Rentierism and Big Pharma — with Nick Dearden

Artwork for podcast Crash Course Economics

Episode 3 • 20th February 2024 • Crash Course Economics • Crash Course

Rodrigo Fernandez

Good afternoon, everybody. A very warm welcome to crash course economics or welcome back. It's nice to see you all here. So today we'll feature the third webinar of our fourth crash course series on rentier and monopoly capitalism. I'd like to ask you to introduce yourself in the chat, so just say who you are, where you're based, and at which institutions you work. So, my name is Sarah. I'm a project manager at the Sustainable Finance Lab and at the Transnational Institute, and I'll be today's host together with Rodrigo Fernandez, who is a researcher at SOMO. And behind the scenes, we have a theme consisting of Jeremy Crawlsmith, our web developer, and tech guy, Jenny Pannebecker, communications officer at SOMO, and case Stott from Global Info, who are working very hard, as always, to make this webinar into a success. So before we go to tackle the heart of the matter, I want to introduce you to crash course so, in case you don't know us, we are a collective of engaged activists and experts from a number of organizations, and we united at the start of the COVID crisis in order to understand how Covid changes the world and to reflect on the challenges we're faced with and also think about possible solutions. Today, of course, there's a multiple crisis we're facing, so all the more urge to reflect on these issues. Creschurs is a platform designed to open up debate on how we can move out of these multiple cris, and we want to, of course, achieve social, economic, and ecological justice for all. But how do we do that? So, first, we need to understand the world before changing it. And therefore, we're inviting global experts to break down complex issues and make them accessible to you all so we can shape our economic system in a just and democratic way. This time, we will be discussing how a few corporate giants gained significant control over market access, technology, and resources, which allowed them to extract increasingly substantial rents to the detriment of smaller competitors, and also undermining stringent regulation and our democracies altogether. So this is the third out of four webinars in this series taking place every two weeks. And in every webinar, we provide you with a 1 hour crash course on a specific subject that makes you understand our contemporary economy and society a bit better. You can watch all our former series and webinars on our website, crashcourseeconomics.org. And, of course, also of this episode, there will be a recording, a podcast, and a summary online. Rodrigo, may I pass on to you?

Sara Murawski

Yes, Sarah. So this is the third episode on the series on monopoly capitalism and rentier capitalism. Today we will be talking about Big Pharma, Big Pharma next to big tech. These are two sectors that really show how monopoly power and monopoly capitalism today is working out for some and not for the many. So, yeah, this really fits well in our series on monopoly capitalism. So back to you, Sarah.

Rodrigo Fernandez

hour, and we finish at: 05:00

Nick Dearden

Yes.

Sara Murawski

So we're very happy to have with us Nick Deirden. He's an activist, a campaigner for over 20 years, working on issues on corporate globalization. He is the director of the british NGO Global justice now. And last October, yeah, this book came out at Verso called the pharmaceutical industry, pharma nomics, how Big Pharma destroys global health. And so, as we were discussing before, yeah, Nick has been working on a campaign on big pharma for some years. So maybe it would also be good to dig into that a little bit. But before we go there, I would like to go straight to the book and to the content. So there's many issues you describe in this book, but if we would like to get more familiar with what pharmonomics is about, I thought a good entry point would be to discuss what you also label as financialization. And so in your book, you emphasize that there are three parts to corporate financialization that are relevant for the pharmaceutical sector. So the first one is maximizing shareholder value or maximizing payouts to shareholders. The second involves growing debt and cash holdings by these firms, and the third revolves around intangible assets. So my question basically is, could you guide us through these different components and tell us what this business model, this financialized business model looks like?

Nick Dearden

ery, very clearly. So between: 2020

Rodrigo Fernandez

Yeah. So about this intellectual property business model, could you elaborate a bit more on that also? How does it indeed imply consequences for society? What are we experiencing that respect, and why is it so problematic, you think?

