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Abdul dissects the incentives that drive Big Pharma and how they tend to get in the way of getting medications to those who need them most. Then he interviews Priti Krishtel and Tahir Amin of the Initiative for Medicines, Access, and Knowledge about their work to take on the pharmaceutical industry and deliver vaccines to the world. 

Transcript

Abdul El-Sayed: A new coronavirus variant with features that are similar to both the UK and India variants was discovered in Vietnam. Oh, and those variants are now called Alpha and Delta, according to a new convention that renames variants, according to the Greek alphabet. The Biden administration declared June a national month of action, kicking off a range of activities to incentivize Americans to get their vaccines. The Tokyo Olympics, set to begin at the end of next month, are at a crossroads as 10,000 volunteers quit and Japanese medical associations urged the government to cancel. This is America Dissected. I’m your host, Dr. Abdul El-Sayed.

Abdul El-Sayed: My family and I, for the first time since the pandemic started, are looking at the prospect of getting on an airplane. I haven’t been on one since March 15th of 2020. I don’t even know what to expect. Obviously, you know, my family and I are going to be masked up, ready to go. But I hope we don’t have to deal with some anti-masker who can’t figure out that this is all for his or her own safety, and decides to make a whole scene about it. Honestly, if folks would just hurry the hell up and get vaccinated, maybe we wouldn’t have to deal with the mandatory masks at all and we could get back to a time when we could put the mask business behind us. With full vaccination rates barely getting to 50%, we’re not there yet. And that’s just the United States. Around the world, there are countless people who don’t even have a vaccine in sight, let alone a post -k future. And what kills me about it is that at this current rate, it’s going to be a long, long time before they get one either. India is one of the world’s biggest countries at 1.4 billion people. It was also the site of one of the world’s most devastating COVID-19 spikes last month. At its height, there were over 400,000 recorded cases a day, though most experts agree that the real number was likely up to tenfold as high. That’s because India remains home to some of the world’s poorest and hardest to reach people. Today, only 3% of Indians are fully vaccinated. The Indian government isn’t even trying to vaccinate the 85% of its people that they need to achieve any sort of herd immunity. Health Minister Harsh Vardhan said they plan to get 250 to 300 million people vaccinated by August. That’s only 21%. Other countries aren’t even that privileged. As of May 9th, for example, in Chad, they still hadn’t had their first COVID-19 vaccine. As we should all know by now, vaccinating Americans without vaccinating the world is a fool’s errand. This virus mutates! And it’s plausible that it could mutate an iteration of itself that is resistant to our vaccine-mediated immunity. This isn’t just science fiction. One of the reasons that the P1 variant, now the Gamma variant, was so concerning is that it arose in a city, Manaus, Brazil, where more than three quarters of the population had already had COVID-19, meaning the variant is resistant to natural immunity. The longer we wait to vaccinate the world, the longer we give the virus to mutate. Just this week, the virus reminded us why we can’t keep waiting. A new iteration of SARS-CoV-2 that combines features of the Alpha variant out of the UK and the Delta variant out of India, was discovered in Vietnam. So far, our vaccines continue to have solid coverage against variants. And yet this underlines the ultimate fear of what could happen globally if we fail to vaccinate people around the world. The Biden administration is considering shipping out doses of vaccine that are set to expire by the end of the month. This, of course, is fraught with challenges. The first is a logistical. Vaccine doses set to expire have to be delivered into arms by the end of the month, and many of the countries that need vaccines simply don’t have the logistical capabilities to do that on time. The second is political. Ironically, the same America First crowd that believes that COVID is a hoax, will fight you if you try to make them wear a mask on an airplane, that aren’t willing to get vaccinated, don’t want the vaccines they’re not taking to go abroad either, because America First, even if that means others never. It highlights a fundamental failure of the global vaccination effort. It centers privileged, predominantly white countries. Leaders who see the value and wisdom in spending resources to vaccinate people abroad are hamstrung by the ethno-nationalist politics in their own countries to do what needs to be done at scale. Others still hold to a patronizing benevolence. The only way that low-income countries could ever get access to vaccines this advanced, this expensive, is when institutions in high-income countries give them to them. That’s the fundamental flaw inherent in the main global effort to vaccinate the world. The Covax project, led by the Gates-backed global nonprofit organization GAVI, is working with the leaders of high-income countries to, in effect, crowdsource vaccine for the rest of the world. So far, Covax has shipped 77 million doses to 127 countries. Just this week, they got another 2.4 billion in pledges, bringing the total raised to $9.6 billion. That may sound like a lot, but 77 million doses and $10 billion is a drop in the world’s bucket. There are 7.7 billion people in the world. Only about two billion of them have had any vaccine at all, and they’re nearly all in high-income countries. Up until last month, Bill Gates has been clear that his effort is as much about protecting vaccine patents for manufacturers, all based in high-income countries, as it is about vaccinating the world.

