03.25.2021

Priti Krishtel: Vaccine Nationalism Is Dangerous to the U.S.

Health inequality was badly exposed during this pandemic, [but Priti Krishtel says it doesn’t have to be this way. She is the Co-Founder and Executive Director of the non-profit Initiative for Medicines, Access & Knowledge. She spoke to Hari Sreenivasan about the need to rethink how patents are regulated.

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CHRISTIANE AMANPOUR: Now, some experts say that most of Africa and parts of South America and Asia won’t even have any widespread inoculations against COVID until 2023. While vaccines are readily available in the United States, the United Kingdom, and Israel, much of the world is still waiting. Health inequality was badly exposed during this pandemic. But Priti Krishtel says it does not have to be this way. She is co-founder and executive director of nonprofit Initiative for Medicines Access and Knowledge. And she talks to our Hari Sreenivasan about the need to rethink how patterns are regulated.

HARI SREENIVASAN: Christian, thanks. Priti Krishtel, thanks for joining us. Your organization, the Initiative for Medicines Access and Knowledge, you work on access to medicines all over the world. And I want to ask about the U.S. first just for a minute. And that is. that right now, we have been thinking about this in a framing and a narrative that there is not yet enough supply to go around for all of the Americans. That is part of what is leading to this. Is there anything that the global pharmaceutical company or countries could’ve done to prevent us from being in this spot that we are today?

PRITI KRISHTEL, CO-FOUNDER AND EXECUTIVE DIRECTOR, INITIATIVE FOR MEDICINES ACCESS AND KNOWLEDGE: So, when we think about access to medicines, I think what we’ve learned since the beginning of the pandemic is that we really live in a hierarchy of health. Where you live determines your ability to get access to testing, to treatment, and now to vaccines. And so. we have seen time and time again in pandemics of the past that this same situation arises where we don’t have enough supply and where the pharmaceutical industry here in the U.S. and in other high-income countries says that we don’t have enough supplies, and it’s not possible to make treatments or vaccines cheaper and expand the global supply. And experience tell us that that’s just not true.

SREENIVASAN: But are there things we could have done to expand global supply in the first place?

KRISHTEL: Absolutely. I think we’ve been asking access to medicines movement over the last 20 years for a diversified global supply chain. That means making investments in other regions of the world, in other countries to ensure that manufacturers everywhere have the ability to respond in the case of pandemics emerging like this one. There’s also a need for a coordinated global response in terms of intellectual property or patents. We’re a year into the pandemic and we’re still debating about whether to share the secret sauce in the vaccine with other country manufacturers. And it’s just not a conversation we should be having. We should have a system that responds swiftly by compelling manufacturers to share the recipe, to share their intellectual property and their knowhow so as many manufacturers as possible can be deployed to scale up the vaccine so that as many people as possible can get it. I want to get to patent and intellectual property in just a moment. I also want to ask, look, the U.S. taxpayers shelled out somewhere north of $10 billion to different companies to try to get this vaccine up and running. And I just want to ask whether did we get a good deal? Did we bargain well?

KRISHTEL: It’s a great question. You know, when you look at a company like Moderna, many of us have taken the Moderna vaccine already in America today. The U.S. government subsidized by taxpayers has invested $2.5 billion in the Moderna vaccine. Now, did we get a good deal? I’m not so sure, because in order to stay safe, we need to make sure that globally people are getting vaccinated with the emergence of new variants. Just because we get the vaccine doesn’t mean that we’re safe. So, the U.S. government should be using everything in its power to make sure that Moderna is sharing its secret recipe with manufacturers all over the world, and it’s just not doing that. And as American, I am very concerned about that. I want to know that my government is doing everything that it possibly can to scale up global vaccination to keep me and my family safe.

SREENIVASAN: Now, the CEO of Moderna has said in the past, I’m going to try to commercialize some of this, not just for this particular vaccine but how we’ve done this, is a relatively interesting novel approach. And we want to make money off of this. What’s wrong with that?

KRISHTEL: Our taxpayer dollars, Hari, almost entirely subsidized the development of this Moderna vaccine. And so, in this particular case, the CEO of Moderna has already made personally over $3 billion. The company is poised. I heard one Wall Street analyst say recently that they are poised to make $100 billion in the coming years. And yet, we’re in the worst global pandemic that we’ve seen in a century. So, there is a deep inequity in this system of global vaccine scaleup. The CEO of Moderna should actually be compelled to share that secret recipe. And he has been very honest. He has said, with taxpayer dollars we developed this platform. And this platform now, I’m not just using it to develop the COVID vaccine, that’s already done now, I’m going to use this platform for 15 different applications. And I’m going to make a whole lot of money over the next decade. And that’s where when the market doesn’t incentivize a company like Moderna to do the right thing, it’s really up to government to step in and claim ownership in a product like this.

