The roll-out of COVID-19 vaccines gives much-needed hope. But if the drug industry keeps being devoted exclusively to profit, inequality and mistrust will cost lives in poorer countries, and eventually also in the wealthy western world.
The rush to find a COVID-19 vaccine has resulted in myriad products rather than medical strategies. In the West, mostly private labs are behind what has become a precious commodity. How did public health and money become contractually tied to privately owned medicine?
In 1955 a journalist asked US doctor Jonas Salk who owned the patent to the polio vaccine he had just developed. He replied, somewhat provocatively, ‘The people, I would say. There is no patent. Could you patent the sun?’ Polio was then one of the most terrifyingly lethal diseases and Salk’s rhetorical question was related to an idea of public health that unfortunately no longer exists.
Today, we are facing a health crisis linked to the SARS-CoV-2 virus, which in one year has claimed more than two million lives worldwide. From the very beginning of the pandemic, hopes of embracing our loved ones again were placed in the development of a safe and effective vaccine: a kind of Holy Grail of public health. Although vaccines are second only to clean drinking water in reducing mortality from infectious diseases, today they are linked more to market logic, ideologies and geopolitical interests than to health system needs.
The neoliberal narrative has taken for granted that the private sector offers the best guarantee of continuous innovation. However, during the pandemic, the shady side of this system has become visible.
Due to the high cost of developing vaccines and the rapid actions of rich countries placing advance orders, more than 85 developing countries may not have access to the vaccine before 2023. Indian economist Jayati Gosh speaks of ‘vaccine apartheid’.
Even the EU, rich as it is, has been left without pre-ordered doses, because it negotiated lower prices than some countries. If vaccines are such fundamental tools for collective health, how and why have western countries completely delegated their production to the private sector?
Following successes within bacteriological science in developing serums against rabies and then diphtheria at the beginning of the twentieth century, new research institutes were needed to provide sera and vaccines. Some countries looked to private laboratories: the Sclavo Institute, Italy, is one example. Others, such as Denmark and Sweden, established public institutions linked to health ministries or municipal public health laboratories.
A common effort to protect public health connected European producers of public and private vaccines in the 1960s and ’70s, who exchanged their knowledge and expertise. However, in the ’80s, economic, political and technological pressures began to slowly erode the public sector.
The last few public institutions that remained afterwards were dismantled in the 1990s and 2000s. In 1993 a Dutch biotechnology company acquired Sweden’s production department once it had been separated from the national lab’s other functions. The pharmaceutical giant Johnson & Johnson then bought out the facility.
In 2009 the Dutch government decided to stop its direct production of vaccines, divided up institutional departments and, a few years later, an Indian company bought the production facilities. The sale of its research department – the last to remain – is still a matter of debate.
Today, western Europe has no public vaccine producers unlike certain post-socialist central and eastern European countries such as Serbia and Romania. The most common explanation is deemed financial. For example, the former Dutch Health Minister Ab Klink highlighted that the cost of producing vaccines for the small Dutch population (around 180,000 births per year) was excessive.
In reality, economic reasons are only part of a more complex story. If we follow the developments of science and technology on the one hand and ideological changes on the other, a scenario emerges in which multiple dynamics intertwine. In the 1960s and ’70s, vaccine technologies, using methods of attenuation and inactivation,1 had to safely preserve and manage cultures of dangerous pathogens, making large and complex laboratories indispensable. By the 1980s, new techniques of genetic manipulation, along with a series of US-implemented public policies, encouraged many scientists to move from university laboratories to small biotechnology companies.
Company knowledge became embedded in increasingly dense networks of patents. As noted by Berkeley economists Mowery and Mitchell, while two patents sufficed to develop 27 new vaccines in 1983, a decade later, Smithkline Beecham (now GlaxoSmithKline) had to collect 14 patents to produce and market a single recombinant DNA vaccine against hepatitis B. ‘Knowledge’ and the inevitable cooperative relationships in research had become ‘intellectual property’. Limiting public interest in favour of individual rights halted the free exchange, development and adaptation of scientific knowledge.
As private and public producers of traditional vaccines had no experience of biotechnology techniques, big pharmaceutical companies began to acquire new companies with the skills and patents they needed. More and more companies merged during this period of acquisition, transforming much of the pharmaceutical market into a transnational, oligopolistic field.
Simultaneously, public institutions were hollowed out. Since they were excluded from the new patent market, unable to play by the new rules, the view spread that public sector producers no longer had the resources, autonomy from political interference and skills to produce good quality vaccines.
Though still interwoven with public research networks, neoliberalism has redesigned the pharmaceutical-health sector. Barriers and fences limit the circulation of knowledge and reduce the public health system’s capacity to react to real emergencies. The western state and its political class no longer see the provision of essential tools for public health such as vaccines as their direct responsibility.
If this pandemic is a wake-up call, and other zoonotic diseases emerge, as they surely will, the renegotiation of public institution participation in vaccine production becomes all the more urgent. Governments can no longer be left unprepared or held hostage to the market logic of the private sector, where inequalities in access to life-saving technologies are considered acceptable.
While inactivated vaccines are produced by growing the bacterium or virus in culture media, which is then inactivated with heat and/ or chemicals, attenuated vaccines use a weakened (or attenuated) live form of the germ that causes a disease.
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