Nick Dearden

Well, patents and intellectual property in general is very interesting, isn't it? Because we've been told for the last 40 years, everything's about free markets and perfect competition and so on. And of course, we know, we've discovered throughout your crash course series, that's not really the case at all. But patents, it's really obviously not the case. What patents do is they give individual corporations complete monopolies over the production of certain medicines. And the logic behind that is, well, it's very costly to produce a medicine. If you simply allow somebody else to begin producing it on day one, you're never going to be able to recoup the money that you've made from that investment, and therefore you will disincentivize the creation of new medicines. But actually, what we found is, as patents have become stronger and stronger, tighter and tighter, more and more stringent over the last 40 years, and that's one of the big developments that's happened in the neoliberal period, that patents have become more and more enforceable, more widespread, deeper, more extensive. Actually, it hasn't bolstered innovation at all. And I think what I try and do is trace why that's the case. And essentially why it's the case is the pharmaceutical industry has become addicted to making absolutely sky high profits through this financialization process. And it's recognized that patents are the number one aspect of its business model that allows them to do that. And so if you're really interested in maximizing the amount of money you're making out of your patents, then what you need to be thinking about is not, am I employing really great researchers and medical experts? It's, am I employing really great lawyers and lobbyists? Because it's the lawyers and lobbyists that are going to enforce your patent rights and ensure that your patents are even more enforceable and even stronger in the future. And so that's what the pharmaceutical industry has spent the last 40 years doing. And it's actually degraded its research and development capacity. It's degraded its productive capacity in order to put as much as it possibly can into maxing out patents. And the consequences of that are really quite stark. So most of us think, and this is a story that's been woven by the big pharma industry for many years now to ward off regulation and so on. Well, okay, we might have problems with the way the pharmaceutical industry makes its money. We might not think they're very nice. We may think they're pretty greedy and their medicines are expensive, but at least we have medicines, because you imagine a world without medicines. And that's very frightening. It's frightening to me. And so they've kind of told us this story, well, you have to put up with all of this, because at the end of the day, we make your medicines. But actually, the more they've told that story and the more they've become dependent on financial markets and on intellectual property, the less they've made our medicines. And what I discovered is these aren't really medical research institutions anymore. And that's a product of this reliance on patents. It's a product of this reliance on financial market. They actually behave more like hedge funds.

Sara Murawski

Now, if I just can come in briefly just to summarize how I understand also your book and other research is that large pharmaceutical firms used to do research, bring out new drugs and so on. And now, increasingly, they buy up intellectual property from other firms. So it's through mergers and acquisitions, taking on debt, and then growing through mergers and acquisitions. And so they are appropriating intellectual property, often created by public money, public institutions. And they are the ones with their connections and their market power that are able to convert it into power into money, so they can monetize it through their specific connections they have. What would be a long term consequence of this? Because what we're seeing is that the ones who used to fill the pipelines of research and development and new drugs used to be these large pharmaceutical firms. But now, yeah, that is drying up. They're buying up these princes all around them that have promising new drugs. Where are the new drugs coming from? And is there a need for new drugs?

Nick Dearden

tibiotic apocalypse, where by: 2050

Rodrigo Fernandez

Yeah, maybe let's zoom in a little bit on something that we all experienced recently, the pandemic, which was, I think, also very blatantly an example of public investments, expenditures and private gains. Right? So there we witnessed how the pharmaceutical sector, and mainly, like the big four greatly benefited from the pandemic, both financially, so huge profits, but also in terms of reputation. Right? They were all of a sudden, like the great heroes of the pandemic. Whereas, as you also rightly state, they had hardly invested in vaccines to fight epidemics like these in the preceding years. And most actually, of the COVID vaccines, or Covid like vaccines, were developed so swiftly because of the huge amount of public money that was spent on former research. Right? Yeah, maybe also more from a campaigner perspective. So how did this narrative shift? Because I think a lot of people are quite concerned about the power of big pharma, and they know this is going on. A lot of people know how the IP issue works. But still, with the pandemic, all of a sudden, it was like, oh, amazing. And they did it so fast, and they're the new heroes, right? So how did this happen? And then a follow up question would be, did governments learn anything from this situation? Do you see any change in their policy regarding how they relate to big pharma? But also, championing big pharma as the big winners of the pandemic, I think, has also very bad consequences for how people perceive big pharma very much.