SREENIVASAN: Right now, according to the “New York Times” Vaccine Tracker, we have administered in the United States somewhere around 128, 130 million doses. Now, that is by far the largest number of doses of any country. But we’re only at about 14, 15 percent of the whole population that’s fully vaccinated. Even partially vaccinated that’s about 35 percent. The Biden administration, the president himself has said, I want to take care of Americans first, then I’m happy to donate extra vaccine that I have. And in fact, we’ve donated some of our excess off the shelf vaccine to Canada and Mexico. So, I’m wondering, what else should the president be doing?

KRISHTEL: It is a tremendous accomplishment that we are on track to get so many Americans vaccinated this year, and that definitely should be applauded. But what the president is saying here, President Trump said the same thing, that we need to vaccinate Americans first before vaccinating people elsewhere, and that is a false choice. That is a false frame. Those are essentially industry talking points. There is no reason that we could not purchase existing vaccine supply to treat and vaccinate all Americans, while at the same time sharing that recipe, sharing our intellectual property and knowhow and making sure already that developing country manufacturers were poised for scale and able to vaccinate people worldwide. It is a false choice to say that we need to vaccinate Americans first. Americans are going to get the vaccine. We have bought up the existing supply to be able to do that.

SREENIVASAN: The administration also says that, look, we’re going to approve — I think Congress already approved 2 billion, we’re going to approve another 4 billion to try — through GAVI, the Global Alliance for Vaccines. And, you know, what more can America do? Why should we be doing it?

KRISHTEL: I think the primary reason we should do it is because we are not going to be safe until everyone is safe. So, that is the number one reason to be thinking about whether people in lower and middle-income countries are vaccinated. It’s also the morally right thing to do. And it’s also what’s needed to get the global economy back on track. But at the heart of it in order to ensure the safety of Americans, we do need to make sure that everyone everywhere is vaccinated. Now, the United States has taken some good steps in the last few months. We have rejoined international agreements and relationships such as with the World Health Organization. And like you just mentioned, with COVAX. But all of that is insufficient, because at the heart of this story, about global equitable access is intellectual property and you can’t dance around that. We saw that with HIV. We saw that with hepatitis. And we are seeing it again now. And we know what is needed. We have to figure out how to share our intellectual property and our knowhow so that we can get global scaleup.

SREENIVASAN: Look, the intellectual property argument essentially always comes down to hitting kind of the scientists and the — you know, versus the patentholders, versus the kind of businesses. What is the way through this? You know, what happened during HIV? What happened with hepatitis? What have you already kind of learned from watching, advocating in this space for so long?

KRISHTEL: So, in the mid-’90s when we saw the development of HIV drugs, it took a very long time. It took almost a decade for those treatments to reach people across the African continent, Latin America, and across Asia. And during that time, millions of people died. And so, what we have to remember about that experience or the experience of hepatitis B with the vaccine is that manufacturers in high-income countries are always going to say that they cannot produce more cheaply, that they can’t partner with more companies, that they can’t share their IP. The market doesn’t incentivize them to do anything else. But what we have seen time and time again is that when we give the opportunity to manufacturers in other countries to produce those products, prices come down, manufacturing capacity increases rapidly, and millions of lives are saved.

SREENIVASAN: This is contrary to kind of the market philosophy that so much of the western world subscribes to. I mean, they’re going to say, listen, when you tell me that I have to give away the secret sauce, whether it’s by government edict or in any other way, if I’m the CEO of Moderna and President Biden calls me up and says, you got to give this up, you got to let a company in China and a company in India and a company somewhere in Nigeria start to manufacture this, he’s going to say, but, look, I spent all this effort and I took all the risk. Shouldn’t I get the reward? Isn’t that what sort of the market structure is there for?

KRISHTEL: You know, I think this is a smokescreen, Hari. In the case of, for example, again, the Moderna vaccine, this is a vaccine that we as the taxpayers paid for. So, first and foremost, we should be able to have a say in what happens with that intellectual property, that knowhow, the vaccine itself. But I think as a larger matter, we have lost our way when it comes to the intellectual property system or the system for patents. There is supposed to be a social contract. Patents provide an incentive for invention, for scientific progress, for innovation. And in return, we get access to those products. And whether you’re talking about the health care worker in Malawi right now who can’t get access to the COVID vaccine or you’re talking about somebody in the Mississippi Delta who can’t afford their insulin, intellectual property lies at the heart of these issues. It is a system that has gotten out of balance in the favor of private rights, and we need to start putting people back into that system. We can’t stay whetted to the idea of innovation. Innovation exists to serve people. Innovation exists in order to save lives. And if you forget that that balance is supposed to exist, then I think that we’ve really lost our way.

