Democratizing Patents: Vaccines For All

As Covid-19 continues to sweep the world and most countries, especially in the Global South, struggle to access vaccines, Radical Imagination takes a fresh look at how the US patent system keeps billions of people at home and abroad from obtaining life-saving medicines. Since our first episode on this topic, early in the pandemic, the situation has become more dire. In India, one of the world’s largest vaccine producers, almost nobody had access to the Covid vaccine last spring, when the virus began tearing through the country. The idea behind patents is to allow companies to protect the time and money they invest in developing drugs and vaccines. In reality, companies profit astronomically while people die because they can’t afford or obtain treatment.  Host Angela Glover Blackwell speaks with lawyer and activist Priti Krishtel, a leader of a global movement to change the patent system and ensure access to medicine for all. We also hear from Leena Menghaney, South Asia head of the Doctors Without Borders Access Campaign.

Priti Krishtel wants to reinvent the patent system. A lawyer and veteran of the global access to
medicines movement, she is exposing how the failures of the patent system are affecting all of
us — and how we can fix it.

As a young lawyer working with low-income communities in India in the early 2000s, Priti
Krishtel had an epiphany. Many of her clients were struggling and even dying, because they
couldn't afford the lifesaving medicines they needed. When Krishtel looked more closely at
patent systems, she discovered a pattern of behavior in which corporations were incentivized to
seek as many patents as possible on a single medicine. These "patent walls" prolonged
monopolies and blocked access to medicines. As the human toll of the global HIV/AIDS
epidemic reached its peak, Krishtel helped lead a successful grassroots movement pressing the
Indian government to pass a first-of-its-kind, health-friendly patent law.

That momentous win inspired her to co-found I-MAK, a team of "patent detectives" who expose
and challenge manipulation of the patent system that fuels high drug prices. Since then, Krishtel
and I-MAK have expanded their work to nearly 50 countries, saving health systems over 2
billion dollars and increasing access to treatment for millions of people.

Leena Menghaney is South Asia head of the Doctors Without Borders Access Campaign.

Angela Glover Blackwell Speaker (AGB): (00:06)
Welcome to the Radical Imagination podcast, where we dive into the stories and solutions that are fueling change. I'm your host, Angela Glover Blackwell. In this episode, we return to a topic from last season, just months into the pandemic. The patent system for medicines. Patents are what allow the pharmaceutical industry to protect the time and money they invest in developing drugs and bringing them to market. But that same patent system is subject to very little accountability and it can fuel higher prices of medicines, making them unaffordable for so many. Earlier this year, a new wave of COVID infection swept through India where vaccines medicines or oxygen were out of reach for most people who desperately needed them.

media clip: (00:54)
India is wrestling with a ferocious wave of COVID-19 and the latest current virus figures show infections there have now passed 20 million.

Angela: (01:03)
India is one of the largest producers of vaccines in the world. Yet, most of what it produces is exported to wealthier countries. Only around 3% of his population had been vaccinated by May, but despite the urgency pharmaceutical companies that own the patents to the vaccines, get to decide if and where they can be mass-produced.

media clip: (01:24)
Vaccine making has become exclusive. They're still putting profits above human lives. So it's time for governments to step in and dictate big pharma. The WTO will meet again on Wednesday, India and South Africa are presenting a fresh draft.

Angela: (01:40)
Last May, India, South Africa, and dozens of other developing nations ask the World Trade Organization to waive patent protections for the vaccine, a move that would allow drug makers in less developed nations to produce more themselves. To talk more about the efforts by the global access to medicines movement, we're joined by a Priti Krishtel. She's a lawyer, activist and co-founder of I-MAK -- a team of patent detectives who were trying to change the patent system for medicines.

Angela: (02:09)
Priti, welcome back to Radical Imagination.

Priti Krishtel : (02:11)
Thank you for having me.