Nick Dearden

pened at all. I mean, back in: 2018

Sara Murawski

But the EU was equally adamant in protecting IP rights.

Nick Dearden

The EU was worse. Yeah, the EU was worse. I mean, the worst countries in the world were Britain and Germany and Switzerland and Norway. Not very good either. They were the worst.

Sara Murawski

But would you say this episode that, well, clearly showed the defects of the IP regime and how unfair it is and how it clearly doesn't work for the majority of the planet? Didn't we already see this with the HIV crisis? But that wasn't a sufficient wake up call somehow.

Rodrigo Fernandez

Yeah.

Nick Dearden

So it's interesting, isn't it? I mean, HIV, the HIV crisis actually happened at the very beginning of the current intellectual property regime. So I should explain, intellectual property is not something that I think most people think of as a trade issue. Right. It's not about me selling you goods and you selling me goods, but actually, because when the WTO was founded in the mid 90s, effectively, trade rules became way more than we used to think about as trade free trade issues, and they came to incorporate so much of the rules that underlie the global economy. And the industries like Pharma argued very hard. The WTO needs to oversee and enforce intellectual property rules and do that everywhere in the world. Everywhere in the world needs to have the same level of intellectual property as the United States. Now, that was crazy at the time. I mean, I can't.

Rodrigo Fernandez

It's.

Nick Dearden

It's hard to explain how big a change that was, because until the late 70s, many european countries didn't put intellectual property on medicines. It was just not the done thing. It was not considered. I mean, my own country did it fairly early after the second world war. But even so, in the 60s, when governments couldn't get antibiotics at a price they could afford, they overrode those patents and bought them from Italy, which didn't have intellectual property on medicines. Right. So the idea in the mid 90s that most developing countries should put intellectual property provisions onto medicines was quite crazy. But it happened. They got it through the WTO, and this was a big thing. Sorry.

Sara Murawski

And just to be clear, it only becomes powerful as a global legal infrastructure if it applies to all countries, if there's no way out of it. Because if just a few countries have bilaterally agreed to do this, you can go through another country. But if the global trade system is organized for all in such a way, you can never go around it.

Nick Dearden

That's right, it is. And one of the particularly problematic things they tried to do was to stop countries importing. This didn't all come in one go. In fact, for the lowest income countries in the world, they're still not bound by these rules. But that's a problem in itself, because many low income countries can't really will struggle to make some stuff, although not all of it. Bangladesh has a good pharmaceutical industry, but what they would say to the next level of countries up is you can't import that stuff. So you have to abide by western intellectual property standards. If you're Brazil, Colombia, South Africa. And South Africa was the real problem, because South Africa in the early two thousand s, of course, HIV was horrific, the way that it was tearing through society, and it was a death sentence for people, despite the fact that by that point, we had drugs here in the west that you could take that would indefinitely extend your life and prevent you passing HIV on to your unborn child. So we had that in the west. But you were talking about, it was $10,000 a patient for a course. I mean, that was completely unaffordable. Nobody could afford that in South Africa. So what the south african government did was say, okay, maybe we need a bit of wriggle room on these intellectual property laws. Let's give ourselves the right to import where we can't make this stuff ourselves, but we can get it much cheaper from overseas. Let's do that. And they knew that in India by that time, you could make these HIV pills for a dollar a pill. So they said, we can import this and we can treat people. And as soon as they did that, 39 pharmaceutical corporations slapped a lawsuit on them, accused them of piracy for stealing their intellectual property, and they took the ANC government to court. Now, they backed down eventually in the face of enormous public opposition, as you can imagine. But it sent a chilling effect, I think, through the rest of the world because people were like, well, that's a bit dangerous. We don't want that to happen. So the bullying, and that bullying, by the way, was helped by the US government and by the European Commission as well. That bullying sent a real chilling effect down the spine of countries around the world. And it's one reason, I think, that countries have been extremely reticent to create their own pharmaceutical industries.

