It’s hard to find a more disturbing example of the problems that accompany the financialization of health.
July 28 will see us observe World Hepatitis Day (WHD). WHD seeks to raise awareness of the global burden of viral hepatitis and to influence real change.
This year’s theme is “Find the Missing Millions” to fund access to life-saving drugs.
Worldwide, 290 million people are living with viral hepatitis without knowing it – most of these live in sub-Saharan Africa and Central Asia, making hepatitis disproportionately a developing country issue. Unless these people get diagnosed, and treated, millions will suffer, and more lives will be lost.
As well as awareness, our battle against hepatitis is underpinned by the global medical industry’s ongoing fight against the virus. A case in point is Gilead Science, who, a few years ago, with a significant contribution of taxpayers’ money, developed an effective cure for hepatitis C.
Gilead then sold the drug at a cost of $84,000 for a 12-week treatment in the US – a price so high (and in fact even higher once you factor it than most patients will need a 24-week course) that it denied many of those suffering from the disease access to the cure and led to criticism that the company was privatising public research.
This price-hiking strategy, which Gilead rolled out to varying degrees in every Western market they could (they charge the NHS £35,000 for a 12-week treatment, for example) played a key role in helping the company triple profits in the two years after the drug launched (taking profits from $11.2 billion in 2013 to $32.6 billion in 2015).
In developing countries these kinds of drug prices are even more prohibitively expensive. As a result, life-saving medicine is kept out of reach of the people who are most impacted. Patents in the EU have been upheld, while in Brazil a federal court suspended the patent in 2018, following similar action in Egypt and Ukraine. Countries suspending patents face potential trade disputes with the United States as a result.
To enter markets in low-income countries, Gilead approached several drug manufacturers in India, a major hub for generic medicine, to sign voluntary licensing agreements for production of the drug. This allowed them to sell the medication at $900 per pill in low-income countries. Though cheaper, this is still a shockingly high price, with a 12-week course costing $10,800 – meaning the drugs are still inaccessible for the poorest in India and have become a potential poverty trap for those who need them.
The licensing agreements Gilead put in place with Indian drug manufacturers prevented them from exporting the drug to middle-income and high-income countries so they couldn’t undercut Gilead in Western markets. In other words, drugs were being produced in India that could have saved lives in the US and elsewhere in the West, but Gilead prevented the drugs from reaching those who needed them – and in doing so cost many lives.
At the same time, the company managed to reduce its worldwide effective tax rate by 40 percent by shifting the profits it generated in the US to Ireland via two Irish subsidiaries to the Bahamas (a tax haven) – a very different take on “Find the Missing Millions”.
Today, in a strange topical twist, the drug Gilead developed as a cure for hepatitis C – its name is Sofosbuvir, by the way – is now being looked at as a potential treatment for Covid-19.
Globally, Covid-19 has shut down economies, put health systems under unprecedented strain and caused misery and death for millions. Governments have called for unity and cohesion in the fight against Covid-19. Thankfully, around the world, most citizens have come together in solidarity and performed their civic duty by adhering to their government’s guidelines.
Now, we have to ask, will any eventual cure to Covid-19 be delivered in the same fashion – with medication being made maximally available rather than maximally profitable? If Gilead’s hepatitis C story is any indication, the answer, sadly, is no.
With this in mind, it’s worth thinking about the fact that the Drugs for Neglected Diseases initiative (DNDi), a not-for-profit pharmaceutical organisation, has created an affordable hepatitis C treatment that has been shown to be just as safe and effective as Sofosbuvir. The treatment is in the final stages of development, and is expected to cost $300 for a 12-week course – or just $3.50 per day.
It’s hard to find a more disturbing example of the problems that accompany the financialization of health than Gilead’s hepatitis C saga – cashing in quickly on the drug while fighting its patent rights in every court – or a more tangible example of how not-for-profit pharmaceutical models can outcompete profit-driven ones.
Indeed, there are serious lessons to be learned. The most important is that, so long as we allow profits to be put over social and economic rights regarding our pharmaceutical industry, health inequalities will continue to exist – and people will continue to die, not because a treatment isn’t available but because they can’t afford it. And that needs to change.
To learn more about Gilead Science, Sofosbuvir and the financializaton of heath, read our Spotlight on Financial Justice Report.