To address the specific (and very difficult) subject of big pharma and its involvement with global governance of health, we must first define “global governance”. What defines “good” global governance is that it must be participatory, consensus oriented, accountable, transparent, responsive, effective and efficient, equitable and inclusive, and follows the rule of law. However, you can’t talk about health governance without mentioning multinational pharmaceutical companies, and you can’t talk about multinational pharmaceutical companies without mentioning one very important factor: money. And as money is “the root of all evil”, it can harm all the characteristics of good governance quite easily.
Pharmaceutical corporations are major stakeholders -if not the most important of all- in one of the most critical global health situations: access to medicine and/or vaccines; they do not only manufacture and provide medicines and vaccines, but also promote the research and development of newer and cheaper alternatives of medications and technologies, that can reach populations most in need.
Pharmaceutical corporations are major stakeholders in one of the most critical global health situations: access to medicine and/or vaccines
As important as it is, global efforts for universal access to medicines are a relatively recent phenomenon. Prior to the decade of the 90’s, most international health policies focused in the coordination of national campaigns for infectious disease outbreaks through WHO. With the rising pandemic of HIV/AIDS, the efforts of control of the disease made a shift for the access of medication into the center of global health policies, as it was noted that prevention and opportune detection and early treatment were crucial to contain the growing threat, as stated by the UNAIDS first ten year’s report.
This has led to multinational pharmaceutical companies to be in the center of public policy-making of not only HIV/AIDS-related issues, but also many other largely present and emerging diseases such as malaria and tuberculosis, and other rising and threatening health problems like antibiotic resistance and the anti-vaccination movement.
Being private companies, pharmaceutical corporations will always be seeking economic profit for their investments and interventions. There has been an ongoing tension between the achievement of effective policy making and the incentives for the pharmaceutical companies towards a wider access to medicines. Due to the nature of politics, these processes are not exempt of corruption, especially in lower to middle countries where good governance is deficient in most health systems. The presence of corruption and thus absence of good governance in the health and pharmaceutical sectors affects deeply the effectiveness of the health systems in every level. Being a purely “political” problem, corruption is not often seen as a problem linked to successful health programs, but global organizations recognize this obstacle as they have developed initiatives to monitor and help fight the presence of corruption, like WHO’s Good Governance for Medicines Programme (GGM).
Although it is a very delicate matter, the correct involvement of multinational pharmaceutical companies is crucial in order to achieve good governance as they dictate the course of many important health interventions, such as agreements with governments over the prices of medications for public use. Examples could be the agreements the Spanish government did with big pharmaceutical companies to negotiate the prices of Hepatitis-C drug Sofosbuvir for its use within its public health systems; these agreements, although immensely beneficial for the population suffering from the disease, lack transparency and evidently involve corrupt interests far from making the medication accessible.
The correct involvement of multinational pharmaceutical companies is crucial in order to achieve good governance as they dictate the course of many important health interventions, such as agreements with governments over the prices of medications for public use
On the other hand, agreements that favor the pharmaceutical corporations in place of the population also exist. In South Africa, a country with a historically huge burden of Tuberculosis, HIV infection and AIDS, pharmaceutical companies are able to maintain the patents for its medicines, mainly through a process called “evergreening” (where companies minimally modify the molecular structure and apply a patent for a new drug, retaining the patent for another 20 years). Even though a change on these laws has been pushed for years by many NGO’s (the Fix the Patent Laws Coalition, for example), and the South African Government has committed to reform South African laws on patents, little action has been taken to adopt and implement a reform and many critical medicines remain inaccessible to the general public.
Even though there are many promising agreements with a huge benefit for the populations most in need on the horizon, there must be further investment and promotion of programmes focusing on controlling and eradicating corruption from all levels that interfere with health policy-making, programmes that have to be completely apart from political influence or economic interest. It is an immensely big challenge, as corruption is an ever-present factor in every governmental level in developing countries, where pharmaceutical corporation’s intervention is most needed.
Big Pharma: Sleeping With the Enemy or a Good Bedfellow?