Sara Murawski

Maybe this would be a good moment, Sara, for you to come in with some questions on IP protection.

Rodrigo Fernandez

Trade for sure. I mean, I've been working on trade investment forever and unfortunately it's a very underestimated topic. Maybe we should do a crash course on it one day because there's so much enshrined in trade and investment treaties. But yeah, no, I'm wondering about what you're saying about the US being concerned now. There might be some cracks in the system because a lot of vaccines in the global south came from China, right? But that's more, of course a geopolitical argument rather than anything that has to do with morality, solidarity or what have you not. But I noticed that there were a lot of campaigns also, and still ongoing during the pandemic, had to waive the trips thing. And I think not all of them were successful. But can you point to some successes and ongoing campaigns and where do you see the next wins? Because indeed there's a whole geopolitical role about a lot of things in the world. Critical raw materials, but also IP. But of course, in the end, the goal should be that everyone has access to medicines, right? Because we all have a right to health, how to ensure that? And what kind of legal steps can we envision in the next years to change the regime, actually, for example, indeed, when it comes to trade and investment rules, but also the possibility of suing countries if they just want to fulfill basic human rights.

Nick Dearden

Absolutely. So, look, the main thing we were campaigning for in the pandemic was a waiver of intellectual property on Covid vaccines and medicines and diagnostics for the length of the pandemic. So it was a fairly reasonable and limited.

Rodrigo Fernandez

Could you say what a waiver is, just in case?

Nick Dearden

Yeah, a waiver would be that the intellectual property provisions at the WTO don't apply. So if a government decides we can make this, and we want to make it, they can get on with it, and they don't have to worry about being sued or lengthy negotiations with the patent holder. Now, that never got passed, and I think there are mean, there was a very watered down version of it that got passed extremely late, but it wasn't what we were demanding. And I think there were lessons in there for campaigning on these kind of global trade rules. But I don't think that means it was a failure, because what I think it did, what I think the campaign did, was to give a kind of umbrella of resistance to all sorts of governments and social movements around the world who thought, we really need to do things differently. And there's something really interesting about the pandemic, which is actually, by the end of the pandemic, how many countries have made their own vaccine? There was quite a few, actually, that have made effective vaccines from Cuba to Vietnam to Thailand to South Africa. That's new, that's really new. And South Africa went one step further. South Africa said, we need to know how this mrna thing works, because it's not just about COVID MRNA is potentially a revolutionary vaccine platform that could be used to inoculate against HIV, against malaria, against tb, against certain types of cancer. This cannot just be the property of a small handful of companies. They asked Pfizer and Moderna to help. Actually, Pfizer and Moderna, surprisingly did not help, but they just said, with backing from the World Health Organization, we're going to do this anyway. And they cracked it. They worked out how they could make one. They weren't able to bring it online before the pandemic ended, but they're now working on a tb vaccine, I think, at the mrna hub in Cape Town. But then they also said, we're going to do something really radical here. This is not something we own. We will share the know how with all governments and producers that we think can produce this thing safely. And there are twelve governments they've already shared this information with. They've come over and learned how to do it. Including Brazil, including Argentina, including India. So this is big stuff. This is research and development potential, which has been stymied, I would argue, by intellectual property provisions at the WTO for years and years and years, which is just kind of starting to happen. I mean, they're just kind of behaving like it doesn't exist. And I think that's really exciting. And I think the wake up call to governments, even if they're not doing research and development, the wake up call to governments around manufacturing was also know. So there are all sorts of experiments with factories being opened in many countries. In Egypt, I mean, China helped Egypt open some factories to produce its vaccine and said, we'll transfer the knowledge to. So that's really exciting. But I do think there is something that goes beyond solidarity, which is also changing in the United States, which also helps make this possible, which is the United States. For domestic reasons, the pharma industry is hating the United States because they've been able to charge whatever they want for their medicines for the longest period of.