[reporter] There’s been some speculation that the change in intellectual property rules and allowing these vaccines, as you say, the recipe for these vaccines to be shared, would be helpful. And do you think that would be helpful?

[clip of Bill Gates] No.

[reporter] Why not?

[clip of Bill Gates] Well, there’s only so many vaccine factories in the world and people are very serious about the safety of vaccines. And so moving something that had never been done, moving a vaccine from, say, a J&J factory into a factory in India, that, it’s novel, it’s only because of our grants and our expertise that can happen at all. The thing that’s holding things back in this case is not intellectual property. There’s not like some idle vaccine factory with regulatory approval that makes magically safe vaccines. You know, you’ve got to do the trials on these things. And every manufacturing process has to be looked at in a, in a very careful way.

Abdul El-Sayed: I want to break down Gates’s comments for a minute. There are three arguments embedded here. The first is that global vaccine manufacturers just don’t have the know-how to do this. But that’s absurd, considering that if we put the time and effort into investing in manufacturers, the same ones that make so many of the generic medications we take here in the US, they would. Another argument is that there aren’t enough reagents or supplies, but that underestimates a whole host of manufacturing capabilities that would come online to supply new manufacturers if they were allowed to. And finally, there’s the argument that waving vaccine patents would undercut global R&D. If manufacturers fear their patent would get waived, it goes, they just won’t take the risks and make the investments in R&D next time. Problem, of course, is that this R&D was bought and paid for by you and I, the US taxpayer. The contracts for vaccines were agreed to before there were even vaccines to distribute. These companies took on literally zero risk to research and develop these vaccines. But there’s another approach, an approach that recognizes that people, if allowed, can be the means of their own protection. That movement for a quote unquote “people’s vaccine” is about breaking down barriers to vaccinating the world by investing in the world’s ability to produce its own vaccine, if major corporations and their patents get out of the way. Last month, the Biden administration announced that it was backing a temporary waiver on patent rights for vaccine manufacturers. This waiver would remove the chokehold pharmaceutical companies like Pfizer and Moderna have on the vaccine, and allow global manufacturers around the world to begin making far larger quantities of the vaccine at far lower prices. But that proposal remains stuck in talks at the World Trade Organization, with several high-income countries digging in. All the while, vulnerable people across the world suffer and die from what now, given the vaccines, is a preventable disease. Time is wasting. In fact, just this week, the WHO reported rising rates in several countries in sub-Saharan Africa, in Uganda, hospitals are overwhelmed. We need to act. Now. Today, we’re diving into the fight for a people’s vaccine and the quest to vaccinate the world. I reached out to Priti Krishtel and Tahir Amin, Co-executive Directors of the Initiative for Medicines, Access and Knowledge, better known as IMAK, to learn more about global pharmaceutical policy, after the break.

[ad break]

Abdul El-Sayed:  OK, are you guys ready to, ready to get started?

Tahir Amin: Yeah.

Priti Krishtel: Sure.

Abdul El-Sayed: OK, can you introduce yourself for the tape, please?