Angela: (02:13)
When you first came on the show in late 2020, you talked about the patent industry, how it works -- globally and in the US, and you raise concerns about how patents could impact the distribution of the COVID vaccine, once it came out, could you give us a recap on the way patents work and the impact the current system has had on people before and after? COVID

Priti : (02:35)
Absolutely. So patents and intellectual property are ultimately about knowledge -- who owns it, who shares it, who decides who can have it. And what we have seen, time and time again, in every major health epidemic or pandemic worldwide is that that knowledge gets concentrated in the hands of a few private actors. And we don't get lifesaving medicines and vaccines to people who need them in time, all over the world. So I was cautioning earlier in the pandemic that we were probably going to see our hierarchy of health play out in real terms; that some people would get the vaccine first and others wouldn't get it at all. And here we are today, 85% of shots that have gone into arms worldwide have been administered in wealthier countries and less than 1% of doses have been administered in low-income countries.

Angela: (03:36)
Why do you think this is such an important moment to push for structural changes and set new rules for the patent industry for medicines?

Priti : (03:44)
I think this is the moment to push for structural change because for too long, we have accepted a system that has left people behind. Worldwide, when you look at the history of medicines and vaccines, whether we're talking about the HIV epidemic, the hepatitis C situation worldwide, whether you're talking about pneumonia for children or cervical cancer, we are not getting those medical products into the hands of the people who need them. And we have tried for a long time. Angela, the access to medicines movement has been working on this for nearly 30 years. And I would say over the last 30 years, what we have tried to do is bring equity into a broken system. And we have really tried to work within the structures of this system to achieve meaningful change. But now reflecting 30 years on, we've gone drug by drug, country by country, disease by disease, and progress has been slow. The situation for people's health and for their economic security is not going to change unless we push for structural changes to the system itself.

media clip: (05:08)
Just as America begins to emerge from the worst of the pandemic, the situation in India is getting more dire. So the government is struggling to ramp up its supply of oxygen and vaccines

media clip: (05:19)
Family members pulling out bodies, such as this one from ambulances lined up in this crematorium ground and taking them for cremation

Angela: (05:33)
Provide some context on the wave of infections that hit India in particular and the current situation on the ground, when it comes to access to medicines in general, and to COVID vaccines.

Priti : (05:45)
The situation in India has been very stark. As you know, there's been a surge there, uh, I've been personally affected. I've lost family. Now, the situation in both India and Brazil, which has also been hit very hard recently, it's turning a corner. It's getting slightly better. If we can trust the surveillance that's happening. But I think it's really important to realize like we in the US right now, we are starting to hug our friends again and to see people in a plan our summer barbecues. But that fear and that grief that we were feeling a year ago, much of the world is still in that moment. People are terrified. There are no clear pathways to getting vaccines to people, to families worldwide, right now. India has over 1.3 billion people. And yet only 3% of the country is fully vaccinated at this point. And it's a similar situation across the African continent, which is obviously many, many countries, but they also have across the continent about 1.3 billion people. And the situation there is even worse, less than 1%, about half a percent of people have been fully vaccinated. So this is a moment that requires urgency and it requires solidarity.

Priti : (07:16)
And there are people in India, amazing activists who are really fighting to make sure that the voices of community are heard. One of them is my friend and colleague Lina, who works with Doctors Without Borders in Delhi. She heads the South Asian operations for Doctors Without Borders. And she has been really lifting up to me the importance of this IP waiver that we're discussing right now. She's been explaining to me what are all the tests and treatments and vaccines people on the ground actually need and connecting the dots in such a powerful way.

Angela: (07:53)
And this is, well, she had to say in a recent phone interview we did with her.

Lina: (07:57)
Well, 4,000 people were losing their lives. Every day. You have a large unvaccinated population. You could see that people would lined up outside hospitals, but we're not being able to get oxygen, but not being able to get ICU. And many people just lost their lives due to lack of access to healthcare. All of April and mid may. I can almost everybody lost a loved one, not a friend or a relative. And since then, things have calmed down, but manufacturing of vaccines have been concentrated in the hands of a few pharmaceutical corporations and a few countries. So you have the United States, you have the UK, you have the EU and you have a foster countries like India. So you have a situation where the pharmaceutical industry AstraZeneca decided to license to just one company in India, to supply India and 58 developing countries. And the monopoly model, the exclusive model of pharma has just shown how millions of people can lose their lives if we leave the rulemaking for pharmaceutical industry. So right now India cannot supply enough vaccines. And at the same time, and they're struggling to vaccinate its own population.

