Tamiflu can combat avian flu, but the Swiss company Roche can’t get us more Tamiflu for well over a year. They won’t (can’t?) set up a U.S. manufacturing plant for almost two years. (Face it, in a pinch neither the Swiss nor anyone else will export much Tamiflu, no matter what the previous agreement.) Roche holds a patent on Tamiflu but India will go ahead and produce a generic version; Taiwan has been making similar noises. What should we do? Here is one argument for producing generic tamiflu. Andrew Sullivan concurs.
I suggest a different approach. Let’s offer Roche a large prize for speeding up the construction of the U.S. plant. This can include legal and regulatory waivers (Bush already has suggested this idea). We also make it clear upfront that if a pandemic comes, the U.S. government will purchase Tamiflu doses at a relatively high price. This latter round of payments can be made upfront, with a refund to the government if no pandemic arrives. Ex post, the government distributes the doses for free, with medical workers and key individuals in the supply chain (food, transportation, Typepad) given priority.
Note how avian flu differs from AIDS. AIDS is a relatively slow acting condition and the possibility of disease hangs around for decades. Avian flu, if it becomes a pandemic, will likely come and go in a few waves of a few months each, spread out over a year or two. That makes the case for abrogating property rights weaker. The key question is not price but whether you have a stockpile at all.
We should not focus on avian flu to the exclusion of other emergencies, including bioterrorism. Avian flu is just one possible pandemic of many. If we confiscate property rights this time around, there won’t be a Tamiflu, or its equivalent, next time. We also need to stop taxing our vaccine-producing infrastructure through liability law.
Respecting Tamiflu property rights would supply an international public good as well. Many other countries will confiscate Tamiflu property rights. If the U.S. holds the line, we are subsidizing global R&D and doing a greater service for the world than our critics are willing to admit.
Addendum: The worthier-than-ever Daniel Drezner notes that no country is well prepared for avian flu. Comments, by the way, are open, please stick to the subject at hand.
The question is a valid one, but not for the reasons given IMHO.
The reason people like me have purchased a personal stockpile of Tamiflu is because if the pandemic starts within the next year, the government will not be in any position to give it to us, for free or otherwise. Whether personal stockpiles are a good thing in the larger picture is far more debatable though. Resistance to Tamiflu is already being noted and the more it is used prior to a pandemic, the more likely that situation will grow.
The patent argument of course will look very different if a pandemic starts and Tamiflu is the only medical assistance available. The first person you see writhing in agony as their lungs are shredded by their own immune system, will likely change any view that patents are more important than people.
Is there any danger of providing a huge economic incentive to start an avian flu pandemic to one of the companies that might have the resources to do so? One has to ascribe a completely amoral character to the actions of a company to worry about this, but on bad days I can think this darkly.
It seems to me that Bernard Yomtov above has a point. Why not do both? Carrot and stick? Extend the offers suggested by Tyler to Roche but also ensure that Roche is aware that if they can’t produce enough Tamiflu we’ll find someone who can.
The active ingredient in Tamiflu was discovered in Chinese star anise which is used in Chinese cooking. Go make your own Tamiflu.
The damages are the profits they would have reaped when demand skyrocketed during a crisis.
Not if they lack the capacity to produce enough to cash in, which seems to be at least part of the problem.
It looks to me like what Roche wants is the profits that would accrue to them if they did have the capacity to meet a huge upsurge in demand, but without taking the risk of actually building that capacity. Isn’t one of the “pro-gouging” arguments that the possibility of extraordinary profits creates an incentive to stock inventory, or maintain capacity, in excess of normal requirements? Roche hasn’t done that.
“Let’s offer Roche a large prize for speeding up the construction of the U.S. plant.” Fine, but what if they still refuse, or try earnestly but screw up and can’t deliver? The government may have little choice but to offer them just compensation for their patent and take it, just like real property.
“If we confiscate property rights this time around, there won’t be a Tamiflu, or its equivalent, next time.” That’s a strong statement! Why does Tamiflu exist? I do not believe it is because Roche targeted a windfall from bird flu.
Tamiflu’s effectiveness against bird flu is, as I understand it, a happy side effect of researching normal flu, not the result of aiming for a windfall from a bird flu outbreak. They’d surely never have bothered researching Tamiflu to treat bird flu strains alone. As a pharma exec, are you going to chase a miniscule chance of profiting from a global plague? I sure wouldn’t.
Pharma is a high-variance industry even when targeting sure things like heart disease or erectile disfunction. Profit variance is astronomical for unlikely-but-devastating plagues. Just like we have the Greenspan put in the case of systemic financial meltdown, maybe we need a NIH call option for development of drugs against apparently unlikely global plagues.
There is a simple solution–apply international law as enshrined in the WTO. WTO permits comulsoy licensing in case of emergency. Avian flu is an emergency. There is no need to split hair over this. Canada did this during the anthrx scare.