Priti Krishtel: Hi, I’m Priti Krishtel and my Co-Executive Director for the Initiative for Medicines, Access and Knowledge.

Tahir Amin: And I’m Tahir Amin, also co-executive director for the Initiative for Medicines Access to Knowledge.

Abdul El-Sayed: [narrating] I wanted to reach out to experts who’ve been working on global pharmaceutical access since before the pandemic, to shed light on the ways that Big Pharma has used its same old tricks to interfere with anything that might get in the way of its profits. Tahir Amin and Priti Krishtel are lawyers who have been leading the fight for global health equity for years. Their voices are uniquely important now as we struggle to vaccinate the globe.

Abdul El-Sayed: We’re really grateful to have you joining us today because we want to have a conversation about putting these vaccines, which, of course, have been now widely-available in the United States in a broader international context, given that this is, in fact, a global pandemic. I was hoping that you could walk us through the development process of these vaccines that you’re fighting to provide global access for.

Priti Krishtel: Tahir.

Tahir Amin: Right. That’s a great question. And I think, what’s been interesting is that there’s been a lot of praise as to how quickly we’ve seen these vaccines emerge, and one has to praise the science that’s gone behind it. But what’s important to recognize is the amount of public funding that has gone to accelerate this process. I mean, usually you hear language about vaccines take about 6 to 10 years to get approved, and here we’ve achieved a number of vaccines to come through within the space of 12 months. And I think that’s all thanks to the billions that, for example, Operation Warp Speed, public funding, the technologies that have been funded in the past by the NIH—and all this has gone into creating the ingredients that now form the recipe for the vaccines that are now being held by private actors such as Moderna and Pfizer. And this is the, one of the big sticking points and the bottlenecks in terms of now trying to release that knowledge so that we can get more people making these vaccines, so that we can really get out of this pandemic as quickly as possible. But unfortunately, there’s billions of dollars at stake. Companies’ pipelines are built on these technologies now, despite all the public funding, and they won’t let go of it. And the governments are not compelling them to to really give that information over.

Abdul El-Sayed: And you touched on this in your eloquent answer Tahir, I want the listener to understand just how unusual this is. Right? You talked about a 6 to 10 year timeline, and it’s been accelerated, it almost 6 to 10 months in the cases of these COVID-19 vaccines. But just how unusual is it that you have a process like this that is wholly backstopped by government? Because when we talk about R&D, one of the misnomers is that a lot of these corporations will fund their own R&D and it’s just a market world out there—how much R&D costs are usually funded by government, and how does that differ in this circumstance?

Tahir Amin: Well, I mean, here we’re talking, for example, at least over $16 billion has gone in from government funding. Whether that be in terms of just the R&D or whether there are also these extra billions of dollars of these pre-approve commitment purchases. And so this is all part of the cost, even some of the plants that these companies have been sort of subsidized in terms of improving the infrastructure. So that, so they’ve got money from left, right and center, to kind of make this happen. And when you think about it in terms of how unprecedented it is, it’s kind of really not happened like this since World War II. This is the sort of the, the scale of the operation, the scale of the public dollars that’s gone into this. And this is not only happening in the United States. We’ve seen this in Europe, we’ve seen in the United Kingdom. And so the money has really been put forward by the public to accelerate this. And yet the pharmaceutical industry is essentially now trying to what I call reputation, reputational laundering. They’re trying to sort of, sort of say that they’re being the heroes. Yet all the money and all the resources that has been given to them to do this, is almost forgotten now.

Priti Krishtel: And I’ll just add to that, that we hear a lot about how the private sector is responsible for innovation today. But the figures are clear, when you look at global funding to combat the pandemic for R&D, there’s been a $100 billion of public money that’s been poured into this. The vast majority of that is for vaccines. So, yes, today is a wholly new situation where you’re seeing the public essentially taking on the vast majority of the risk. But it’s important to remember also that public funding contributes significantly to most research and development that comes out of the pipeline. And that’s something we don’t talk about enough.