Lina: (09:22)
If you look at the fact that, uh, out of 1.7 billion doses that have been dispensed on COVID-19 vaccines, 0.3% have gone to low-income and that shows you the disparity in the system. So what really needs to change is we need to stop concentrating manufacturing power within a few countries and within a few companies. We need to check technology, share the benefits of science and not treat it like private property any longer. So if we were to reimagine the goal, we would reimagine it, that we wouldn't be forced to constantly negotiate for technology and licensing rights.

Angela: (10:06)
That was Lena Magani, South Asian head of Doctors Without Borders access campaign.

Angela: (10:14)
Coming up on Radical Imagination, we continue the conversation with lawyer activists, and I-MAK co-founder Priti Kristel. Stay with us. More when we come back.

Angela: (10:33)
And we're back with I-MAK co-founder Priti Kristel. who's been working to re-imagine the patent industry for medicines.

media clip: (10:41)
As mounting for the U S and other wealthy countries to put an end to vaccine hoarding and share their supply with India and the rest of the world. The White House now says that it supports waving the intellectual property protections for the COVID-19 vaccines. Now that is a move that could help speed the distribution of vaccines around the world, but it's also clearly already hitting the US drug manufacturers.

Angela: (11:03)
In recent months, the Biden administration announced it would wave intellectual property rights for COVID-19 vaccine, India and South Africa. Along with dozens of developing countries also asked the world trade organization to ease its intellectual property rules to help increase vaccine production. How would lifting these restrictions help in the fight against COVID?

Priti : (11:25)
So it's important to name upfront that what South Africa, India, and the over a hundred countries that have supported this request have asked for is waving intellectual property, which includes patents, but it includes other things, trade secrets, regulatory data, all forms of monopoly protection on knowledge. This is what they asked for, not just for vaccines. I think in the U S we get very focused on vaccines. So then that becomes the popular conversation. What the countries are asking for it is that this waiver apply across medical products. That means for tests, for treatment, this intellectual property waiver would help them produce more, to be able to help clinicians on the ground test and treat people and vaccinate people as quickly as possible.

Angela: (12:20)
How was this effort received by big pharma? The WTO and world powers like the U S and EU countries.

Priti : (12:28)
It's really, the responses have been all over the map in the US. We have seen a historic development where for the first time an American president has said, we are willing to sit down at the table and have these negotiations. In principle, we support a temporary waiver on IP. We still believe in intellectual property, obviously as a nation, but this moment requires extraordinary measures. This is in sharp contrast to governments in Europe who're pushing back against the idea of a waiver; who are saying that voluntary actions by the industry will be good enough to get medicines into the hands of billions of people across the world. And the pharmaceutical industry has also been saying the same thing. I just don't buy it. I've been working on pandemics now for two decades, we have watched the efforts to try to rely on the Goodwill of companies across diseases. And it just has not worked, even in the limited places where voluntary action has worked a bit. Um, it just falls so far short of what is needed in a moment like this -- to scale projection, to unlock the world's manufacturing capacity in every corner of the world, get shots in the arms of people who need them.

Angela: (14:02)
Some critics say that waiving vaccine patents won't make much of a difference in dealing with vaccine shortages. Some say, there simply is no capacity. What's your response to that?

Priti : (14:13)
The request to waive intellectual property isn't just about patents. It's about all forms of knowledge monopoly in relation to medical products. And it's not going to be an overnight fix. That's why the window that countries are asking for is at least three years for the waiver, because in that time period, they can meaningfully get manufacturers and domestic production going. Uh, I also think that what this conversation comes down to is do you believe in the old way, or do you believe in a new way. The old way relied heavily on suppliers? So for example, in the context of pneumonia, uh, for children, which is a leading killer worldwide, the vaccine is called the PCV vaccine. We have relied for many, many years on Pfizer to determine who and other countries can produce to scale up manufacturing. We've relied on that single supplier model, but it hasn't worked.