Rodrigo Fernandez

Time and get away with people also. Right?

Nick Dearden

And of course, within the last few years, this awful opioid scandal, people who haven't seen painkiller, it's a hard watch, but it's well worth understanding just how deep this has gone into the american psyche. And I think that has taken hold through the Bernie Sanders campaign, through into the Biden administration. Big pharma has kind of become enemy number one, and they are not interested in protecting the rights of this industry anymore. I'm not saying they're going to radically transform the industry at a global level. But the United States traditionally has been one of the leading defenders of intellectual property and the pharmaceutical industry at a global level. And it is not at this moment in time playing that role. And that gives space for us as campaigners to push around the world governments to take that leap into creating their own research and development and their own industry and running those industries in radically different ways to the way that we see it being run at a global level.

Rodrigo Fernandez

And what about the EU? Because you said the main problematic countries are based here, like UK, Germany, some Nordics. Do you see any change here happening?

Nick Dearden

There is change, but it's very hypocritical. So there is change happening in terms of how it affects us at the EU. The UK, I would say, is not massively interested, although even in the UK, I mean, we've just been renegotiating the price that the National Health service pays big pharmaceutical companies for their products. And even there, the UK government was pushing back on what big pharma wanted. But at the EU, there's lots and lots of talk. There's been lots of talk in the parliament, european parliament, there's been lots of talk in the commission about how we deal with the fact, a, of another pandemic and b, of the fact there are now big medicine shortages around Europe. So something about this system is not working. And also a recognition that even if we get some big breakthrough in coming years, our health systems, frankly, even our very well funded health systems, are not likely to be able to afford very many of the medicines that come from that. So it's a kind of a recognition, even at a very high level, that something needs to change here. So there's been discussion, know, even in France, they've been talking about public manufacturing, more public elements to the industry. They've been talking about how they override patents, compulsory licensing, it's called. I mean, this is always a right of countries, but it's a right that the EU has not tended to use and certainly not encourage other people to use. So they're now saying, well, actually, no, we need to consider this. This may be necessary. And I think this is all part of the change in discourse around global economics, away from the idea of ever longer supply chains, ever more free markets. Let the market do its work and everything good will come to you. That's changing. And there is a recognition of the need for state intervention, for state planning. Now, what that looks like is still up in the air and there's a huge debate to be had around it, but there is a recognition of that. The problem with the EU at the moment, I think, is that it is still, and the UK and even the US, it is still blocking the demands of southern countries at the WTO for a relaxation of intellectual property rules.

Sara Murawski

that they were erected in the: 1950

Rodrigo Fernandez

Just very briefly in between. Sorry, Nick, if anyone else has a question, because we're sort of going to wrap up from Rodrigo and me, please put your question in the Q A tab. We already have one question there, but we could have some more.