Tahir Amin: Yeah, I would just add to what Priti just said, remember, this is not just the vaccines, even the initial therapeutics such as Gilead’s remdesivir, that had a significant amount of public funding, too. And when we think about neglected diseases and pandemic preparedness for pathogens that just randomly break out, the market model doesn’t really have any interest in these issues until there’s a real market. And here you have the biggest market that anyone’s ever imagined, some 8,, 12 billion doses that are needed. And the companies I mean, they essentially got the got the best deal out of this. Sure, they had to do things, and we have to be grateful for that. But this is the biggest market ever, and they arrived at the party when everything was basically de-risked.

Abdul El-Sayed: So the scenario you’re painting here is almost like, you know, we give you the money to do the job that you say you can do, we buy the product before you even do that job, and then we give you the rights to be able to sell that product wherever it is. The interesting sort of analogy here, right, just to paint the picture of how, how lopsided this is, is almost think about an engineer who works for a tech company, right? The tech company provides the laboratory, they provide the resources, they hire and pay the engineer, and then they keep access to the software. And in this scenario, it’s like the government is the tech company and these pharmaceutical companies are the engineer, except for it’s like the engineer gets to just walk out with the product and sell it to whatever or whomever they would like for a profit. And it just goes to show just how lopsided things are in the favor of these corporations. Of course, because the tech company is a corporation and the pharmaceuticals are a corporation, and either way, whether you’re talking about government funding or the labor of an engineer, the corporation wins. And it speaks in a pretty profound way to the way we think about the value of our overall pharmaceutical enterprise. Is it intended to prevent and treat disease, or is it intended to make large corporations a lot of money? And I think we are at a crossroads about where the rubber hits the road on what the values there are. At issue here now is the question of patents, right? Patents, of course, being the right to profit off of intellectual property that was produced—of course, as you all mentioned—on the dime of taxpayers, whether in this country or abroad. Can you tell us a little bit about how these corporations are using their patents and why they’re fighting so hard to keep those patent rights inviolable?

Priti Krishtel: Well, ultimately, this is about power, and the way we’ve set up the system right now with what we just talked about, the public is bankrolling the development and purchase of these vaccines, but ultimately, because these companies hold the ownership rights, which is intellectual property—people talk about patents a lot, but it’s also about trade secrets, it’s also about clinical trial data—so because the companies have all of these forms of intellectual property, they hold the power. And we’re seeing what happens now in the middle of a global pandemic where the power to decide who gets access and who doesn’t is in the hands of a handful of private companies. And it’s just not OK.

Tahir Amin: And I would just add to that, we have to remember, I mean, not only just in the United States, but this is happening globally. And I’m sure we’re going to get to discuss it, you know, what’s happening at the World Trade Organization and how countries in the global south that are appealing to waive these intellectual properties so that at least they have a chance of producing some of these vaccines themselves. But the whole infrastructure, the whole system was actually kind of written by the pharmaceutical companies, and also the copyright industries. Which kind of then became the World Trade Organization, what we call the TRIPS agreement, which is required all these countries in the global south, which were emerging and developing countries, to essentially provide what we call a minimum level of intellectual property protection—countries that never had these protections before. And so this is all playing through at the behest of the likes of Pfizer that concocted this idea that we need to put intellectual property and enforce it on these countries back in the ’70s. So it’s actually affected also drug pricing in the United States as well. People often forget that this, oh this is only an international issue. This is actually also affects drug pricing here because the companies have got so much power from it that now we can’t even sort of bring them back in.

Abdul El-Sayed: Mmm. Walk us through what is the WTO’s role in all of this? I think folks don’t really quite appreciate the history around the WTO, which you just quickly laid out there Tahir. Can you guys walk us through that a little bit more, and help us understand what their role is and why this WTO waiver that’s now being discussed is so significant.

