Every time that the world faces a major epidemic outbreak, we are reminded of how ill-prepared we are to effectively deal with the emergence of new infectious diseases. This is despite the fact that we know that another epidemic is inevitable. And yet we are unable to ensure adequate availability and access to vaccines, diagnostics, and treatments. Just like the West-African Ebola epidemic in 2014-16, the covid-19 pandemic is triggering multiple critical reviews of the global response, and proposals for reform are being debated in different policy fora.

The research and development (R&D) ecosystem forms an integral part of any pandemic response and its current fragmentation and limitations have come under close scrutiny, with calls for a ongoing, coordinated system, and more sustainable financing for end-to-end global health R&D. A critical aspect missing from these debates, however, is the importance of industrial policy in steering pandemic response R&D. In today’s global economy, the rules and incentives governing the pharmaceutical industry are not designed to respond to critical health needs. Instead, they aim at delivering financial and economic gains through developing and selling medical technologies. 

The development of several effective covid-19 vaccines in just a year is a testimony to our global scientific and technological capabilities. It shows what is possible when political will exists and (public) resources are made available. However, the stark inequalities in access to these vaccines are leaving large parts of the world exposed to the risk of covid-19 and the resulting health, economic, and societal consequences. These inequalities are fuelled by a combination of private sector control over the intellectual property rights and industrial capabilities, together with vaccine nationalism by wealthy governments who are buying up the majority of doses. Our failure to translate technological progress into an effective global health response to the pandemic and protect the most vulnerable everywhere is not only a moral failure, as WHO Director-General Dr Tedros points out, but also a colossal failure of our industrial policies to respond to the most important challenge of our time. 

Pandemic preparedness and response requires R&D to deliver critical health technologies such as diagnostics, treatments, and vaccines, and the global pharmaceutical industry clearly has a key role to play. However, for an end-to-end R&D ecosystem to effectively produce pandemic countermeasures that are available to all, it must incorporate rules and policies to deliberately govern the collaboration between public and private sectors. This must cover incentives and financing, and clarify roles, responsibilities, and liabilities. Critically, we must design a pharmaceutical R&D ecosystem that is symbiotic and not parasitic in terms of how risks and rewards are shared across the world. It must be fit-for-purpose to deliver global equitable access, rather than taking a business-as-usual approach to health innovation in which global corporations develop and sell proprietary products destined for wealthy country markets, leaving the rest of the world dependent on the goodwill of donors, development assistance, and charity to eventually gain access to those life-saving health technologies.

For too long the world has accepted economic and industrial policies that are blind to our collective health needs. Financial gains have prevailed over people’s health and profit prospects dictated which health technologies are developed and made available where, exacerbating existing health inequalities.

If the covid-19 pandemic taught us one thing, it is that health and the economy are deeply intertwined. We must adopt people-centred and sustainable economic policies that deliver Health for All. A newly created WHO Council, chaired by one of us (MM), will start examining this soon. Vaccines and other health technologies for pandemic preparedness and response often benefit from generous public R&D support. There is therefore a strong case to be made that these technologies should not be under the control of a handful of private companies, but be considered global health commons, available and accessible to all those needing them. We must redesign the underlying industrial policy to make it work for public health, and take a hard look at intellectual property rules and practices. We must adopt and reward transparency and sharing of know-how, technologies, and platforms for the common good instead of defending monopolies and secrecy. Given the massive public investments into these technologies, we need to foster open science and collective intelligence for pandemic response R&D, not private rent-seeking.

Developing an pharmaceutical R&D ecosystem which effectively addresses critical global health needs is an absolute priority. This will require more than global coordination and sustainable financing. We must redress the rules by which the industry is playing, and shape industrial policy with a clear purpose and mission to work together with public health researchers and institutions to deliver needed health innovation in a timely and equitable way to people globally. At the same time, we need to re-think our collective global health governance so that every region in the world can, and will, contribute according to its capacities and benefit according to its needs, in order to keep us all safe.

Els Torreele, Institute for Innovation and Public Policy, University College London, UK

Michel Kazatchkine, Global Health Center, Graduate Institute for International Affairs and Development, Geneva, Switzerland

Mariana Mazzucato, Institute for Innovation and Public Policy, University College London, UK

Competing interests: none declared