SREENIVASAN: Some of the drug companies have said, you know what, we aren’t going to try and sue a company that takes the sauce and starts to make it on their own. Is that enough?

KRISHTEL: So, Moderna has said that, and they got a lot of positive PR for saying that they wouldn’t enforce their patents during the course of the pandemic. Again, I think it was a bit of a diversion tactic. While they may not be out there suing, for example, a manufacturer in Bangladesh who may try to make the vaccine, the truth of the matter is other manufacturers cannot make this vaccine as quickly as possible to save lives unless Moderna actively shares their knowhow, actively teaches other companies how to make this vaccine as quickly as possible. [15:50:00] That’s why many advocates are calling on the Biden administration to join W.H.O.’s endeavors to actually create a place where people can share intellectual property and knowhow.

SREENIVASAN: You know, we have been talking about access to medicines. And one of the recent op-eds that you wrote in the “New York Times” says that essentially the way to racial equity and justice is through the U.S. patent office. Explain that connection.

KRISHTEL: Yes. There’s probably three reasons, Hari, why we really need to start thinking about racial equity at the U.S. PTO. The Patent and Trademark Office is an agency that I think most Americans don’t even think about. But the truth is the U.S. PTO claims that it touches IP intensive industries that make up 40 percent of our GDP. So, when you talk about innovation being the heart of the American economy, you have to start thinking about the U.S. PTO. And so, the U.S. PTO basically has two functions. It thinks that it has one, which is to grant patents, to drive innovation, to drive economic growth. So, when you look at who actually gets a patent, research has shown that less than 1 percent of patentholders are black. The leading economists in our country say that it’s going to take 118 years to achieve gender parity in our patent system. So, these are equity issues that on day one need to start being addressed by the new administration. But then on the flip side of it, what happens to that innovation? Is it actually reaching people? And so, there’s no better place to look — to think about that question than the high cost of prescription drugs. Over the last 40 years, patent rights have started to be granted at rates that are unprecedented. So, our research has shown, for example, that on a given drug product, on the best-selling drugs in America, each drug is now getting somewhere close to 100 patents per drug. And these companies are continuing to file hundreds of patents on these drug products. So, what happens, then? The monopoly periods are getting longer and longer and prices are continuing to go up, and Americans are crying out for relief. 13 percent of Americans are reporting that they lost a loved one in the last five years due to the high cost of drugs. And that number is twice as high for people of color. So, when you talk about the president’s executive order calling for racial equity to be embedded across all of its operations, we need to start with the U.S. PTO.

SREENIVASAN: I should clarify, I mean, you also came up with an entire 10- point plan on what the Biden administration should do. Distill that a little bit for us. I mean, you’re not in opposition to the idea of patents. You just think they need reform.

KRISHTEL: Absolutely. I think patents — you know, I grew up in a household, my father was a pharmaceutical scientist. He has many patents. Those patents paid for my education. They gave me the opportunities that I have today. I think in America, patents represent opportunity. Patents represent the ability for us to have the kind of progress that we want to see. But the system has gotten seriously out of balance. Skewed in favor of private interests who are leveraging the system to advance their business aims, which is what the market incentivizes them to do. What we are calling for is greater equity in that system, more public participation. The office right now essentially operates as a closed-door entity available only to what it defines as its customer, which is people applying for patents, which is primarily corporations and universities. What we are saying is that there needs to be representation from people living with diabetes, with groups advocating for greater HIV drug access, that there would be other types of public representation available at the patent office where our voices are really heard to make sure that those patents are actually serving the people that they are intended to be there for.

SREENIVASAN: Priti Krishtel of I-MAK or the Initiative for Medicines Access and Knowledge, thanks so much for your time.

KRISHTEL: Thank you.

About This Episode EXPAND

Chinese ambassador to the U.S. Cui Tiankai gives an exclusive interview on U.S.-China relations and Beijing’s treatment of the Uyghur population. “Bring Back Our Girls” author Joe Parkinson discusses Boko Haram’s 2014 kidnapping of nearly 300 Nigerian girls. I- MAK co-founder and executive director Priti Krishtel discusses vaccine nationalism and the problem with the United States’ patent system.

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