Tahir Amin: Yeah, so the WTO is essentially just a member state, member-driven organization, it’s more like a body that really administers the trade rules. It was created in 1995 after at least a decade of negotiations and pressure that was put on a lot of the emerging countries, or at least low-income countries back in the ’80s—they were actually trying to avoid it, but eventually it became where, it housed all these intellectual property rules under the trading system. So countries like India, where previously they didn’t have patent laws on actual the product that is made, like a drug, eventually they had to do that. And so now these rules are, 164 member countries actually now have to adhere by these rules. Some of least developing countries, as they’re called in sort of the World Bank terms, they may have what we call transition periods where they don’t have to have intellectual property laws fully enforced yet, but many do already. That’s something that’s not often known. And so now they basically can’t really sort of climb the technological ladder the way they might have been able to had these rules not being forced on them. And so now they’re trying to say, well, let’s remove these rights so that we can actually avoid all the intellectual property landmines in order that we can actually scale up supply of these vaccines. But, of course, the commercial interests of these pharmaceutical companies and—but also state actors. You know, the global north countries are holding onto power. Remember that technology is power in this modern age of a knowledge economy. And it’s kind of, it’s great that the United States has said that we support the waiver, but it’s also a restrictive waiver—just on the vaccines. But yet you’ve got the Europeans now, who are kind of playing tough cop and not going with the game. And so really, this is all, as Priti says, it’s all about power as well. It’s not just about sharing technology. This is about actually a deeper sort of political economy at play.

Abdul El-Sayed: So what would happen if this WTO waiver were to pass? What would it actually mean for getting vaccines out to global south countries?

Tahir Amin: Well, what it, what it would mean is it would actually remove all the various components that could go into a vaccine, for example. But it also, this proposal is not just about vaccines, it’s important to stress this is also about therapeutic. So it could be some of the pills that may emerge either now or later that you can take orally. It’s to do with diagnostics. It’s to do with even some of the raw materials and supplies that might go into a vaccine such as bioreactor bags. That way, you know, you actually, you use to kind of grow cell, live cells. Some of the vaccines may require that. The mRNA vaccines, which are the more modern technologies, might not require that. But all these different components have, are likely to have some IP to them. And as Priti says, the clinical trial data and so forth. And what this waiver would do, it would say basically we have, we’re creating a level playing field and if you’re a company that has the ability to make these vaccines, you basically have a green light, you have the freedom to go out and make it. Now, of course, there will be some other hurdles, such as getting through the regulatory process. But what some of these companies will be able to do, like many companies in India or elsewhere, such as Korea, they may be able to kind of get at least 80, 95% of the way and then we can try and then get rid of some of these regulatory hurdles, which require sort of sharing of knowledge. But it could also encourage other companies to start sharing their data and sharing their technology. So it’s a bit of a stick and carrot approach, but I think the waiver actually really allows us to optimize and utilize all the possibilities on the table that might be there. At the moment we’re not using the full capacity and abilities that people may have to try and get us out of this pandemic in terms of scaling up vaccine supplies. And that’s what the waiver is supposed to sort of kick start.

Abdul El-Sayed: And if I’m not mistaken, it doesn’t necessarily mean that the corporations who currently hold these patents inviolable wouldn’t have any kickbacks for their work. No, it’s just that they wouldn’t be able to independently negotiate those deals, correct?

Priti Krishtel: Right. They absolutely would still be able to negotiate deals with companies. In fact, there are some vaccines where those partnerships, that licensing, that sharing of technology is going to be very important. So hopefully the waiver will serve as leverage, as a bit of pressure for those companies to expedite what right now is a very slow process where they are not partnering adequately with suppliers in other countries,

Abdul El-Sayed: Generally, when we think about patent rights, and specifically when we’re thinking about this waiver to patent rights, folks argue, they say: well, if you were to waive patent rights generally, and even in this case, waive the patent rights for these vaccines, what you’d be doing is undercutting the incentive that these corporations have to invest in research and development. What do you all say to that?

