"The pharmaceutical industry must put its patents on hold in the face of the coronavirus."

Deputy Director of MSF Access Campaign Dr Tammam Aloudat co-leads the campaign of access to medicine. | MSF

On  May 18th, the World Health Organization opens its annual meeting in Geneva. At the heart of the debates: the question of global and equitable access to diagnostics and to the future treatments and vaccines needed in the face of the Covid-19 pandemic. While an unprecedented research and development effort is being pursued by the pharmaceutical industry, the question of future access to the technologies developed remains unclear. Who will be entitled to what? With what priority? And at what prices? In the face of this emergency, Médecins Sans Frontières (MSF) is calling for a truce on patents and profits of the pharmaceutical and medical industry for its products useful in the face of the pandemic. Tammam Aloudat, deputy director of MSF Access Campaign, explains.

After a few attempts to take advantage of the crisis, the pharmaceutical industry seems to have largely rallied to the idea of serving the general interest in the face of the pandemic. Isn't that enough in your opinion?

Indeed, initially we saw companies such as Gilead try to take advantage of the situation by obtaining the very favorable orphan drug status for its treatment remdesivir, originally for Ebola and repurposed against Covid-19. In the face of opposition from various non-governmental organizations, including MSF, it gave up. The company now indicates that it will waive its royalties on the manufacturing by generic companies of this treatment during the pandemic crisis. Other companies such as Abbvie or Johnson & Johnson have also indicated that they will forego their profits for therapies related to the epidemic. This is a step in the right direction, but apart from the fact that these are isolated cases, we cannot be content with charity in the face of the scale of  a pandemic.

Why not?

Donations are not going to solve the problem because they will never be on scale. Despite mobilization, global demand will exceed the capacity to produce and supply various essential commodities. Whether for diagnostics, treatments or vaccines, the challenge in the face of the pandemic is threefold. These technologies and therapies must be accessible and affordable, equitably distributed and capable of meeting an enormous demand. The key to achieve this is for the industry to agree to put the patents that protect these products on hold, and for governments to prepare to suspend and override patents to save more lives. And it is desirable to facilitate the transfer of these technologies so that other manufacturers can produce therapies especially for developing countries. To achieve this, a global governance must be put in place. It is not enough to wait for donations, we need tools to enforce this global access and avoid protectionism.

What kind of tools?

MSF is calling for a binding and enforceable global mechanism from member states of the United Nations to guarantee equitable access and distribution of COVID-19 medical tools. But this can also be done at the level of member countries. The 2001 Doha Declaration on Trade Related Intellectual Property Rights (TRIPS) introduced an exception related to health emergencies. It allows a member country of the World Trade Organization to suspend patents on a therapy in order, for example, to produce generics or other forms of copying. This is called compulsory licensing. Some countries such as Canada, Germany, France, Chile, Brazil have already taken steps to  facilitate its use to cancel patents on drugs and other medical technologies against Covid-19. But it would be better to have a global enforceable mechanism. The World Health Assembly at the WHO next week is an opportunity to put such an agreement in place. MSF is going to make proposals to that effect.

Without the know-how of the original companies, wouldn't the products copied through this compulsory licensing mechanism be of lower quality?

First, regulatory standards and assessments are equally applied to both generic and brand-name medicines to ensure quality checks. But also, many generic producers in some countries have experience of "reverse engineering" on therapies. So they do not need the know-how of the company behind the product. However, for complex vaccine platforms and biological drugs, we have been calling on companies to share technical know-how with other manufactures to ensure enough production to meet the global needs. Governments should also negotiate knowledge transfers with pharmaceutical companies. It doesn't have to be an all-or-nothing situation. The possibility of compulsory licensing opens up a space for negotiation. We really feel that what is needed right now is a binding and enforceable mechanism at global level to ensure the transfer of technologies, data and know-how with the right to use and produce for all countries.

Are there no other leads?

Much of the research and clinical development against Covid-19 is financed by public funding. Gilead's remdesivir owes a lot to such funding, for example. That is why taking advantage of the crisis to impose high prices would be scandalous. Now the donors conference held last week at the initiative of the European Union has released 7.4 billion euros. Many of these are public funds that will be used to finance research and clinical development carried out by companies. But it is not yet clear who will bear the ultimate responsibility for ensuring that these funds are used to produce medical tools against Covid-19 that are accessible to all. What we propose is to make public funding for research and development conditional on transparent, comprehensive and fair rules on future access to these therapies. MSF will issue a position paper on this issue at the World Health Assembly.

But isn't it important that pharmaceutical companies are also rewarded for their efforts?

If pharmaceutical companies relinquish their patents on therapies against Covid-19, there are still various ways in which they can be compensated, including through royalties on cheaper generics or through subsidies. They will still be able to sell their products at the level of their manufacturing costs with a reasonable profit. In any case, they benefit from public and philanthropic funding for research and development, so they are unlikely to lose anything. We would be delighted to look further into the issue of costs and innovation with pharma, which has never been very clear and transparent on these matters.