Every once in a while, as a student at Yale, you look around and realize the astounding power and prestige of the University around you. The announcement of a promising AIDS vaccine being developed here is just that kind of moment. An effective AIDS vaccine would change the world.
It would also earn Yale colossal amounts of money, and an enormous responsibility. If the vaccine works, how will we ensure that it is available to all who need it? Should Yale profit from it? How much, and at what cost?
Once upon a time, universities considered it unseemly and contrary to the public good to patent innovations like vaccines. Patents are government-granted monopolies, and as such, they allow holders to charge high prices, ostensibly to get sufficient return to make good on their original investment. But when is enough profit enough? What happens when profit and access to essential medicines and vaccines conflict?
Yale’s experience with its AIDS drug, d4T, should guide us as we think about the potential uses and abuses of an AIDS vaccine. Yale patented d4T widely, not only in the United States but also abroad in countries like South Africa. The drug was licensed to Bristol-Myers Squibb, which agreed to test it, bring it to the market, and give Yale a share of the profits.
Access to the results of the research were apparently not a priority in the negotiations. Last year, the humanitarian organization Medicins Sans Frontieres sent a letter to Yale requesting that it give up its patent in South Africa, because it was preventing generic manufacturers from selling d4T there. Generic companies were offering d4T at three percent of the cost of the version sold by Bristol Myers Squibb. Bristol-Myers was taking advantage of their monopoly, at the expense of more than four million South Africans living with HIV and AIDS. Challenged by MSF to remedy the situation, Yale struck a private deal with Bristol-Myers, and announced that patents would no longer be a barrier to d4T in South Africa.
Yet, today there is still no generic d4T being sold in South Africa. Why? Bristol-Myers has dragged its feet, and Yale, unfortunately, has allowed them to. The pharmaceutical giant has just recently granted permission to one, and only one, company to produce generic d4T, but until there are a number of firms producing generic versions, competition will not drive down the drug’s prices. The truth of the matter is that Yale’s patent is still standing in the way of access in South Africa.
We can learn a number of lessons from this experience. First, the Yale community must remember that ensuring access to Yale-invented medicines is our problem to solve, not someone else’s. The University should act now to develop a detailed patenting and licensing policy based on the principle that medication is not a privilege, but a human right.
Second, Yale should not file patents in countries that cannot pay high monopoly prices for essential drugs. Profits can be recouped in wealthy markets — that is where most sales are, anyway. Africa represents less than two percent of the world’s pharmaceutical market.
Third, the University should be transparent about the development and licensing of drugs. In order to have an informed discussion about adequately compensating investments while still making drugs accessible, students and faculty need to know the costs of drug development and production.
Finally, when Yale enters into agreements with companies, it should require fair pricing for essential medicines, and retain the right to take unilateral action if they determine that a public health need is not being met.
Yale has the honor of developing medicines to treat and prevent diseases like AIDS. But technologies themselves are of little use to the world if they remain unavailable to the people who need them most.
Amy Kapczynski is a second-year student at Yale Law School.