Priti Krishtel: Companies don’t invest in vaccines to begin with. They don’t invest in preparing for pandemics. We’ve talked about this extensively over the last 20 years because there are these areas of the pharmaceuticals marketplace that are clearly market failures and yet governments have responded inadequately to help create appropriate incentives or to create alternate modalities like government production, to prepare us better for pandemics. There are no incentives right now. Private actors do not invest in this type of work. The only reason they are doing it to meet this moment is because of the $100 billion that’s been pumped into subsidizing this process. So I think it’s a fear tactic to say that they won’t invest in the cures of the future if we take away their IP rights today.

Tahir Amin: I think it’s also, just to tack onto what Priti’s saying, I wrote a piece in the publication Stats, last year about how the sort of pharmaceutical market model doesn’t really serve us for a pandemic. And I think that’s really showing up in terms of just the initial question you asked. If you think about neglected diseases, diseases that really don’t get any interest in terms of a sort of market approach where you can make billions of dollars—I think in 2018 there was, the pharmaceutical industry only put in about $650 million of research money to neglected diseases. And if you think that the top 20 companies in 20191 made $662 billion, that’s not even 1% of their revenue. So really, this idea that, oh, we’re going to, you know, sort of, clip their wings in all this research that they’re doing in these kind of pathogens and neglected diseases, is actually a myth. And I think it’s important to, even the WHO in its blueprint for R&D preparedness for pathogens and pandemics actually says the current market-driven model does not serve us. So, again, as we’ve seen in with all the public funding, we would not be in this position where we have all these vaccines had it not been for the public funding that’s got us here. So and for the, for the companies to take all the credit, I think is unfortunately the media is bought into that as well. And that’s half the problem. Half the battle.

Abdul El-Sayed: So more good-faith arguments are that a lot of these manufacturers just don’t have the skills and the know how to take on something as technical as an mRNA vaccine, or that there’s going to be a run on the global supply of critical reagents and supplies to being able to manufacture them. What is, what is your response to that?

Priti Krishtel: So I’ll respond to the first one. I think this is where American exceptionalism really gets us into trouble. And we’re going to see right now that these types of arguments about the capacity for whether other countries have the capacity to manufacture COVID-19 vaccines is fundamentally racist. There are already new mRNA vaccines that are coming forward in India and China. There are several companies in other middle-income countries who are manufacturing COVID-19 vaccines. The WHO has established a technology transfer hub to support regional manufacturing across the world of these vaccines, and there’s high levels of interest from manufacturers. So this is one of those diversion tactics that is used by the industry. And unfortunately, a lot of Americans, when they hear that, when we hear that, we accept it as Americans. That, oh, it must mean that it’s true that other countries can’t do it. You know, our team at IMAK has spent the last 15 years working on the ground in the emerging markets with manufacturers, either private sector manufacturers or with governments who have established their own manufacturing capacity—there are brilliant scientists and manufacturers who are highly capable of meeting this moment, and we are hurting our pandemic response by not engaging them, and supporting them to get started right away to start to scale up global access of COVID-19 vaccines.

Abdul El-Sayed: I really appreciate you making that point. I think there is a, an assumption about the global south that the capacity isn’t there. The reality is, is that, you know, a disproportionate number of the scientists that work in the labs in Pfizer or Moderna are often foreign-born scientists in the first place. And I think it is really critical for us to disabuse ourselves of that notion.

Tahir Amin: This might not land, but it reminds me of these kind of, it’s like a Hollywood Marvel Comics movie that all the superheroes only exist in the United States. It’s like, it’s such a warped perspective. There’s so many great scientists out there that, let’s not be so self-centered. Please.

Abdul El-Sayed: I appreciate that. And what do you say to the conversation about global supply chain and reagents?