Nick Dearden

Nick, thanks. So Marianne Masacardo, as you know, is very keen on this idea that she wants to dispel this myth that innovation and creativity comes from the private sector. Mean, her argument is, basically, it doesn't. It comes from large amounts of public sector money and strong objectives, or missions, as she calls them, which the public sector sets. And so she thinks pharmaceuticals are an amazing example of quite how bad the private sector is when it comes to innovation and creativity. The most risky parts of almost all drugs that are invented is done by the public sector. So her argument is, and particularly, and I think this is really going with the grain of the times, economic thinking of the times at the moment. Her argument is, if we want cutting edge drugs of tomorrow, we've got to set some missions to create those drugs. We've got to put the money behind it, but we've also got to put a regulatory system in place that means that any resulting intellectual property cannot simply be privatized, and we allow a bunch of investors to essentially max out what they can make on it. There needs to be a completely different way of doing this. And so we wrote this report for what that could look like, a government coming to power. What kind of a framework could they set to do this? And sure, it might cost them more in terms of the public money they need to put in the first place, but at the end of the day, they wouldn't be paying twice for things, because they would then be able to put conditions upon any drugs that came out of that research so that it wasn't simply possible for someone to walk away with the intellectual property and charge whatever the market will bear for the next 20 years for it. So it's an appealing case, I think, for decision makers. I would also argue, and there's some of it in there, there needs to be public options, like you were just talking. I mean, our government did the same with vaccine manufacturing. It privatized the vaccine manufacturing facility that we'd finally got ready by the end of the pandemic to privatized it. It's now sitting mothballed. A private investor has taken it over. They're not really interested in making vaccines. It seems they're interested in seeing what they can get on the market by selling it or taking it apart. I don't know what they're doing with it, but anyway, it's not doing anything.

Sara Murawski

This is crazy because doesn't this also go a bit to the heart of the problem of monopoly power, that there's many problems involved with monopoly power. Prices, productivity declines. But, yeah, it contradicts with democracy and the democratic decision making. And it leads to state capture eventually, large corporations setting their own rules. So isn't this the terrain where the problem lies, that these are such a big corporations that they basically set their own rules? And, yeah, it is very hard in that structure to change anything.

Nick Dearden

It is hard. I'm not saying it's easy, but that's why I do think we need the public option in there, because otherwise you are reliant. Look, what we found with COVID was all these companies, like I said at the beginning, had kind of degraded their productive capacity because there wasn't enough money made in factories just pumping this stuff out, and yet we put nothing else in place to replace them. Decision makers still kind of believed their own rhetoric that the market would provide, even though we could see they were scaling back their productive capacity and their research and development and whatever research and development we did put money in to mean that there was still stuff in the pipeline, but when it came to manufacturing, we did very, very little. And so what that meant was we were dependent on them. They had us over a barrel, essentially, when the pandemic started. We can't let that happen again and again. I'm actually going to look to the United States of somewhere. I think there's something quite positive happening. Insulin. I mean, the problem with insulin is partly intellectual property, but it's a bit more complicated than that. But anyway, there are huge monopolies on insulin, despite the fact it's been around for more than 100 years, which means that most Americans can't, who need insulin, struggle to afford it and have to ration, which at great cost to their health and possibly even their lives. California has now said, to hell with this. We just need to produce this stuff at cost. And they've put 100 billion on the table and they've said, we're going to get a nonprofit to manufacture this stuff. I think it should have been completely public. But anyway, they've gone with a nonprofit company which is manufacturing this stuff. Seven other states in the US have now said they're going to do the same. This is the heart of free market capitalism, where they're essentially saying, we're going to have at cost production of medicines, paid for by the public, available for anyone who needs it. I think that represents an enormous change, and I think it's something we've all got to learn from and there's some real hope there and some stuff, I think, to get stuck into in terms of campaigning for a better system.

Rodrigo Fernandez

So before we go to the audience, we also have a question from Jenny from our team, and she's asking whether there's a role for antitrust legislation at the moment. So we're also going to discuss these things in the next episode. But would it make sense, you think, to break companies up? Is that feasible, let's say, in the next, well, five years? I guess the EU needs to decide upon that, right?

