Today, Explained - “Free the vaccine!”

Episode Date: May 7, 2021

President Joe Biden heeded calls from low-income countries to try to relax patents on Covid-19 vaccines so they can make cheaper generic versions. Big Pharma was furious. Transcript at vox.com/todayexplained. Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit connectsontario.ca. India today reported a world record in new coronavirus cases. The number was 414,188 new cases, probably an undercount. And at the same time, vaccinations in India are down. They're the world's biggest vaccine manufacturer, but there's a shortage of shots. Just over 2% of the country is fully vaccinated. On the other side of the world, COVID is surging in South America, Colombia, Peru, Argentina, and Brazil are all hitting record numbers of cases and none of them have even 10% of their populations fully vaccinated. to head into a sort of maybe normal summer, which helps you understand why people have been clamoring for Western leaders to make their vaccines more accessible to the world. And vaccine patents are seen as one of the biggest barriers. So for months, countries, mostly low-income ones,

have said, lift the patents and let the generic vaccines flow out of every pharmaceutical factory possible on the planet, which was why Biden's announcement this week was such a big deal. The announcement is that the Biden administration has carried out what is essentially a 180 degree turn in U.S. policy, and it is now going to back a suggestion at the World Trade Organization that there should be a complete waiver for intellectual property rights on COVID vaccines.

Kieran Stacey covered the news for the Financial Times. So this means all these companies that have been working for the last year, developing and manufacturing vaccines, could be faced with not being able to prosecute anybody who tries to then make a cheap knockoff and sell it elsewhere in the world. Now, intellectual property is absolutely vital for the pharmaceutical industry. That's how they make their money. They make sure that other people don't copy their ideas as soon as they generate them. So this is a really big deal for some of the biggest pharma companies in the US and elsewhere. Well, let's talk about how we got here because I know this decision has been sort of bandied back and forth all week.

Where does this story begin? Well, the story begins months ago. South Africa and India are leading a movement to suspend the World Trade Organization's agreement on intellectual property rights for COVID-19 vaccines. All kinds of COVID drugs. Actually, the original suggestion by the two countries was that it would apply to any kind of medicine used to treat or prevent COVID. So a huge range of drugs were envisioned in that original proposal. That was immediately opposed, as I think the two countries expected, by most of the West, by countries that have large international drug makers. Europe opposed it. The US opposed it. Plenty of other places did too.

They say waiving the patents would put off private investors and slow down scientific innovation. Then on the campaign trail, Joe Biden, when asked about it, would say that he did support the suggestion that companies should waive their intellectual property rights, particularly to COVID vaccines. Absolutely, positively. This is the only humane thing in the world to do.

People didn't pay that much attention because there was so much else going on during that crazy campaign. But when it became a policy issue in the last few months, there has been this week a World Trade Organization meeting and people knew this was up for discussion. For a while, it was assumed that the US would just stick to their previous position, which was, by the way, not only that they didn't support this suggestion, but they didn't even support discussion of it.

But it started to become clearer. Catherine Tai, the US trade ambassador, was having a bunch of meetings with anybody she could think of, drug companies, lobbyists, also progressive activists, it was clear that she was thinking this over. And so when it got to this week, when this meeting was due to take place, it seemed that we were at a crunch point. Now, I actually thought on Monday, I spoke to Dr. Tony Fauci, who many of your listeners will know as the chief medical advisor. Friend of the show. Friend of the show, friend of many shows. That's what we love about Tony Fauci. Wait, we're not special. I'm so sorry. I'm so sorry. I'd love to say he was a

friend of the FT, but it turns out he speaks to other people as well. But he actually called me and he said, he laid out a bunch of reasons why this might not be such a great idea. Principle of which was it could end up just getting involved in litigation and taking too long to get the vaccines where they're needed. One of the complicating issues of the so-called waiving the patents is that by the time you then get set up to get the technology transferred to other countries to be able to do it, you may be going into the end of 2022, the beginning of 2023, at which point a lot of people will have died. So I'm not against transferring technology.

And I'm agnostic about the TRIPS waiver. So I put down the phone to Tony Fauci on Monday thinking, OK, the administration is probably going to stick with the status quo. And then on Tuesday, there was a meeting in the White House. Now, Tony Fauci wasn't at that meeting. Catherine Tai, the trade ambassador, was the person who presented her materials to the president and a few of his foreign policy and domestic policy advisors

and said that she did back companies being forced to waive their intellectual property rights as far as COVID vaccines go. We're just finding out a little bit more about what happened during that meeting. But from what the White House has been telling me this week, the president always intended to stick to the promise that he made during the campaign to actually force the companies to give up their intellectual property rights on this absolutely vital piece of pharmaceutical genius. So Fauci was wrong?