Priti Krishtel: I think too much of the conversation right now is focusing on what’s not possible rather than what’s possible. There are a number of arguments. Reagents are one. There are so many arguments coming out every day to justify why Pfizer, Moderna, AstraZeneca, the other companies, are not sufficiently meeting global production. They are falling far behind the targets that they set. The last figure that I read was that their only meeting 5% of the production that they promised. The system itself is reliant on a monopolistic model. So, for example, we saw that where Serum Institute in India was being heavily relied upon to supply Covax, which is the global mechanism to get these vaccines out, especially to the poorest countries in the world—now, Serum just announced last week that they are seven months behind schedule now. So we’re not going to see Covax being supplied by the Serum Institute for seven more months. What happening right now is that there’s two things happening. One is we’re assuming the usual monopoly-based model is going to work in a global pandemic. It’s not. And then we’re allowing the pharmaceutical industry to put excuse after excuse up about all the reasons why they can’t partner with suppliers in other countries. And what we need right now is leadership. We need the government to step in and compel them to partner.

Tahir Amin: I would just like to add that if you look, if you look over the last sort of eight months where the waiver, the TRIPS waiver, it was it was announced in October 2020, and since then, the roadblocks that have been put up by the, the rich countries and the pharmaceutical companies that are against the waiver—the goalposts keep shifting. Every time you disprove a point, they kind of shift it to another place. And interestingly, even mechanisms that were set up by the World Health Organization back in May 2020, where they—I think it was Costa Rica that led the proposal—was to kind of create this technology pool, it’s called C-TAP, where companies could actually put their technologies into the pool and then everybody could share and they’d get some kind of royalty or compensation, the companies that put the technologies in so that others could use them. And they just totally pooh-poohed that. And there’s no technology in there. It’s been a year on. Hence what propelled the waiver. And then they tried to, they tried to oppose that. And now you’ve got the European Commission, for example, saying, oh, well, we need to do this kind of voluntary agreements, which is essentially what the C-TAP was for. So they just literally gone around the houses wasting time and then back to a point which was proposed back in May last year. So everything is designed to keep the status quo and the power dynamics, largely because the pharmaceutical companies are so powerful, and can actually lobby to make sure that the rich countries just don’t give away their, their power source.

Abdul El-Sayed: Yeah, I really appreciate that point. And meanwhile, we have to remember the context, that thousands of people of around the world are dying of what is now a preventable disease. And then the broader context is, you know we didn’t even talk about, but the power of these large corporations to compel their suppliers around future contracts and to make decisions that can choke out the global supply chain is absolutely critical as well. This waiver is ultimately a shor- term fix. Can you walk us through what a real structural solution would look like? What are the bodies at play? What are the kinds of public policies that we need so that if we get to the next pandemic, we are not in a situation like this one again, where large corporations that have fed off the public trough continue to try and own and choke out access to needed necessary medications. What is the real-long term solution here?

Priti Krishtel: We believe that the solution is the democratization of the entire medicine system, from drug development to drug access. It’s a system that’s been completely captured by private interests. And we focus primarily on the system for intellectual property or patents. When you look at a country like the US, the United States Patent and Trademark Office, most members of the public couldn’t tell you who runs that office or what it does. There is very little congressional oversight, and it completely escapes public scrutiny. But we’re seeing in a moment like this that this office actually has the power to save billions of lives. This office is going to be so influential in what the White House does next. Do they negotiate a waiver that is going to maximize the number of lives saved? Are they going to obstruct the president’s efforts? And so for us, it starts with really looking at how is government functioning for people? Has it gotten too skewed in favor of private interests? And let’s start to put people back into these systems, and let’s start by really paying attention to who’s going to be the next director of the US Patent Office. Our organization has worked with 30 other organizations to send a letter to the president to say that whoever heads the PTO next, that appointments coming up soon, it should not be somebody associated with industry, and it should not be associated with, that person should not be associated with any private interests.

