A crippled healthcare system

The writer is a Karachi-based freelance journalist.

The recent novel coronavirus has exposed the fault lines in the healthcare system around the globe. It has unmasked the ugly face of the big money-hungry pharma monsters. Even states that spend a huge amount on healthcare failed to tide over the crisis.

For instance, the United States spends more on healthcare as compared to other wealthy countries but even then the number of fatalities is higher in the second-largest democracy than anywhere else in the world. It seems that the exorbitant amount the US government allocates for health does not benefit its citizens in a true sense but a cabal of insurance and pharmaceutical companies is a real beneficiary.

Member countries of the Organisation of Economic Co-operation and Development (OECD) spend on average 8.8 percent of its GDP on healthcare whereas the United States spends around 18 percent of its GDP on healthcare as of 2020. Healthcare spending depends on utilization and price. The US has the lowest utilization rates and highest prices. Currently, the US is spending $10,600 per person in healthcare, whereas Switzerland spends $7,300 per person and all the other member OECD countries spend $5,300 on average. If the government is spending the highest amount per person then the overall situation should have been very stable but that does not seem to be the case.

Donald Trump rolled back the Affordable Care Act that allowed many junk insurance plans to flood the market. They all look cheap to pay for and one might think that it is better to have something instead of no coverage at all. In reality, these junk plans not only crush people under huge out of pocket bills but also do not cover the pre-existing conditions. So first, the insurance company will check people's previous three years of medical data to see if they had these symptoms before opting for the plan. It is a two-way fraud with people, first with expensive unaffordable medical and then with the junk insurance.

The US has the lowest utilization rate in healthcare. The main reason for this lower rate is the affordability of healthcare. Due to the current conditions, 26 percent of women against 19 percent of men delayed or went without care owing to long waiting times. Around 20 percent of women against 15 percent of men did not access the recommended test due to high cost. According to Ishani Ganguli, assistant professor at Harvard University, 46 percent of the adults didn’t pay a single visit to the primary care provider for a year.

Despite spending a phenomenal amount on health, the US healthcare system is not capable of providing an adequate number of beds in time of need. According to statistics from the World Health Organisation, the US has 2.5 beds available per 1,000 people, Germany has more than 8 and Japan has more than 13 beds per 1,000 people. Healthcare was a major problem even before the coronavirus. The US has the highest mortality rate as compared to Germany and Japan. The reason for comparing the US with Germany and Japan is that these countries are believed to have the best healthcare system in the world. It is no secret that Germany handled the situation far better than the US. Not only was the government honest with its people, it also took timely decisions besides but assuring equal services to everyone.

There are concerns about the availability of corona vaccines, if it is at all developed, at an affordable price for everyone. According to figures by the World Health Organisation, the vaccine market witnessed explosive growth during the past decade. By the year 2025, the global vaccine market will reach $100 billion mark. However, the pharmaceutical market seems to be an oligopoly. GSK, Sanofi, Merck, and Pfizer hold 85 percent of the total market share. These giants have the power to dictate the whole international market. Merck’s vaccine business generated around $8.4 billion in revenues for the year 2019 and the figures for other corporations are not very different. These companies make a profit on the research of other institutes and then patent those drugs for decades in their brands and make billion of dollars per year from them.

Internationally most of the research is state-funded, different institutes and universities work together to produce a vaccine but if they succeed in making one they can’t produce the drug in mass quantity. The big pharma companies spend more money on marketing then they do in the research. These pharma companies only research chronic conditions that are longer in nature and where they expect their drug to keep selling for years. Research for SARS, which was also a coronavirus, was given up after the virus disappeared because there was no future market for the drug to be sold. If that research were kept alive, today we would have had crucial information to develop the vaccine for Covid-19.

To control this situation, the Coalition of Epidemic Preparedness Innovations (CEPI) was founded. The objective of the CEPI was to research on drugs and vaccines. According to reports when the CEPI reached out to the pharma companies, they had to sign a contract without profit sharing on the drug and had to give up proprietary rights to the company as well. When the swine flu attacked the US in 1976, infecting 45 million Americans, pharma companies didn’t show any willingness to sell the drug to the government until full liability indemnity and guaranteed profit were signed by the government. As a result, pharma companies made millions but the US government suffered financially because the side effects of the drug attracted so many lawsuits that the Department of Justice had to appoint 10 attorneys just to defend those cases. According to estimates, those lawsuits ultimately cost $100 million to the US government.

In a way, the entire humanity is hostage to these four pharma companies. They have the means to produce any vaccine or drug on a large scale and governments are dependent on them. Even all the medical curriculum in the US comes from these pharma companies. The pharma industry requires strict regulations and legislation. Healthcare is a fundamental right of every person and these pharma companies do not have the right to sell drugs that they produced on the research funded by taxpayer’s money and at a price that they choose. The US government spends around $800 per person on the administrative cost, which is five times higher than what other countries are spending. This means there is some serious inefficiency in the system. Instead of spending billions on nuclear arsenal and weapons, attention must be given to the healthcare system and practical steps should be taken against the pharma mafia for the benefit of humanity.

The specter of more pandemics is still haunting mankind. Even if we manage to tide over the current crisis of corona, there is no guarantee that such outbreaks do not hit us in the future. Therefore, the welfare of the people must be kept above the profit of the companies. Not only the US but other states of the civilised world should also come forward making strict regulations to rein in profit-hungry companies.

Many critics have suggested putting the control of future vaccines into the hands of the WHO that should be responsible to provide such vaccines to all countries at affordable rates or free for the poorest states. It is time we gave serious consideration to such suggestions to curtail the influence of the big pharma companies. The US, being the most influential country, should take the lead.

Email: sfahad9064@gmail.com