The World Health Organization has launched an initiative to accelerate and broaden global access to any forthcoming COVID-19 vaccines, treatments and diagnostics. The COVID-19 Technology Access Pool, or C-TAP, was announced on May 29 and has the endorsement of at least 40 countries and organizations to date, including Belgium, Norway, the Netherlands and most recently the European Parliament. Canada has not joined them.
It appears that ensuring future COVID-19 drugs, vaccines and technologies are shared equitably, particularly with countries with less economic might and global power, is not a priority for our government. Canada’s absence from the list of C-TAP supporters is a continuation of its stand on intellectual property (IP) rights since the 1990s. When it comes to deciding between preserving the IP rights of drug makers and ensuring access to essential medicines for people in low- and middle-income countries, we have been neutral at best, and most of the time we have opted in favour of IP. This lack of willingness to engage on issues of significant global health importance may have been one of the reasons why Canada failed to win a seat on the United Nations Security Council, losing out to Ireland and Norway.
Recent beggar-thy-neighbour responses by powerful nations indicate that the world is facing a real threat that vulnerable populations and those at highest risk may get left behind when effective medical technologies for COVID-19 become available. Some of the barriers likely to arise include high prices, monopolies on products and commercial exclusivity, and a lack of sufficient manufacturing and supply capacities to meet global demand.
WHO outlined five priorities for C-TAP, which it described as “a one-stop shop for scientific knowledge, data and intellectual property to be shared equitably by the global community.” These include ensuring transparency in the publication of clinical trial results; tying public research funds to affordable and equitable distribution; and licensing patents from promising discoveries to the established and UN-backed Medicines Patent Pool so that they can be produced at scale by generic manufacturers.
President Carlos Alvarado of Costa Rica, who first proposed the need for C-TAP in March, emphasized that “no country will be able to overcome the pandemic until all have overcome it.” In her statement of support for WHO’s Solidarity Call to Action, the Prime Minister of Barbados, Mia Mottley, made a plea for the global community to “exit this crisis together on fair and equitable terms.”
The initiative has also attracted support from some industry representatives — a former CEO of Gilead Sciences, Gregg Alton, and a recent head of global intellectual property for Novartis, Paul Fehlner — as well as prominent economists Joseph Stiglitz and Mariana Mazzucato. Stiglitz and Mazzucato both emphasized the huge investments in R&D for COVID-19 made by governments. The Canadian government, for example, has already invested $777 million in research for vaccines and COVID-19-related clinical trials and another $40 million in vaccine research by CEPI, an international research foundation. With such large investments of taxpayers’ money, it should be expected that any vaccine or treatment would be free and accessible worldwide. Yet Canada has not attached any conditions to its funding to ensure that patent holders of COVID-19 discoveries will facilitate equitable access, even if the discoveries were made possible through public investments.
The current R&D system, with its skewed incentive structures and lack of transparency, has failed to deliver the drugs needed for public health at a price that is affordable for all countries, particularly for those in the Global South.
A drug that already exists, remdesivir, was developed with a contribution of US$70.5 million from American taxpayers. Evidence indicates that it shortens hospitalization time for patients with COVID-19. Gilead, the company that holds the patent rights, has voluntarily licensed five generic companies in India to produce remdesivir for select low-income countries, but those licences do not cover middle-income countries such as Brazil and Mexico, where the virus is running wild. Gilead has set the price for remdesivir at US$390 per vial, totalling US$2,340 for a five-day course of treatment. At present that could be the price in the many countries excluded from the voluntary licences, while countries included in licensing deals can access the drug at lower prices. For example, a generic version of remdesivir manufactured by Cipla in India is priced at US$53.34 per vial.
As C-TAP supporters have pointed out, we can’t wait for typical drug development timelines. This is an opportune time to explore a cooperative approach like C-TAP to expedite R&D and equitable access. The current R&D system, with its skewed incentive structures and lack of transparency, has failed to deliver the drugs needed for public health at a price that is affordable for all countries, particularly for those in the Global South. Some diseases are almost completely ignored and, increasingly, the prices of newer drugs can break the bank even in the richest countries. As for equitable access to COVID-19 drugs, the only statements we have from drug makers are vague promises from Stéphane Bancel, the CEO of Moderna, to be “very thoughtful” when it comes to pricing of any vaccine it may develop and from Johnson & Johnson, which says its vaccine would be “affordable.”
Through changes introduced in Bill C-13, Canada has asserted its right to issue compulsory licences for medical products that may be needed to respond to the COVID-19 pandemic. Compulsory licensing means that our government can override a company’s patents to ensure speedy access to crucial health products during a public health emergency. Since we have clearly identified patents as a possible barrier to our own national COVID-19 response, Canada also has a moral obligation to support lower-resource countries wishing to take advantage of measures that would speed up their response. If life rafts for all are within our reach, will we just settle into safety while others drown?
A major challenge of C-TAP is that it depends upon voluntary participation. Researchers have made an unprecedented effort at data sharing and collaboration. Companies, on the other hand, have largely come out against initiatives such as C-TAP. Albert Bourla, CEO of Pfizer, said, “I think it [C-TAP] is nonsense and at this point of time it’s also dangerous.”
Dangerous for profits, that is.
Canada must now act with courage and show the solidarity needed to respond to this global crisis. Our researchers can voice their support for C-TAP by mobilizing their professional organizations to lobby the federal government. They can make sure that the universities and hospitals where they work agree that any IP that comes out of their research becomes part of C-TAP. Our government has the power to increase C-TAP’s likelihood of success; without it, the costs of business as usual — more needless deaths — are too high.
This article is part of the The Coronavirus Pandemic: Canada’s Response special feature.