It is well known that, during the 20th century, the pharmaceutical industry became extremely powerful at the international level, alongside financial, energy, technology, and manufacturing companies (Wells, 1984). The internationalization of the pharmaceutical industry only rose after the internationalization of patent protection in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPs Agreement) (Haakonsson, 2009). This industry is highly concentrated around a small number of very large transnational groups (65% of global sales are made by the 20 largest players – the ‘big pharma’) that operate worldwide through subsidiaries in 150 countries, on average. Revenue in the worldwide pharmaceutical market increased at a considerable rate, even during the global slump of 2008, and was estimated at an astounding USD1.143 trillion in 2017 (Statista, 2019). Recently, we published an article on pharmaceutical value chains, which investigates how they are embedded in an international division of labor, from a new-structuralist theoretical perspective. We ask: how global are the pharmaceuticals value chains? Are there centers and peripheries in pharmaceuticals value chains, and if so, which countries are in each pole?
What is new with contemporary (global) leading corporations? If gigantic monopolies are a repeated phenomenon in capitalism’s history, why all the fuss we see every day regarding high concentration?
Leading corporations of the 21st century are intellectual monopolies. These are firms that rely on a permanent and expanding monopoly over portions of society’s knowledge. A recent joint OECD and European Union report shows that the top 2000 corporations in business expenditure in research and development (BERD) concentrated 60% of total IP5 patents between 2014 and 2016 (Dernis et al., 2019).
How did this happen if intellectual rents enjoyed by the innovator were supposed to disappear once the rest of the industry adopts the new technique? They disappeared if the secret was broken, the patent expired, or when another firm innovated, overcoming the innovating firm’s advantage. Knowledge is cumulative and those innovating have a greater absorptive capacity to keep innovating. Aided by a more stringent and global intellectual property regime, the continuous reinforcement of knowledge monopolies has led to a perpetuation of the core, maximizing rentiership over time.
Intellectual monopolies may not monopolize the markets they operate, which can even be competitive markets like Amazon’s marketplace, where Amazon sells its products with millions of other sellers. Their monopolistic condition relies on their capacity to significantly and systematically monopolize knowledge, which generally – but not always – contributes to market concentration.
A flawed understanding of the concept of “public good” hampers the fight for equitable access to the upcoming COVID-19 vaccine
The term “global public good” has been used in very different ways by policy makers, economists and others. The term “global” is not particularly controversial, and in this context is generally understood to involve cases where the benefits of the service or good impact residents of more than one country, even if not necessarily the whole world. The term “public good” is subject to more diverse uses, often depending upon one’s educational or professional training.
For many people, perhaps most, the term “public good” is loosely defined to include cases where governments are willing to undertake measures to expand access, with universal access at least an aspirational goal. However, among the other influential definitions of “public good” is one that is exceptionally restrictive. A proposal by Paul Samuelson first published in 1954, meant at the time as an extreme and polar case, has found its way into countless articles, textbooks and academic courses, and has parameters that are rarely met in practice. At times, Samuelson’s 66-year-old paper is actually an obstacle to collective efforts to supply and distribute goods that have considerable impact on society.
The COVID-19 pandemic presents an astonishing global challenge regarding the control of the pandemic and the reduction of harm. The health impacts are large, particularly for older patients, and growing unpredictably, and the pandemic has had an enormous social and economic impact on everyone, with no obvious end in sight.Read More »
In his report on the Minimum Core Doctrine (MCD) John Tasioulas states:
“the essence of the concept will be taken to be the sub-set of obligations associated with socio-economic rights that must be immediately complied with in full (obligations of immediate effect)” (p. 3).
He contrasts these against those obligations that require significant resources and are therefore subject to ‘progressive realization’. Thus, the defining characteristic of MCD is that it differentiates obligations between those of immediate effect and those of progressive realization. And the focus is on the nature of the obligations (what the state must do when) rather than the nature of substantive rights (the condition of people’s lives).
However, the discussion about what constitutes minimum core obligations in substance focuses on the nature of rights enjoyment and a package of minimum goods and services that would be required rather than the nature of obligations. This starts with General Comment 3 that refers to ‘a minimum core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights’, and to the provision of ‘essential primary health care’ (ICESCR quoted in Tasioulas p. 5). Further, human rights-based practice begins to specify specific types of diseases to be treated and goods and services that would be included in the minimum, as under the ‘selective primary health care model’ adopted by UNICEF (Tasioulas p. 5).Read More »
September’s UN special session on antimicrobial resistance (AMR) was a vivid reminder of the shared responsibility of governments to promote research and development (R&D) combat global health threats. The complexity of the AMR threat made clear that a combination of market forces, policy incentives, and regulation, as well as norms and standards was needed to ensure innovation that would deliver accessible and affordable treatments.
The report of the UN Secretary-General’s High-Level Panel on Access to Medicines offers an important opportunity for national governments, UN organizations, philanthropies, civil society, and pharmaceutical manufacturers to move forwards and address this challenge. AMR is just the latest global health priority that cannot be resolved with the current incentive system for investing in medical R&D. AMR threatens to render a whole range of treatments ineffective and reverse 20th century advances in medicine. Numerous other health priorities are neglected because they do not present a business potential for investment, and millions of people lack access to medicines and treatments that are priced out of reach.
In a world of unprecedented medical advances, these unmet needs present a moral dilemma, and one of the most critical challenges for humanity. The Panel, on which I had the privilege to serve, makes a number of concrete proposals to promote needs-driven R&D financing and to expand access to medicines for people in need. As a whole, the report makes short-term and long-term recommendations towards introducing more systematic and sustainable approaches to meeting unmet needs in innovation and access.