Look, what he told me was, he was agnostic about whether or not to do it, but then he gave me a bunch of reasons why it was a bad idea. As far as I know, he still thinks those things. He is, of course, not the only voice within the administration. So I think what has happened is simply that the people arguing the other side of this have won out. And one of the reasons that the other side of this has won out, by the way, is that it's going to take a long time

for this to actually come to anything. These negotiations have to happen over the next few months at the World Trade Organization, and every single country there has to sign up. Now, as I'm speaking to you, we are Thursday lunchtime. I have literally just seen an alert suggesting that Angela Merkel is refusing to back what's known as a TRIPS waiver, the intellectual property waiver. Now, if she stays to that position, it's dead in the water. It needs unanimous consent. So the entire World Trade Organization, all the member nations need to sign on. That's right. Everybody needs to agree to this. Now, the US changing its mind is a huge deal. If the US does, its allies tend to do the same. But Angela Merkel says this would be a problem for our domestic manufacturers. And of course,

they have BioNTech as a German company. That is the company who developed the vaccine that Pfizer has been rolling out everywhere in the US. So it might be that this ends up coming to nothing. But what the Biden administration has done very cleverly is look like a friend to the developing world, look like a friend to those countries that are really suffering from major COVID surges right now. And I think that's one of the reasons that the arguments of the progressives who've been pushing for this within the White House, I think that's one of the reasons that the arguments of the progressives who've been pushing for this within the White House, I think that's one of the reasons they won is simply because they said to the skeptics, look, it's going to take some time. We're going to have input into this.

We can make sure that the exact policy is tailored to what we want. But it's not going to happen tomorrow. Don't worry. This isn't going to suddenly undermine the US vaccine rollout. We can take our time over this and make sure we get it right. What are the pharmaceutical companies themselves saying? I know we can assume that Merkel is acting on their behalf, but have they come out and publicly said,

no, we don't want to help the poorest countries in the world. We don't want our technology getting out there. Well, they have said that they oppose it. Absolutely, they've said they oppose it. Funnily enough, they don't couch it in terms of we don't want to help the poorest countries in the world. Weird. Funny that.

What they say is two things, really. One, it doesn't make a difference. And actually on this, they have a point. They say that the major constraint to getting vaccines to the developing world is not intellectual property, especially because Moderna has already said that it will not pursue its intellectual property rights if somebody else chooses to make a cheaper version of their vaccine. They say the major problem with getting vaccines to other parts of

the world is supplies. mRNA vaccines in particular, these are the vaccines made by Moderna and by Pfizer, are very difficult to make. And they're very new things. And we're just starting to build up the supply chains to them. So you need all kinds of specialist equipment and specialist supplies to be able to make them. And they say those supplies are in constraint. That's why we can't get as many vaccines as we want instantly. Simply allowing other companies to set up and try and make them

is not going to help. We just need more supplies. So that's their number one argument. The number two argument is that intellectual property in general matters. It's their incentive to try and develop these immensely expensive, immensely risky drugs in the first place. And that has been true for almost every drug ever produced. But on this occasion, actually, the government took a bunch of risk. The US government very early on pledged billions of dollars trying to get these vaccines off the ground and said to the vaccine manufacturers, we will buy these vaccines, we will pay you for these vaccines, even if they don't work, and even if we don't end up approving them. So there is an argument here where the US government

can turn around and say, you haven't taken all the financial risk yourself on this one. We've put in a bunch of money, and we think it's right that this is how it should be used. President Biden's decision isn't going to change the world tomorrow, but it's a historic stance against big pharma. More in a minute on Today Explained. Support for Today Explained comes from Ramp. Thank you. precedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained, ramp.com slash explained, r-a-m-p.com slash explained. Cards issued by Sutton Bank, member FDIC, terms and conditions apply. Bet MGM, authorized gaming partner of the NBA, has your back all season long.

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Biden made some big news this week when he came out in favor of waiving intellectual property protections for COVID-19 vaccines. That doesn't mean it's going to happen just yet, but it's a historic shift in thinking that's been the norm for decades. We asked medical ethicist Harriet Washington to take us back to when things got really cozy

between the government and big pharma. I trace it to the year 1980. In that year, the Bay Dole Act became law, and essentially it was sponsored by Bob Dole. I'm Senator Bob Dole. Some describe me as tough. Well, I've known tough times, and I've made many tough decisions. And that's what it takes to get the job done in Washington. And Birch Bay, and they wanted to mediate facilitation of the transfer of intellectual property,

molecules that might be medically important, for example, from universities to industry. The argument by industry was universities were generating all these new medications and all these potentially useful things, but they were not being developed. They were laying fallow. No one was making them into medications. Industry said, let us do that. It'll be better for the American people.

