Chemistry and Humility

The handful of nations that found themselves at the back of the queue when it came to receiving COVID-19 vaccines are looking for action in other therapeutic areas. Protesters in Colombia, Brazil, and South Africa in particular are calling upon their respective governments to put pressure on pharmaceutical companies to drop patents for small molecule drugs designed to combat HIV and TB. 

During the pandemic, low- and middle-income countries (LMICs) were unable to compete with the speed and resources of wealthier nations when it came to COVID-19 vaccines. The latter were able to acquire the lion’s share of the now Nobel Prize winning mRNA technology-based vaccines from Pfizer/BioNTech and Moderna, leading to – and exposing – a global vaccine inequity. On January 18, 2021, WHO Director-General Tedros Adhanom Ghebreyesus decried this inequity: “It’s not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries [...] we must work together as one global family to prioritize those most at risk of severe diseases and death, in all countries […] the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”

There is now a gathering movement demanding improved access to lifesaving medicines. Colombia’s Ministry of Health, for example, is taking the lead in challenging the power of the global pharmaceutical industry by threatening to issue a compulsory license to produce HIV drug dolutegravir within its own sovereign borders – with near neighbor Brazil’s government under pressure from civil rights groups to do the same. More than 120 global civil rights groups – including Medecins Sans Frontieres (MSF) – agree that Colombia’s course of action is commensurate with its health challenges: Francisco Viegas, Medical Innovation Policy Advisor, MSF Access Campaign, said, “We welcome Colombia’s announcement to take steps toward enabling access to more affordable generic versions of dolutegravir. This commitment underscores the belief that people’s lives should take precedence over corporations’ profits.”

In South Africa, demand for bedaquiline resulted in government officials investigating Johnson & Johnson’s pricing policies, only to find that it had been paying more than twice as much as countries that were receiving the drug via the Stop TB Partnership. J&J’s patent expired in South Africa in July 2023 and a company extension was met with fierce opposition from health campaigners. Shortly after the government’s investigation, however, (and in fairness to J&J) the patent was dropped so that cheaper, generic versions could be made available.

I’m reminded of how the great Nelson Mandela took on pharmaceutical pricing policies during the AIDS epidemic of the 1990s and 2000s. And it is humbling to know that the industry – for all the benefits it brings to society – is still held accountable to and responsible for the people that depend upon it. Many people believe that patents do not grant pharma companies the power of life and death – and failing to remember that will only galvanize those who stand on the shoulders of giants like Mandela. Lessons have been learned, surely – and that’s a good thing; after all, when giants battle, it’s the little people that pay the price.