Pooling Knowledge: Private Medicine vs. Public Health?

The Coronavirus and the Need for Systems Change, Pt.1

The Coronavirus pandemic raises many questions about public health, global diseases and the way we produce and distribute cures and treatments. Who pays for the corona vaccine and how? How is that innovation organised? Who profits?

Commons Network has been an advocate in this domain (‘access to medicines’) for years. In the next few months, we will publish a series of articles about the problems with the current system and the ideas and visions that exist to change this. Today, we discuss the proposal for a Covid-19 Knowledge Pool.

COVID-19 is a global health crisis that demands an immediate global response. But this crisis also lays bare many other crises in our societies. In many Western countries, the response to the virus has shown the vulnerabilities in our public health systems and other essential sectors of society. One major issue that the coronavirus exposes is the dire state of our biomedical system and the role that pharmaceutical companies play in that system.

  • In The Netherlands, for instance, hospitals didn’t have enough test kits because Roche, the world’s largest biotech company, initially refused to hand over the recipe that is needed to perform these tests.
  • In the United States, Trump’s ‘corona-minister’ Alex Azar released a statement saying that the government could not guarantee that a potential cure for Covid-19 would be affordable, because the innovation that is needed for that cure would only be spurred by high profits.
  • The rush to create a vaccine was delayed for up to two or three years, because in most countries, pharmaceutical companies had sold their vaccine research facilities. And the companies that still had the capabilities to do the research had effectively scaled down their coronavirus research because there was no money to be made.
  • Scientists were close to a coronavirus vaccine years ago, and then the money dried up.
  • The vaccine market was even called ‘an oligopoly’ by Wall Street analysts at AB Bernstein. In fact, after countries abandoned infectious disease research, most companies also moved away from investing in this field, according to DNDi director Bernard Pecoul.
  • In France, it was debated why a testing kit for coronavirus should cost 135 euro, eventhough the production costs are only 10 euros. The sub-optimal availability of tests was cited as a major reason for not testing in the fight against the pandemic in many European countries, leading many people to ask if this had economic reasons as well.

More and more people have now come to realise that the global race to find a cure for Covid-19 and a vaccine is slowed down considerably by the fact that the system we have now runs on market incentives and patent monopolies. Instead of shielding essential knowledge, companies could work together, share research results and new insights.

Moving away from a deficient system

The pharmaceutical industry is driven by profit and guided by shareholders. The research and innovation that is needed to come up with cures and treatments is monopolised. A system of patents and licenses is fine-tuned to produce the maximum wealth for a few multi-billion euro corporations. This is how we have organised the world of medicines today. Our system is not driven by public health needs but by profit and the only logic that counts is that of capitalism.

Our system is not driven by public health needs but by profit and the only logic that counts is that of capitalism

This model is based on the belief that the flow of biomedical knowledge should be privatized and protected through intellectual property rights in order to stimulate innovation. This monopoly model gives pharmaceutical companies the freedom to charge as much as they can get away with. It also stifles innovation where we most need it, like in the area of infectious diseases, because there is no money to be made. And finally, this system makes us, the people, pay three times: once to fund the universities and research facilities that create a lot of the knowledge needed for pharmaceutical innovation, once to pay these companies to produce and distribute, and once to our governments to fund our health care system.

It’s hard to estimate how many medicines are not invented, how much talent is wasted and how many people have to suffer because of what not is being researched and developed. This sytem limits the ability to collaborate, share knowledge and build on each other’s work. The public good of scientific medical knowledge and health related technologies has been transformed into a highly protected, privatized commodity.

The COVID-19 crisis marks a critical moment for generating the change we need. But how do we go from this neoliberal capitalist logic to something else, towards a system that is driven by the needs of the public and the health of the people?

Knowledge commons

The proposal to build  a global knowledge pool for rights on data, knowledge and technologies that was presented by Costa Rica is a great example of a step in the right direction, towards transformational change. On March 23rd, the government of Costa Rica sent a letter to the World Health Organization, calling for a Global Covid-19 Knowledge Pool1. In his letter to the WHO, the president of Costa Rica demands a global program to “pool rights to technologies that are useful for the detection, prevention, control and treatment of the COVID-19 pandemic.” It now also enjoys the support of the WHO as well as from the UK parliament and the Dutch government and civil society, which has announced their support the idea of a COVID-19 pool as well.