Tahir Amin: And I think on a, just adding some other ways we can really structurally change the mess that we’re in, in terms of these monopoly systems, I think, first of all, the WTO needs to be revised after this. I think part of the waiver is really we’ve had so many public health emergencies where developing countries have had to fight tooth and nail to get any kind of concession in that system. And often it’s never worked out. So we’re not holding our breath here because the negotiations have to happen. But after we get through this, hopefully, we really need to look at the WTO rules. Because here you have literally a handful of rich countries holding the rest of the world ransom in terms of knowledge and technology. So I think that needs to change. We also need to start building government systems whereby instead of just doing the upstream research, as we’ve seen with a lot of the technology that’s going into the vaccines, and then handing it over, maybe we should be building these systems right through, so that we have other manufacturers which are in the public hands to be able to kind of step in in these pandemic movements and scale up supply immediately, or at least actually state maintain control of the technologies and get as many actors in to try and scale that up. Just simply handing over, public research over to pharmaceutical companies and then hoping that they’ll do the right thing, just doesn’t work in these situations. And hasn’t even worked in day-to-day drug basis. And I think also we need to create systems that actually separate the risk of research and the cost of research from the actual end price, and who then is able to produce it. Because the entire sort of pharmaceutical market model really only leaves power in the hands of a few, and both in a domestic level in terms of drug pricing, but also international crises like this, it’s just showing that it’s not really functioning. And to your point, actually, earlier Abdul, we’ve overly financialized the system. The terminology, that means that everything is about the shareholder and the investors, and it’s not really about health anymore.

Abdul El-Sayed: We really appreciate your work and your advocacy, and taking the time out to share with us how the system works, why it under-invests in these kinds of diseases in the first place and then tries to claim credit, when all of its investment de-risked, because there’s a contract on the back end and all the research costs are ae fronted. And the way that that robs people who fundamentally need treatment from getting it. And we have to remember that as we watch this pandemic burn through countries like Brazil and countries like India, that it is a function of a system that our choices and our tax dollars have underwritten, and that we have power here. And so I hope that folks will listen. Is there a place that people can go to both learn more, but then also to put pressure on their legislators to do the right thing?

Priti Krishtel: Sure. There’s a number of places that people can join to follow this movement. There is the Free the Vaccine campaign, which you can look up online. There’s also the People’s Vaccine. Both of these are umbrella groups for the work that’s happening to fight for global vaccine equity.

Abdul El-Sayed: Thank you so much. We really appreciate you.

Priti Krishtel: Thanks, guys.

Tahir Amin: Thanks so much.

Abdul El-Sayed: As usual, here’s what I’m watching right now: SARS-CoV-2 keeps evolving, but at least now we know what to call every new variant. Last week, the World Health Organization rolled out a new, more simple, less racist naming convention. Each new variant of concern will receive a name coinciding with its order in the Greek alphabet. The first, the U.K. variant aka B117, will now go by Alpha. The second the South Africa variant aka B1351 is Beta, and so on. What happens if we exhaust the Greek alphabet? Let’s hope we don’t have to find out. The Biden administration kicked off a national month of action, pulling out all the stops to meet their goal of getting 70% of eligible Americans at least one shot by July 4th. As of today, we’re hovering at about 64% of Americans with at least one shot. To reach 70, the Biden administration is offering free childcare for people who need it, extending hours at participating pharmacies, phone and text banking, and instituting a host of programs, including a quote unquote “shots at the shot” program to offer shots at Black-owned barbershops and beauty salons, a college challenge, a mayor’s challenge, and so on. Oh, yeah, and there’s a lot of incentives, including free beer, lotteries for free Super Bowl tickets, cruises and cash, Door Dash gift cards, X-Boxes and free baseball tickets. The Tokyo Olympics are set to begin in late July. However, 10,000 of the 80,000 volunteers needed to kick off the Olympics quit, citing COVID-19 safety fears. In addition, one of Japan’s top medical groups called on the Japanese government to cancel the Olympics amid a recent spike in cases. In an open letter to Prime Minister Yoshihide Suga, they wrote “We strongly request that authorities convince the International Olympic Committee that holding the Olympics is difficult, and obtain its decision to cancel the Games.”

Abdul El-Sayed: That’s it for today. If you like our pod, tell everyone by rating and reviewing it today, it helps other people find us. So please do your part. And don’t forget to pick up your Science Always Wins dad caps, sweatshirts and Tees, in both adults and kids sizes at the Crooked Media store.

Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra and Lyra Smith. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.