In November, I was humbled to meet politician and eager humanist, Dr Ellen 't Hoen, when she visited Manchester as a key speaker at the inaugural event for Universities Allied for Essential Medicines (UAEM). The article was my first one-page article, but I learned alot from it. Not only as a journalist, but also about the capitalism of the drug industry. I recommend this as a read for anyone interested in how drug companies actually manage to reel in those big bucks.
The article was published in Student Direct : Mancunion on the 7th of December 2009, and can also be accessed here.
Scientists tend to get caught up in a so-called ‘research bubble’, forgetting to consider the real world-implications of their research. An interview with Dr Ellen ‘t Hoen, key speaker at the Universities Allied for Essential Medicines (UAEM) inaugural event that took place two weeks ago, is evidence enough that this bubble is in need of some serious bursting.
Dr Ellen ’t Hoen has been ranked as one of the top 50 most influential people in intellectual property for two years running. When confronted with this, ’t Hoen responds with a humble smile: “Well, anyone can draw up a list, right?”. Despite such humility, she has an impressive resumé as an advocate for the Campaign for Access to Essential Medicines. In addition to a ten-year history at the Médecins Sans Frontiers’ (MSF) Policy Director, she is currently Senior Adviser for UNITAID, an international interest organisation that aims to initiate a patent pool for HIV/Aids medicines.
The idea of a HIV/Aids medicines patent pool was first suggested by MSF in 2006, where ’t Hoen was working as Policy Director. While at MSF, ’t Hoen gained personal experiences of the reality faced by those out of reach of medical treatments. This period in her life undoubtedly helped shape the motivation with which she drives her patent pool cause forward today.
For those who may not be familiar with the subject, a patent is a form of intellectual property that describes the details of a drug, thus serving as a list of instructions for its manufacture. Currently, pharmaceutical patents last 20 years, meaning that a company can charge whatever price they choose during this time period. After the patent expires, other pharmaceutical companies can start producing the drug at a lower cost.
The current patenting system finances research into improved drug treatments through revenue from sales. This system is effective in developed nations, such as the UK, thanks to what ‘t Hoen refers to as the “safety net” that we take for granted – namely the social security system. In Britain, Aids patients are offered anti-viral treatment by the NHS at no cost. However, in developing nations, patients are required to fund the cost of these drugs themselves. “In a world where the patent system is globalised, but not the social security systems we’re used to in Europe, we will face huge problems. Developing countries must at the same time comply with these rather stringent ideals (of intellectual property rights), but there are no safety nets to deal with the consequences.”
Thus the pharmaceutical patenting system does not work in favour its main patient group, i.e. Aids sufferers in low and middle-income countries. ’t Hoen explains that this problem stems from the fact that Aids drugs are developed mainly in the US and the UK. “Most of Aids research goes toward developing new drugs for Western countries. After that we try to figure out how they can be used in developing countries. There isn’t a specific research and development (R&D) agenda for Aids in the developing world”. There are many disadvantages to this system.
A staggering six million Aids sufferers (that’s more than the population of Scotland) are without access to existing drug treatments. This results in a few million yearly deaths among Aids sufferers. Now imagine how large this number will be in the space of 20 years – how long it takes for a patent to run out.
Can we really afford to wait 20 years to make Aids treatments affordable? Dr ’t Hoen feels passionately about this. “If lives are lost because our R&D system is based on exclusion of people, then we need to think of another way to finance R&D – because at the moment it is done through high drug prices. We can hardly call it useful medical innovation, if it is based on as system of excluding people.”
’t Hoen is referring to exclusion on two levels. Firstly, patents prevent the competition allowed in a free-market economy and lead to monopoly on life-saving treatments. Secondly, an estimated 80 per cent of the world’s population cannot afford the newest Aids drugs, due to their high prices. This notion violates the World Health Organisation’s (WHO) Human Rights declaration, which states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” By subscribing to the current Aids drugs patenting policies, we are indirectly allowing this violation to continue.
The Aids drugs patent pool initiative by UNITAID aims to change this injustice, by joining several organisations to share their patents. Third-party pharmaceutical companies can then, against a fee, use these patents to produce affordable drugs. This incurs no profit loss for initial patent holders, as they would receive royalties from third-party sales. More importantly, patent pools allow combining several drugs into one pill. Combined treatments have the advantage of being effective for those resistant to traditional Aids therapies.
However, combining drug formulations is only possible if no legal boundaries exist. Until 2005, this scenario was a reality in India, as product patents for medicines were not allowed. This intellectual property freedom allowed the Mumbai-based company Cipla to join three anti-HIVdrugs into one pill, known as a triple fixed-dose combination. ’t Hoen refers to this event as “revolutionary” for Aids care in the developing world. “They could achieve this only because no initial patents existed. Here in the UK, combining treatments would not have been possible, due to different parties owning the intellectual property rights to each treatment”.
The sharing of drug patents has already been carried out on a country-wide scale. This can be achieved by the government imposing a so-called compulsory licence, which involves forcing a pharmaceutical corporation to give up its exclusive rights to a drug patent. “When Thailand issued a compulsory licence, it was facing a huge backlash from the industry for doing so. Following this, people around the globe mobilised in support of the Thai Government’s decision, gathering in Thai embassies in ten different capitals in the world.”. ’t Hoen underlines this particular case as a good example of the solidarity that is necessary to mobilise the HIV/Aids drugs campaign on a global scale.
’t Hoen explains that another advantage of a patent pool is that it makes scientific innovation more available. This aspect makes the initiative attractive for particularly university researchers. Indeed, The University of Edinburgh has already embraced the patent pool initiative by signing a global access policy, with no reported losses in profit. As one of the largest research organisations in the UK, the University of Manchester is also encouraged toward changing their intellectual property policies. This is the main aim of the student-driven UAEM Manchester.
I asked what the response has been from the pharmaceutical companies, such as GlaxoSmithKline (GSK). “The opposition is huge. Some companies are more willing to cooperate than others.” ’t Hoen coins a term for this opposition, “GSK attitude.” In spite of this, she remains hopeful in terms of the future. “There is willingness amongst the pharmaceutical industry to be more flexible with its intellectual property, and allow others to work with it.” At the moment, the Aids medicines patent pool implementation plan awaits a board decision on whether to move ahead.
So, what can we do as students? ‘t Hoen is convinced that university students “really have the potential to change things.” In particular, she praises the achievements of UAEM, which started in the U.S. in 2001 as a student movement. UAEM campaigners at Yale University were successful in lowering Aids drugs prices in South Africa from an annual price of $1,600 per year to $55.
Dr ’t Hoen stresses that in order to change people’s attitudes, it is vital to reach as wide an audience as possible. To achieve this, ’t Hoen has made her recently published book entitled The Global Politics of Pharmaceutical Monopoly Power, freely available online. As I was handed a copy of the book, the humanitarian in me felt a tingle of hope, in knowing that I was holding what could potentially change the lives of millions of people.
To find out more visit www.essentialmedicine.org and www.unitaid.eu
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