We'll generate more and better drugs. It sounded like a good argument, and the law was passed. And ultimately, I think it has become a disaster, because as a result of the law, the decision about which medications become developed and how much they cost has passed wholly into the hands of corporations. And they're guided by a fealty to the bottom line, not to the welfare of American patients. They're looking for drugs that will affect many, many, many people, so they can sell many, many, many drugs,

but they may not be the most important problems. I used to make love to my wife. Whenever we wanted. It was... Wonderful. So when I couldn't, I tried to avoid couldn't I tried to avoid it I tried to avoid it but then I made a call and now we're back if you or your partner isn't living life to the fullest because of erectile difficulties there's something you can do make erectile dysfunction we now have what many many many drugs for erectile dysfunction and only one new drug

for malaria, clearly, it's not the medical needs of people, but the bottom line that is driving them. And you know, the thing is, that's the role of industry. We're a capitalist society. We're here to make money. I don't indict industry as much as I indict the government, because it's the government that is supposed to watch out for our welfare and our health. And I think the government should be doing, reigning in industry more as it is now. And you're saying it was this Bayh-Dole Act that led to this set of circumstances we find ourselves in now, where this pharmaceutical drug culture in America is sort of driven by profit? Exactly. In transferring these molecules,

these developments to industry, we gave industry the power to decide which ones would become drugs, which ones would not, which ones would be developed. And the industry began determining what new drugs would be needed. And when they made that determination,

they based it upon what was going to make the most money for them and their stockholders. So now, in one sense of the word, it's industry that has control over the medical research agenda and not incidentally over medication pricing. The pricing issue is huge and that's completely dependent on patents. If there were not patent protections for industry, they could not charge whatever they wanted for a drug. And it's no accident that the most expensive drugs are those for the most deadly, usually fatal diseases. Cancer drugs that cost a million dollars a year, for example. They're paying what people are able and willing to pay to stay alive. That's what they're charging. It's not really predicated on what the drug costs them to provide,

which is what you often hear. No, it's predicated on what people are able to pay. And that's why in the West, prices are very high. The patents allow the companies to not have any competition. And so where you have patents for drugs, these are monopolies. You have someone who can set the price without interference from the outside. And you mentioned this passed in 1980, just before the HIV-AIDS crisis hit. How did this impact how accessible AIDS drugs were?

It had an impact on how drugs were priced. In the early 1990s, AIDS drugs were not at all affordable. They cost $19,000, $20,000 a year, and not everybody could afford them. So you had people who were able to buy the drugs or had insurance that covered the drugs, and these were people who were medicated. Then you had people who couldn't afford them, who were not insured, and they simply didn't have access to the drugs, and they died. Now, the government did step in and create the ADAP program.

Congress created ADAP in 1990 as part of the Ryan White program. Which was meant to provide monies for these drugs so people couldn't afford them. The ADAP has helped me to get these same drugs which would cost you an arm and a leg in most cases if you're not insured. But the program was administered by states in different ways and the country became like this crazy quilt of risk. If you lived in one state, ADAP would cover you,

but in many states, ADAP ran out of money very quickly, leaving people with no way to pay for these drugs. And the drug prices began to come down, which is something that typically happens because the patents have a time limit. Right, though it takes decades. And this is surely having an impact on the rest of the world in the meantime? The patenting of drugs enabled by the Baydol Act does indeed have an effect on the rest of the world and how it prices drugs. In the developing world, you have situations where the average income of people is so low, they simply cannot afford the drugs at Western prices. Well, one country that for a very long time supplied drugs

to a good part of the developing world at low prices was India. This is what's known as the medicine market, a very visual reminder of India's status as world leader in low-cost drugs, made locally, sold all over the world. It did it for a long time. It did it very well. And it did it partly because the patent system in India is different. In India, patents were predicated on the manufacturing process. In the US, patents were predicated on the formulations. So under Indian law, they could take a drug, reverse engineer it,

and produce it, and then sell it at cost if they wanted, or sell it at a low enough price that they would still make a profit, but not the huge profits of the pharmaceutical companies. Here they produce exact copies of branded medication with the same standards as those in the West, but at a fraction of the cost. Different types of anti-cancer drugs are being manufactured and marketed in the domestic market as well as some of the export markets. So India did a very good job until the World Trade Organization, the members got together and decided to put an end to it. They decided to enact what they call a TRIPS,