Priti : (15:16)
And I think it's because of these questions, you raise around capacity. But I've worked now for 15 years on the ground in countries, many across the African continent and in other places in Asia and Latin America. And I can tell you firsthand Angela, that there is so much capacity today. half of all vaccines that are supplied to kids worldwide by UNICEF actually do come from India already. But at worst, I think this is a classic example of American exceptionalism and, you know, very colonial attitudes, frankly, at work. Other countries are the ones that are supplying most of our medicines today. It's kind of like Apple products, right? We design them, but they're manufactured elsewhere. That's how the medicines market works today. It's the same thing. And yet in these moments, when there's such a huge market. You know, moderna alone stands to make a hundred billion dollars in coming years, we then buy those talking points that other countries can't do it, and it's not true. And it's going to cost lives, if we don't change our thinking.

Angela: (16:28)
Now, could you talk about your organization, I-MAK, and about the work it's currently doing in the context of vaccines and the pandemic.

Priti : (16:37)
Sure. So we founded I-MAK the initiative for medicines access and knowledge during the peak of the HIV epidemic. We worked with health ministries and governments all over the world to try to bring equity into what we saw as a broken system. And in a moment like this, as we spent years working on pandemics, you know, Avian flu, hepatitis C, we realized that we were never going to fundamentally change the health and lives of people at the scale that we wanted, unless we started to address the system itself. And so we now work in the US. We do a lot of research. Last month we testified in front of Congress on the drug patent problem in relation to Americans not being able to afford their drugs. We hope to build a bigger and more inclusive table to think about the patent system. We want to make sure we're shifting power dynamics, uh, between who has power in the system right now and who doesn't. But ultimately what's going to come out of it is a whole of government agenda to thinking about how would we transform the patent system into being something that actually centers equity and puts people back at the heart of the system

Angela: (17:59)
Priti, what would a patent industry with a more equitable appoach to global health actually look like?

Priti : (18:05)
I believe that right now, from drug development to drug access, we call that the medicine system equity is an afterthought. We can't afford for equity to be an afterthought. We need to make sure that we're re-imagining the system to ensure that equity is at the heart of it. And for me, the first step to getting there, it means we have to democratize this system. The patent system today here in the United States, nobody knows about it. First of all, there's very little transparency. There's very little congressional oversight. There are not meaningful mechanisms for participation by the public. The patent office itself does not recognize people who are affected by patents as part of their core constituency. Their user is defined as a customer, essentially, which is people who apply for patents. So that would mean major corporations or universities who essentially act like corporations now. And so that's the starting point of where we'd like to see a shift happen -- that the definition of the user would expand. The public advisory committee would expand to also include representation from communities who are most affected.

Angela: (19:27)
Priti, thanks for speaking with us.

Priti : (19:28)
Thank you so much for having me, Angela.

Angela: (19:31)
Priti Kristel is a lawyer activist and co-founder of I-MAK. If ever there was a need for us to reimagine our systems, our institutions, and our collective responsibility, this is it. Worldwide millions of lives are still being lost to COVID-19. The knowledge to save them is there, but capitalists and power structures rooted in colonialism stand in the way. This is the moment to change the rules and make sure that knowledge benefits all of humanity and creates a healthier, more equitable world.

Angela: (20:18)
We and our partners Unfinished, invite you to reflect and respond to this question: "What would it look like if knowledge was shared equitably across the globe?" Submit your ideas at Radical Imagination or on social media using #RadicalImagination and #ThisIsUnfinished.

Angela: (20:50)
Radical Imagination was produced by Futuro studios for PolicyLink. The Futuro team includes Marlon Bishop, Andreas Caballero, Sophia Paliza-Carre, Ruxandra Guidi, Stephanie Lebow, Jess Alvarenga, Julia Caruso, Leah Shaw Dameron, Elisheba Ittoop, Rosana Caban, and Gabriela Baez. The PolicyLink team includes Glenda Johnson, Rachel Gichinga, Ferchil Ramos, Eugene Chan, Fran Smith, Jacob Goolkasian, and Vanice Dunn.

Angela: (21:23)
Radical Imagination is supported by Omidyar Network, the David and Lucile Packard Foundation, Pivotal Ventures: a Melinda Gates company, and Unfinished. Our theme music is composed by Taka Yusuzawa and Alex Segiura. And I'm your host, Angela Glover Blackwell. Join us again next time. And in the meantime, you can find us online at radicalimagination.us. Remember to subscribe and share.

Angela: (21:58)
Next time on Radical Imagination. Re-imagining the Juvenile Detention System. That's next time on Radical Imagination.