Big Pharma, Big Question: Access to Medicine

 Simon Nkoli died at the age of forty-one. The year was 1998. Cause of death, AIDS. He was not the only one. The HIV/AIDS pandemic was running rampant at the time. Hundreds of thousands in Nkoli’s home nation of South Africa had already contracted the disease. Millions more around the world were falling victim too.

The human immunodeficiency virus that lies at the root of the AIDS disease is indiscriminate. Rich or poor, developing world or developed, HIV ruthlessly eats away at the immune system. The pharmaceutical trade, in contrast, is heavily discriminate.

As Nkoli lay dying, patients in richer countries with better health systems were fighting off the disease. Behind their successful struggle lay groundbreaking anti-retroviral drugs. Developed at great expense, the drugs did not come cheap. Access, logically, was restricted to those with deep pockets.

Nkoli, an apartheid activist and gay rights campaigner, didn’t think restricting access to life-saving drugs was fair. Again, he was not alone. His death triggered a small but influential group of gay activists to establish the Treatment Action Campaign. The Campaign’s message was straightforward: increase access to HIV treatment. The idea found a passionate and influential advocate in the then president, Nelson Mandela.

Fast forward three years and the scene had expanded in scope and profile. Around the world, manufacturers of generic drugs were popping up with low-cost alternatives to Big Pharma’s antiretrovirals. A new law in South Africa could, theoretically, open the door to the import of the cheap generics.

Activists and HIV/AIDS sufferers saw the move as a lifeline. The pharmaceutical industry saw it as the death knell. Amassing their collective weight, 39 international pharmaceutical companies challenged the South African government in the courts. The global reaction was immediate. And it did not lie in the companies’ favour. Big Pharma quickly, albeit reluctantly, backed down.

Ethical Corporation’s recent ‘Classic Case Studies’ picks up the story from there, describing how the global pharmaceutical industry has had to develop new business models to deal with changing societal expectations.

Like all CSR stories from the last decade, the industry’s journey has been an iterative one. From philanthropically-motivated donation programmes, Big Pharma has experimented with price innovations, patent pools and new research streams. By its own confession, it hasn’t yet got all the answers.

A recent report by the World Health Organisation finds many essential medicines remain “unaffordable” to poor people. If practices don’t change, UN Millennium Goals on access to medicine will fall wide of the mark.

The lessons from the story are multiple and open-ended. More must come. This is an evolving story. Yet what all the various parties agree – companies, governments, citizen groups and health agencies – is that collaborative solutions hold the most hope.

Today, the pharmaceutical industry boasts some of the largest and most serious cross-sectoral initiatives of any industry. Low medicinal access is not just an issue of high prices. Weak health infrastructure and sub-standard local capacity play their part too. Working together could just resolve these.

It’s too late for Simon Nkoli. But not necessarily for the millions of others currently suffering from treatable diseases.

n.b. other stories from the Classic Case Studies report include the Bhopal disaster, Exxon Valdez, the McLibel case, Brent Spar, Monsanto’s European fall out over genetic engineering, the Kimberley process, Trafigura’s toxic spillage and Toyota’s global recall.