Trade Related Intellectual Property Act, which suddenly forced India and all other developing countries to adhere to Western patent laws. Slogans that have been perfected in recent months among the protesters patients who owe their lives to generic medication calling on pharmaceutical giant Novartis to drop its case against the Indian government problem really is they're trying to cut off the supply of generic medicines from India so that their monopolies can continue

so they bullied India into adhering to the Western way? Right. India was a chief way that people in these countries got their drugs. Ciple is one of the most important Indian manufacturers of generics to treat HIV AIDS. It is now producing second-generation HIV AIDS drugs, which are mostly sold abroad. Other companies were able to bypass the law, or even, as they did in Thailand and Brazil and Nigeria, they were able to use a loophole in patent law to force the companies to render their patents and give it to a company that would promise to divide the drug at low price. But when they did that, the U.S. was one of the prime actors

stepping up to say, it's intellectual property theft, you can't do that. It wasn't legally wrong, but the U.S. was opposed to it. So there are other ways of getting around the law, but they were quashed by this World Trade Organization TRIPS law that said that now all these companies had to adhere, had to recognize and honor Western patents. What was the result of that? I mean, did that mean that poorer countries couldn't supply their people with the drugs they needed? Yes. And it meant that India could not provide their own cheaper versions of the drugs. But there was a lot of furor over that. Nelson Mandela had denounced it. Is this acceptable? We know that there are treatments available which restore the opportunistic infections, especially TB,

and which return AIDS sufferers to good health for several years at least. Is it acceptable that these dying parents had no hope of access to treatment? Many prominent people were concerned about the fact that you had these fantastically wealthy Western companies bullying dying people in the third world who were just trying to keep themselves alive. And as a result, there was a compromise. There was a meeting in Doha. The meeting in Doha provided for certain loopholes so that these companies could indeed obtain and pursue cheaper versions of drugs. Everyone agreed to it.

But when the time came to actually sign the agreement, the U.S. refused to sign. And it wasn't the only country. Several wealthy Western countries would not sign the agreement, leaving these countries in legal limbo. So it's been a very ugly situation, frankly, a situation where there's intense bullying based on profit-making of poor people in the developing world. Hello and welcome to WTO Forum. Today's topic, the WTO's rules on trade-related intellectual property protection.

The question, does the so-called TRIPS agreement strike the right balance between the rights of patent holders and the rights of national governments? I imagine an argument that's been made by the pharmaceutical companies historically is that it costs millions, if not billions of dollars to research these medicines. And that's why they need their patents to make their money back so that they can create more life-saving vaccines. I get the feeling you don't buy that argument. That's precisely what they say. The argument is that drugs cost, initially the Demasi report said that every new pill costs $800 million. Since then, it's been modified upwards several times. Now they're saying that every new pill costs about $2 billion. And their calculations provide that claim that we spend so much money developing new drugs, and we also have to cover the price of all the drugs we spend a lot of money and time and

effort into that never make it to the pharmacy shelves. But that's not true. If you look at what they really spend on drugs, which has been done by groups like Public Citizen, they all agree it's relatively low. One economist said the real estimate is closer to like $100 million. That's not chump change, he said, but that's not $2 billion either. So it's nothing more than, you know, an excuse for the high prices that they administer. They're actually pricing medications based on what they think people will pay for them, not what they're costing them.

And this week, 40 years plus after the passage of the Bayh-Dole Act, the tide may have just ever so slightly turned in the opposite direction? Actually, we've had that opportunity many, many times in the past. I will say that I do think it's a watershed moment. Having the president and the highest tier of government agree to relaxation, if not revocation, of a patent, I think that's very important. But we need to stop letting patents interfere with people's access to the drug. This just feels like a global opportunity to rethink the system. That being said, it also feels like a bit of a long shot.

Frankly, I can't imagine a longer shot than the one we've been living with up until now, where, you know, your cancer drug might cost a million dollars, where if you live in the wrong country of the globe, you can't afford, you know, your malaria drug. It's hard to imagine anything worse than that. I'm not to imagine anything worse than that. I'm not saying that nothing worse than that is possible. We all know it can always get worse. But, you know, to me, I'm willing to take my chances on innovation. So it sounds like you're hopeful and actually optimistic.

Cautiously optimistic, absolutely. Harriet Washington, she's the author of a few books I want to tell you about. One's called Deadly Monopolies, The Shocking Corporate Takeover of Life Itself and the Consequences for Your Health and Our Medical Future.

The second is Medical Apartheid, The Dark History of Medical Experimentation on Black Americans from colonial times to the present. I'm Sean Ramos from Zero Books, 808 episodes of Today Explained. Thanks for listening. Thank you.