ups on their product in order to reclaim their original investment and turn a profit. This system of market control represents the only viable means to ensure the sustainability of the industry – the only real way to ensure that companies continue to invest in pharmaceutical development.
However, it is futile to charge high prices during the patent period unless there is a viable market that is capable and willing to pay the excessive mark-up. This is where the patent system fails the developing world. It is simply not cost-effective for pharmaceutical companies to invest in drugs that are targeted towards diseases which predominately affect the poorer populations – populations that are unable to afford expensive medicines.
38% of the world’s population are currently without access to essential medicines. 50,000 people die each day from largely avoidable causes. Meanwhile countless others suffer horribly from the symptoms of such preventable illnesses. This represents a global disease burden that produces social fragmentation, erodes domestic savings, precipitates diasporas, limits the capacity of governments, impedes economic growth, and entrenches cycles of poverty. Yet pharmaceutical investment routinely neglects diseases such as malaria, tuberculosis and dengue fever in favour of the aesthetic maladies of affluent customers, such as erectile dysfunction and male-pattern baldness.
It has become the capacity to pay that drives pharmaceutical development, not the capacity to alleviate harm and suffering.
It is therefore unsurprising that Ebola, as a historically African affliction, has failed to attract the most minimal levels of research funding. And when, on the rare occasions that preliminary studies have been set up, such as that undertaken by Johnson & Johnson, they have proven to be vacuous (the Johnson & Johnson research had remained dormant until the overwhelming size of the recent outbreak unexpectedly transformed Ebola from an isolated third-world problem, into a truly world-wide health challenge and an impediment to international growth). Whereas 40 years of immense suffering could not motivate pharmaceutical investment in Ebola research, the sudden realisation that such research might be profitable produces an immediate application of resources.
By breaking with the mould of his profession and venturing into the world of practical application, Yale Professor of philosophy Thomas Pogge has developed a solution to this paradigm of pharmaceutical development – the ‘Health Impact Fund’.
Operating in conjunction with the current patent system, the Health Impact Fund would be an alternative payment scheme for pharmaceutical development. Financed by governments (individually or collectively), pharmaceutical companies would be offered the ability to surrender their ‘patent option’ and register to be paid according to the health impact (using the metric of ‘quality adjusted life years’) of their drug rather than the profit margin of sales. Registered drugs would subsequently be sold at the lowest feasible cost in order to increase global access to them over the period that they are protected by the Fund (Pogge envisions 10 years). This would maximise the scope of the drug’s potential health impact, and thereby increase the potential profit margins for the pharmaceutical manufacturers.
Fundamentally, the Health Impact Fund rewards pharmaceutical innovation according to the successful outcomes of the new medicine, rather than according to whether or not the new medicine has a sufficiently wealthy target audience.
Though not cheap to implement, when divested across multiple state actors, and when considering the Fund’s ability to provide future cost savings by mitigating against humanitarian crises, the Fund would not be restrictively expensive - potentially even cost-neutral.
Pogge’s initiative represents a significant improvement upon the alternative of governments individually selecting under-researched diseases and attracting scientists by competing with private sector salaries. Such ‘push’ factor incentives are notoriously ineffective, especially when compared to the ‘pull’ factor incentives provided by the possibility of exponentially large back-end profits. As opposed to direct government funding, the Health Impact Fund maintains an inducement for private enterprise participation.
By delivering a viable alternative to the patent system, the Health Impact Fund offers an otherwise absent encouragement for socially conscious companies to develop drugs targeted toward global health challenges such as Ebola. What’s more, pharmaceutical companies would likely be further tempted to participate in the Fund by the prospect that they would receive a public relations benefit above and beyond their profit margins.
Large-scale global institutional reform is near impossible to achieve. It is here that Thomas Pogge’s project gains increased credibility. Rather than a sweeping reform, the Health Impact Fund is a relatively small, non-intrusive supplement to the existing institutional order - yet intelligently targeted in such a way as to have the capacity to produce disproportionately large global health outcomes.
As a means to ensure that private companies continue to invest in pharmaceutical development, there is simply no conceivable alternative to the patent system. It is therefore vital that the harmful side-effects of the system, such as under-investment in diseases that prominently affect poorer populations are offset as much as possible by supplementary design features. Thomas Pogge’s Health Impact Fund is the best available means of achieving this. The best chance of ensuring that research and developed is targeted towards the diseases and regions where it can have the greatest health impact. And the best means of mitigating against future global health crises on the scale of the current Ebola outbreak.
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