We need a social business model of medicine production

The World Health Assembly, which is meeting in Geneva for the first time since the Covid-19 pandemic began, has agreed to set a framework to begin preparing for future pandemics. But this decision-making body of the World Health Organization (WHO), with its many delegates from middle- and low-income countries, faces a difficult reality: Even as the world only begins to comprehend the scale of our devastating failures responding to Covid, the rich countries of the world want to move on from the pandemic.

Preparing for the next pandemic will require more than a commitment from delegates at the World Health Assembly. It requires a structural shift towards a fairer framework of global health, where power is distributed more equitably via a social business model of vaccine and drug production. Social business is the form of business which is built on the principle of solving human problems in a sustainable business way, where owners are not interested in taking any profit except for the return of the original investment amount over a period of time. It's a non-dividend company aimed at solving social problems, not personal money-making.

There are concrete steps that world leaders can make towards this framework. If governments can give billions of dollars of grants to pharmaceutical companies to develop and distribute vaccines, they can invest these funds in social business pharmaceutical companies and pass on the benefits to the needy users of the vaccines.

The global inequities wrought by the pandemic are apparent: More than 20 million people have died of Covid, with the deaths overwhelmingly concentrated in lower-income countries. The WHO had set a target of vaccinating 70 percent of the world's population by the middle of this year. But, as we approach that deadline, just 16 percent of people in low-income countries have received a single dose. At this rate, it will take another two and a half years for the poorest countries to hit the WHO target.

After lower-income countries were denied vaccines for more than a year, some doses are finally beginning to arrive. Supplies arrive unpredictably all at once, in large volumes, and often close to their expiration date. When doses do arrive, lower-income countries have little say about which vaccines are delivered, in what volume, and on what timeline, making it nearly impossible to plan vaccination campaigns. Production, meanwhile, remains concentrated in the Global North.

And now that effective treatments such as antiviral pills have been developed, the cycle is beginning again.

Wealthy countries have already bought up almost the entire supply of Pfizer's Paxlovid and Merck's Lagevrio for 2022. The companies are gatekeeping which countries can produce the drug—excluding many countries, including almost all of Latin America. Pfizer has even made the outrageous claim that an attempt to produce Paxlovid in the Dominican Republic would be a breach of the company's "human rights."

Wealth is power. And the brutally unequal global roll-out of Covid vaccines and treatments is a consequence of an ever-increasing concentration of wealth and focus on profit maximisation. Today's pharmaceutical industry supplies drugs to the highest bidder to make ever greater profits. Equity and access are treated as little more than public relations issues.

Against this backdrop of stark inequity, immediate funding for the global roll-out of Covid vaccines, treatments, and tests is essential. It is the wealthy nations, the G10, the continuous beneficiaries of the wealth-concentrating economic machine, that have benefited from the current pharmaceutical model at everyone else's expense. They have the resources to narrow the great vaccine gap, if they want to. And to make a start, I recently called on US President Joe Biden to take the lead with a USD 5 billion commitment to support global vaccination efforts.

Increasing numbers of vaccines are getting produced, but they are not reaching the right places and the right people. When new, more effective vaccines are ready, they will once again be sold to the highest bidder, leaving lower-income countries fighting today's virus with yesterday's tools. It's imperative that this system be changed. We must have clear decisions on where vaccines and treatments are produced, by whom, for what objective, and how accessible and affordable they are. And freeing Covid vaccines from profit and patent is the key.

I have appealed for the establishment of social business pharmaceutical companies. These would be non-dividend-seeking companies that would produce vaccines and medicines to reach out to places and people who are always missed by the current system, and sell them at production cost, without markups, also at prices that are affordable to the lowest-income people, through cross-subsidies. It is the clearest thing the health sector could do to address one of its most pressing problems, reaching everyone, everywhere from the bottom up. But it requires removing barriers like intellectual property rules and social business initiatives. And, while the appeal to make vaccines patent-free to allow global production gained some good traction, it has not been enough to deliver action.

Now, amid a crisis of this depth and breadth, is the best time to undertake this initiative. If we decide to switch gradually from a charity model to a social business model, we will lay the foundation for local manufacturing and distribution of vaccines, tests, and treatments. Leaders can start with the next generation of coronavirus vaccines, by overriding patents and investing in socially driven generics manufacturers, to ensure the Global South does not have to fight tomorrow's variants with yesterday's tools.

World leaders can clear away the barriers to generic vaccine and treatment production, by supporting a comprehensive waiver of intellectual property rules on Covid tools at the World Trade Organization (WTO) this month. And they can do everything in their power to compel pharmaceutical companies to share their vaccine, test, and treatment technology with the Global South.

Instead, however, the EU, UK, and Switzerland have blocked an intellectual property waiver for more than a year. The US has refused to countenance removing these barriers for treatments, insisting that a waiver cover only vaccines. They can sense that the domestic political pressure on Covid is waning. So, just as negotiations intensify, rich countries are closing ranks.

Any meaningful progress will be too late for the millions who have died needlessly from Covid. But our actions today can correct our course for tomorrow's variants and set a model for future health crises. There is still time for world leaders to say never again, to ensure that the right to health is extended to everyone, and to commit to a fairer system of global health that prioritises human life over the profits of a handful of pharmaceutical companies.

Dr Muhammad Yunus is an economist, social business entrepreneur, and civil society leader. Founder of the Grameen Bank, He received the Nobel Peace Prize in 2006.