• Lamlela Plaatjie (South Africa)

Unequal access to biomedical technologies between the global North and the global South

Socioeconomic inequality is multifaceted and compounded in complexity by its relationship with globalization and technology. During the third industrial revolution, the rise of the internet era in the 1980s coincided with accelerated globalization during the same period. Consequently shifting and shaping new models for business operation and employment trends. Corporations and employees were no longer restricted by geographical boundaries, trade liberalization and migration policy reforms allowed for easier cross-border exchanges. Global human capital transfers in particular had implications on national income distribution trends. A shift toward an information and knowledge-based economy emphasized the value of knowledge and highly specialized skills. The commodification of Intellectual Property (IP) has hastened the need to protect IP rights, simpler to enforce in the context of trade but more complex in the context of the biomedical and pharmaceutical industries.

The pharmaceutical industry is often conflicted to either prioritize capital gains or maintain moral responsibility by availing accessible solutions to all. Millions of human lives were lost from AIDS in the 1990s, the scale of mortality could have been avoided if vaccine patents were easily accessible in Africa as gatekeeping practices prevented lifesaving technology transfers. Unequal access to health technologies that are needed to contain and manage devastating diseases such as the HIV pandemic in the 1990s and the current Covid19 pandemic has had negative impacts on reducing socioeconomic inequalities. IP regulatory frameworks and enforcement tools in the health sector were initially implemented to regulate the manufacturing and trade of pharmaceutical products maintaining high-quality standards and integrity. However, this has had negative impacts on the poorest nations who cannot financially access biomedical patents and technology, unintentionally creating restrictions and barriers to access. Before the establishment of the World Trade Organisation (WTO), many countries had excluded pharmaceutical products from IP rights protection and exempted them from patent protection. Introduced in 1995, the Trade-Related Aspects of Intellectual Property (TRIPS) agreement is a multilateral agreement on intellectual property that mandated WTO members to comply with and enact IP laws. TRIPS later made concessions for flexibilities of licensing agreements and parallel imports of antiretroviral treatment drugs (ARVs) under patent protection, but the flexibilities weren’t legally sound.

In a dispute between the South African government and the Pharmaceutical Manufacturers Association (PMA) for lowering ARV drug prices, PMA cited that reducing the cost would not improve accessibility due to the poor distribution infrastructure in the country. India was a referenced case by the PMA, where despite the availability of generic ARV drugs, access remained an issue. After South Africa proposed legislation to authorize parallel imports of ARVs was passed in parliament, the pharmaceutical industry in the United States supported by the American government filed suit against the South African government to oppose parallel imports of ARV drugs in 1999. In 2001, the adoption of the Doha Declaration was a response to the outcry from low and middle-income countries (LMICs) regarding the urgent need to access biomedical resources, the document made the flexibilities of the TRIPS agreement legally binding. This was monumental in advocating for the health needs of LMICs, especially in African countries confronting the AIDS epidemic at the time. The subsequent fall in ARV pricing reduced the price barriers to drug access. Similarly, during the peak of the Covid19 pandemic LMICs experienced limited access to medical resources, perpetuating inequalities and imbalances between the global North and the global South. High-income countries could afford to procure Covid19 vaccines with advanced purchase commitments, reducing the limited global supply of vaccines available.

Concurrently, the manufacturing capacity of pharmaceutical companies owning vaccine patents could not keep abreast with global pressures, further exhausting production and access to medical resources. An appeal for a TRIPS waiver during Covid19 was denied by the European Union, the United Kingdom, Switzerland, and the United States; who chose to amend the TRIPS flexibilities instead. High-income countries should be held accountable for morally responsible actions and decisions. The contradiction of the TRIPS agreement impacted LMICs through the monopolization of pharmaceutical companies in manufacturing and the skewed distribution of biomedical technologies. Discourse on equity, accountability, and ensuring the sustainable availability of life-saving biomedical technologies became prominent on the public agenda following the denial of the Covid19 TRIPS waiver. After initially being introduced as a progressive tool, IP protection and enforcement have become major obstacles to the equitable distribution of biomedical resources in many LMICs. Policy interventions to regulate the monopolization of markets and exploitative practices in the biomedical industry need to be discussed in detail to ensure equitable access for all