Drug development and pricing: in need of a vaccine

By Chandran Nair


This column by Chandran Nair appears in the April 2007 issue of the Ethical Corporation magazine.

Until a few weeks ago, the name Siti Fadillah Supari will have meant little to anyone outside Indonesian politics. Now, it registers with the most powerful people in global business and, certainly among developing countries, it would be no stretch to call the Indonesian health minister heroic.

With the most deadly strain of bird flu her daily burden, Supari has taken on “big pharma” as it sits behind its fortress walls of patents buttressed by high prices.

More than 60 people have died in Indonesia from the H5N1 virus; nowhere else has suffered as much. Yet, when an Australian commercial drugs company announced it had developed a vaccine for the particular strain that has been taking lives in Indonesia, the health minister’s reaction was far from joyful.

In a rapid sequence of events, the World Health Organisation declared that Indonesia had stopped taking part in an important project to study, track and develop vaccines for virus strains. The government in Jakarta accused the WHO of misusing its sample of the virus by releasing it to a commercial company without its consent. Jakarta declared it would withhold samples from anyone unwilling to agree not to use the Indonesian strain for commercial reasons. And the Indonesian government then signed an exclusive pact with another drugs giant to help develop an affordable vaccine to be made and sold in Indonesia.

Access denied

There was at least one suggestion that Jakarta was being irresponsible. But in defending the move, Supari alerted consciences to the injustices of a far greater killer, an endemic condition so entrenched that it has become an accepted – and legally protected – routine blocking people in poorer countries from life-saving vaccines and drugs, because they cannot afford them, something she described as “dancing over the corpses of others”.

One irony is that patented drugs are often developed using virus strains from those poor countries. Another, as UK medical journal “The Lancet” points out, is that “in a pandemic, it is industrialised countries that will have access to available vaccines, whereas developing countries – where a pandemic is likely to emerge – will be left wanting”.

Even the WHO has come to the “depressing conclusion” that “most developing countries would have no access to vaccine during the first wave of a pandemic and possibly throughout its duration”.

Under these circumstances, Indonesia’s move to try to secure affordable vaccine for its population “was understandable”, “The Lancet” comments.

Pharmaceutical corporations have used patents to hew a path to profits. And while there are provisions in World Trade Organisation rules allowing patent monopolies to be overridden, for public-health emergencies or where there are unfair price practices, the power and influence of “big pharma” backed by western governments often compel developing nations to accede, and toe the patent line.

It is no wonder that Vandana Shiva, a leading Indian activist and scientist, has called patents the new imperialist’s tool that prevents others from “having food and medicine, countries from having technological capacity”, damning them as “a negative tool for creating underdevelopment”.

This makes Supari’s stand and public outcry all the more extraordinary. However unwitting, she has exposed in the public arena a number of issues for too long smothered by legalistic menacing.

Big profits

“The Lancet” raises another interesting point, this time on price and with specific regard to Aids drugs.

The anti-retroviral drugs that are used in rich countries to convert Aids from a death sentence to a chronic condition – but are too expensive for African and Asian countries – were often discovered by public laboratories and swiftly developed in clinical trials supported by public funds. But the commercial rights were granted to private companies. Those companies’ defence of the high prices they charge – the need to recoup huge investments in research and development – is immediately exposed as spurious.

A general fear of a bird flu pandemic brings an urgency to the need to rethink the WHO’s virus-sharing system of developing vaccines. But Indonesia’s fear of being left without recourse in a pandemic storm and the stand its health minister has taken must surely flag up deep, entrenched inequities that take this beyond being a medical issue. It is about profits, politics, and the re-establishment, extension and corruption of power. But most of all, it is a social and moral issue.