Nick Dearden

It absolutely is, and I think there is some appetite for it. Again, you see a bit more appetite in the US for this, where, of course, the focus everywhere is on tech and the size and power of the tech companies. But Pharma, two, there have been recent mergers and acquisition that have been halted or under investigation in the United States. And that's really important. I mean, these companies have been getting more and more and more powerful and bigger and bigger and bigger since the second World War. Really. It was after the second World War that they managed to bring together lots of different bits of the production chain. So that right from research and development through to selling the pills, you had one company sitting on that. And of course, in the age of neoliberalism, those mergers and acquisitions just got greater and greater and greater. And again, of course, that means that the power these corporations hold over society isn't just about the fact that they have monopoly rights to produce a specific medicine. It is the fact that there are not very many of these companies left anymore. I mean, they are bigger and bigger, huger and huger companies. And so when they make a decision about actually it's not profitable to be in vaccines anymore, that's a huge problem because you don't have anybody else who's saying, well, don't worry about it. We can make those. We are dependent on it. So I absolutely think antitrust law is a really important part of this equation.

Sara Murawski

Maybe we can go to a question by a participant. It's named Kada. I don't know exactly if it's an organization or a person, but the question reads, how do we campaign effectively to resist big pharma without any wins being co opted by the far right?

Rodrigo Fernandez

And maybe you can take into account european elections coming up.

Sara Murawski

Yeah, and german elections and many us.

Rodrigo Fernandez

And many, and many and many election disaster year.

Nick Dearden

It's a really good question. And I don't know if part of that question also refers to some of the conspiracy theories around medicines, vaccines and so on. Yeah, because yes, it does.

Sara Murawski

He or she.

Nick Dearden

So that was a huge problem, right? We were campaigning on this through the pandemic, and I remember going on kind of an online protest, and we had a real protest, and I remember being cheered on by some people who were vaccine skeptics. And then they kind of realized what we were calling for, and they were like, oh, no, they're pro vaccine there. We don't like them. It got very confusing. And I think for many people, we're talking about why the pharmaceutical industry structurally works in this way. And of course, anybody who is inclined towards conspiracy theories can use that to make up a story about how this company is run by, I don't know, lizards or paedophiles or whatever who are trying to poison us. One of my arguments around all of this, actually, is the whole structure of the industry does not help at all in terms of our ability to convince people that many of these vaccines are a good thing. The structure creates conspiracies almost. It certainly creates a lot of suspicion, and I think quite rightly so. Actually, one of the, for me, part of this campaign is precisely about saying this is science, technology, and medical innovation, which is too important to be left to enormous monopolies to profiteer off and to profit from. You said, rodrigo earlier, that so much of this is actually about democracy when it comes down to it. And I think that's exactly right in this country. And I guess it's worked in a similar way throughout other european countries, too. After the second world war, there was a huge movement and a big argument around whether you live or die when you're ill, whether you get treated and how you get treated should not be dependent on the money in your pocket. It should not be dependent on how wealthy or poor you are. And we created the national health system, and most people in Britain still believe the national Health Service is probably the pinnacle of what a civilized government has ever done in this country. And despite all attempts to privatize it, they've not quite been able to take it off us. I think those kind of arguments where you bring down. So what I say now is taken for granted, that nurses and doctors and whatever, they don't work for us personally, depending on how much you pay them, the treatment you get is what you need. Why is it that we accept that, but we seem to think it's okay that the medicines that are administered in those hospitals are created in the most cutthroat, capitalist way you can possibly imagine? It doesn't make sense. So how can you make a kind of democratic argument, and I think that's beginning to happen from what I've seen in the EU as well. So I know there's a conference coming up in a couple of months time around public pharmaceuticals in the EU where know experts, academics, health practitioners, I mean, the things being run by some doctors, I think are saying we need to make medicines democratically in the public interest. And for me, that is okay. It is clearly a stronger argument where there's a case of a medicine you can't get hold of because of this particular intellectual property over here. But I think there are stronger long term arguments that we can make that say the medicine system that we need and that we want and that we can create is part and parcel of building a democratic culture.

Sara Murawski

Would you say that basically it has gone too far? This pharmaceutical system is not working? It wasn't working for a long time for the global south. But now, increasingly, as we are seeing the consequences for the global north, that we are seeing these spaces of hope emerging, of changes in the global north, but also in the global south. You were mentioning new production and trade facilities being set up by South Africa, Argentina and so on. So is it basically that the system went too far and this is creating these changes?