Why do we need a knowledge pool and why is it transformational?

As mentioned above, under our current system the privatization of knowledge limits the ability to collaborate, share knowledge and build on each other’s work. This really is artificial because knowledge is by nature abundant and shareable. Hence the current handling of medical technologies not only limits access to the ensuing treatments, it also limits innovation.

The Covid-19 Poll would pool relevant knowledge & data to combat Covid-19, creating a global knowledge commons2. It is a proposal to create a pool of rights to tests, medicines and vaccines with free access or licensing on reasonable and affordable terms for all countries. This would allow for a collaborative endeavor, and could accelerate innovation. It would be global, open and offer non discriminatory licenses to all relevant technologies and rights. As such the pool would offer both innovation and access.

Inputs could come from governments, as well as from universities, private companies and charities. This could be done on a voluntary basis but not only. Public institutions around the world are investing massively in Covid-19 technologies and all results could be automatically shared with this pool, meaning this could be a condition attached to public financing.

So, placing knowledge in a commons does not just mean sharing data and knowledge without regard for their social use, access and preservation. It means introducing a set of democratic rules and limits to assure equitable and sustainable sharing for health-related resources. As such it allows for equitable access, collaborative innovation and democratic governance of knowledge. At the same time knowledge commons could facilitate open global research and local production adapted to local context.

Placing knowledge in a commons does not just mean sharing data and knowledge without regard for their social use, access and preservation. It means introducing a set of democratic rules and limits to assure equitable and sustainable sharing

If we consider the COVID-19 pool holistic initiative that treats the knowledge as a commons, not only to accelerate innovation but also recognizing this knowledge as a public good for humanity which should be managed in a way to ensure affordable access for all, it could be transformational. In contrast to the existing Medicines Patent Pool this pool would be global and not primarily focus on providing access to exitisting technologies, but more also on innovation: developing diagnostics, medicines and vaccines.

Transformational change

Instead of proposing tweaks it is now time to challenge the idea of handling medicines principally as a commodity or product, and to propose structural changes in order to approach health as a common good.  This means referring to our collective responsibility for – and the governance of health when reframing biomedical knowledge production. Instead of leaving it entirely to markets and monopoly based business models.

For this we should move to an approach based on knowledge sharing, cooperation, stewardship, participation and social equity – in practice, this means shifting to a public interest biomedical system based on knowledge commons and open source research, open access, alternative incentives and a greater role for the public sector. Knowledge pools are a crucial piece of the puzzle.

The current COVID-19 pandemic demonstrates how it is possible to make transformational changes overnight when acting in times of an emergency. Let us use this crisis to acknowledge the failures of today’s biomedical research model and usher in the systemic change needed. The world after Corona will require the consideration of alternative paradigms –  it is indeed, as Costa Rica, Tedros and now the Netherlands as well rightfully confirmed – time for the knowledge commons to flourish now.

For some more background about commons thinking in the field of biomedical R&D and possible alternatives to ensure access to medicines for all, read our our policy paper ‘From Lab to Commons’. See also last year’s work on ‘The People’s Prescription’ by our allies in the UK, in cooperation with professor of Economics Mariana Mazzucato.

  1. The idea of a knowledge pool is to organise the governance of knowledge by pooling intellectual property, data and other knowledge. This can accelerate the development of health technologies and thus stimulate affordable access to the public. In 2010 the Medicines Patent Pool was set up as a response to the unequal access to HIV/AIDS treatments in developing countries. It has proven to be a great success and now functions as a United Nations-backed public health organisation working to increase access to medicines for HIV, Hepatis c and Tuberculosis.
  2. Knowledge commons refer to the institutionalized community governance of the sharing and, in some cases, creation, of information, science, knowledge, data, and other types of intellectual and cultural resources.