Covid-19 Proves We Need a Global Public Health System Built on Shared Technology and Public Goods

Despite multiple technological breakthroughs in the fight to control COVID-19, twice as many people died from it in 2021 compared to 2020. The Omicron variant is a stark reminder that effective vaccines are merely the first step toward ending the pandemic. Until we establish a process to manufacture vaccines at scale and distribute them where they are needed, we will lack the collective capacity to curb this or any future pandemic.

The goal must be to deliver timely and equitable access to vaccines, therapeutics, diagnostics, and essential supplies everywhere, not to protect monopoly profits.

The shameful inequity in global vaccine distribution shows that we cannot rely on monopolies, commercial imperatives, and charitable efforts alone if we are to achieve the World Health Organization's goal of "Health for All." As the WHO's Independent Panel on Pandemic Preparedness and Response concludes, we need a globally coordinated, end-to-end innovation system in which intellectual property (IP) rules and fiscal policies are designed to support collaboration between the public and private sectors. The quantity and quality of financing must be restructured around the overriding goal of delivering essential health technologies as a global common good.

Value in health innovation is created by many participants, including research institutions, corporations, governments, international organizations, philanthropies, scientists, and trial participants. The fruits of this collective labor should not be exclusively in the hands of pharmaceutical companies whose main priority is to maximize shareholder returns. This extractive model has prolonged the pandemic and undermined economic recovery.

Value created collectively must be governed collectively. And COVID-19 vaccines should be regarded as "People's Vaccines," as many eminent scholars and political leaders have argued. These vaccines benefited from unprecedented public funding, yet they remain largely under the exclusive control of private monopolies.

A handful of wealthy countries have blocked a widely supported proposal at the World Trade Organization to waive IP protections for pandemic-related technologies, effectively putting the interests of pharmaceutical corporations before global health equity and solidarity. We must ensure that future vaccines against the Omicron variant--developed using genetic sequencing data that South African researchers shared openly--will be accessible to all.

To that end, we cannot continue merely to correct market failures through donations, voluntary sharing mechanisms like the COVID-19 Technology Access Pool (C-TAP), or restrictive voluntary licenses. We must go beyond marginal fixes and imagine a new health innovation system, as outlined by the WHO Council on the Economics of Health for All.

First and foremost, this means addressing current global inequalities in innovation capabilities and infrastructures by fostering local and regional innovation networks and capacity-building efforts that target low- and middle-income countries. Technology and know-how must be shared to correct for the historic disparities created by the blanket application of IP rights, which has systematically favored those with existing technological capacity. We must promote open science, collective intelligence, and the sharing of public health data, while ensuring information is not used for extractive or disciplinary purposes.

Second, long-term strategic financing must be directed toward building end-to-end health innovation systems governed with the goal of providing common goods. Most health innovation is backed by extensive public investment--either directly or by de-risking private investment--from which the public should benefit. Public funding must come with conditionalities to guarantee wide availability, fair prices, transparency, and technology sharing. And because private finance also plays a critical role in health innovation, conditionalities, regulations, and incentives should be used to forge symbiotic public-private partnerships, and to align private investments with the goal of Health for All.

Third, critical health technologies must be considered part of a global commons rather than the exclusive right of private IP monopolies. Patents should cover only innovations that are fundamentally new and useful. To avoid the privatization of research tools, processes, and technology platforms, patents should focus on downstream inventions, and they should be readily licensable, with commitments to sharing technology and know-how to facilitate follow-on innovation, as patent law originally intended. These changes call for a thorough revision of patent rules and their application. The current debate about the WTO IP waiver must be seen in this broader context.

Finally, pharmaceutical company boards and investors have a role to play in transforming this broken model. Just as investors demand action on climate change, so, too, can they demand that companies assign high priority to equitable access and broader technology sharing. They can also push for corporate governance models that share value fairly between all stakeholders, not just shareholders. This action could translate into a mandate to focus on public health needs during crises, and to limit or eschew stock buybacks (especially in the case of firms that benefit from publicly funded research).

We are running out of time. Countering the COVID-19 pandemic and future health crises will require adopting a holistic, global approach to governing health innovation. The goal must be to deliver timely and equitable access to vaccines, therapeutics, diagnostics, and essential supplies everywhere, not to protect monopoly profits.