Nick Dearden

Well, it's eaten itself. I mean, I think it's true of a lot of capitalism. Capitalism is eaten itself, Corey would call it institution. Right, exactly. I think there's a recognition of that amongst even some people who quite like the mean. I read the Financial Times. I think it's really interesting paper to know what investors are thinking and so on. But there's an editorial line in the Financial Times for the last few years now, which is kind of like what I would call an enlightened capitalism, that actually. Yeah, it's gone too far. And if you simply allow these individual capitalists to do anything they want, the whole system is coming down. So for them, there is a reason for a government being able to take a step back and say, in the interests of the whole system, we need to regulate this in a different way. Now, we may not want that system at all. We may want a fundamentally different system, but clearly the fact that argument is happening gives us a space to begin arguing for that. And I think with pharmaceuticals, you have some really surprising people. I mean, we've got somebody in the UK called Jim O'Neill. He used to work for Goldman Sachs. He was a big wig at Goldman Sachs. He coined the term bricks.

Sara Murawski

Yeah, right.

Nick Dearden

And he's in the british parliament and he was a conservative. I mean, he's not anymore. But he was a Conservative sitting in our house of Lords, and he was trying to get antibiotic research done in big pharma, and he put this incentive framework into place, and blah, blah, blah. Five years later, he comes back, what have you done? And he knows they've done nothing. And he says, I don't believe a word you people say. Frankly, I think part of this industry should just be nationalized. That's someone on the center right of the political spectrum. Simply recognizing this does not work for how we want society to be in 20, 30, 40 years time. So I think there are interesting alliances. I think there are interesting ways of convincing people that we need really quite big change here.

Rodrigo Fernandez

And that also means that you can sort of operate around the WTO, or do we really need to tear down the WTO before we can actually make this happen?

Nick Dearden

I think this is a great question, and I think it's something we as campaigners need to think more about. My experience of the people's vaccine campaign in the pandemic is that it is going to be very, very hard to get agreement at the WTO to rip up deals that were made in the mid to late 90s. It was great. We were trying to stop these deals happening in the first place. I think that's what those of us old enough who remember fighting against globalization when it was being constructed. We needed to stop some of this stuff happening. We did stop some of it happening. We didn't stop all of it happening by a very large margin. I don't think globalization is going to be untangled simply by going back to those forums and trying to pressure governments there to untangle them. There are too many vested interests, and I think it is going to be untangled by people simply doing things differently at a national level, first of all. But hopefully, as much as possible in the South Africa model, cooperating, and particularly, I think, southern countries cooperating because they have very little to lose in terms of cooperating around medical research, development, and manufacturing in the way South Africa is doing. I think that's going to be absolutely vital. So regional cooperation and South south cooperation, I think, is going to be an absolutely vital way to overcome the rule of the WTO and its agreements.

Sara Murawski

I think we need to wrap up. Sharon.

Rodrigo Fernandez

Yeah, well, there's one more question in the Q A, so maybe, Nick, if you can answer it within a minute, then we can still do it. The question is from Miguel Vandenbedem. What kind of reaction could one expect from pharmaceutical lawyers if a nonprofit organization would go to court to condemn a certain pharmaceutical company for taking too much profit on the medicine for a rare disease causing the loss of budget for national healthcare?

Nick Dearden

Well, that's a great question. And there is a case at the moment in the Netherlands, I believe, which has been brought by a nonprofit over the drug homeera. It's an anti inflammatory, one of the most expensive drugs in the world. Like, just ludicrous amounts of money it costs, and most health systems have to ration it. And they are taking a case to say, you have profiteered off public insurance money. So we'll see what happens. And I think there are some guys in Belgium doing the same thing. We haven't tried it here, but I think it's a great idea.

Rodrigo Fernandez

at: 04:00

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