If economics were an honest profession, we would have hundreds of papers that compared the efficiency of patent financing of prescription drug research with other mechanisms (e.g. direct public financing, as with NIH, or prize funds). The basic arithmetic does not look good for patents. In the U.S., patent monopolies raise annual prescription drug expenditures by approximately $150 billion above what they would be if drugs were sold in a competitive market. For this $150 billion, the industry tells us that we get about $25 billion in research, roughly two-thirds of which goes to develop copycat drugs. In other words, we spend an additional $150 billion a year in higher drug prices to get about $9 billion in research on breakthrough drugs.
Where does the rest of the money go? The largest comnponent is the marketing campaigns that allow drug companies to maximize the value of their patent monopolies. While providing information is beneficial, providing misleading information and in some cases outright lies is not a social good. Of course, in some cases marketing includes various forms of kickbacks or bribes to doctors who prescribe certain drugs.
When it comes to trade tariffs on imported clothes or shoes, economists go nuts over intervention in a free market. But for some reason, economists don’t consider patent monopolies on drugs, which can raise prices by several thousand percent above their competitive market price, a topic worth their time.
I won’t comment on the economics but on the biology: Tamiflu is an antiviral, and a not very effective one at that. There are already some reports that viral isolates have been described that have resistance to it. This is to be expected, especially as southeast Asian countries have been dosing anything that clucks with the drug for the past two years.
It’s more important to improve and expand vaccine production. Right now, influenza vaccines are grown on chicken eggs. This is a remarkeable archaic and inefficient process, made more so by the specifics of the two prototype H5N1 vaccines, which each demand 4x as much dose as typical flu vaccines, thus using even more eggs for even less protection. There are molecular techniques to grow up vaccine using bacteria and recombinant DNA — but they are patented. Those should be nationalised, now.
Pace Dean Baker above, economists have criticized the patent regime, e.g. Arnold Plant, Edith Penrose and Fritz Machlup, and Murray Rothbard. MIT Press published a collection a few years ago attacking them, mostly in the software area.
Abolish patents, now more than ever!
Tyler: “If we confiscate property rights this time around, there won’t be a Tamiflu, or its equivalent, next time.”
I suppose this would just be another manifestation of the same well-understood economic principle by which drug cartels simply give up on smuggling cocaine after one of their shipments is confiscated.
Tamiflu can only lessen the symptoms (it’s not a cure) and must be taken within 40hrs from onset of symptoms to be effective … so looking to it as a panacea is pointless.
Some countries, like Australia, have fairly good government processes set up to manage the medical side of things, but nobody seems to have a handle on the economic preparations. That is, ameliorating the business collapses when people cant (or wont) go to work. Giving mortgage holidays for people who are prevented from earning income. Managing the collapse of “just in time” component distribution chains, etc.
If this pandemic is a big one (still a big IF) then it could presage the collapse of this phase of globalisation.
ryan writes: “No, reaping profits doesn’t require they produce more — they can also gain more profits by having price increase, which is certain to happen if demand spiked due to a pandemic. Quantity produced doesn’t need to increase for profits to increase.”
Another way of expressing this is that Roche has found a way to monetize death. Given their self-limited production capacity, the more people die (especially in affluent Western countries) the more the living will want Tamiflu, and the more money Roche can charge.
Infidel:
“Next question: how do we encourage reaearch into drugs that go beyond Tamiflu or have to replace Tamiflu?”
Give money to researchers, given the downside of a major epedemic, it will most likely be worth the cost to have a more reliable supply than whatever excuse Roche is using to justify not expanding it’s capacity.
Jon H,
Well, yeah. It’s not exactly a new thing to do, or a new way to do it. I was simply pointing out that it’s not true to say that their profits don’t go down if they lose their patent, a suggestion that was contended initially. Tyler’s point is that, in the future, companies will be be more likely to want to produce drugs that have the chance of helping during once-in-a-century crises if they know they will reap profits. You’re point about Roche outsourcing production might be a good one, but I’m unclear why that means it doesn’t make sense to compensate them. Your Hobson’s choice means they lose the profit motive. It’s true that the odds of a particular patent creating this profit opportunity is low, but I’m unclear as to why that makes it any different from any other profit motive associated with research.
http://crookedtimber.org/2004/08/04/how-should-we-pay-for-medical-research/
Should be of interest. My sense is to come down with a combination of incentives, but mostly relying on research rewards.
To me, a more interesting question is how you might politically start to deconstruct the IP rights regime that we currently have. I apologize if this is too far off topic, but I think an interesting political coalition could be formed by an attempt to take away copyright protections forhardcore pornography (at least the types that are currently occasionally prosecuted under obscenity laws). I am not coming down for or against, but it is interesting to think of how a campaign like that might progress.
Ryan,
You are arguing that by violating the patent the US would reduce the number of bidders for Roche’s relatively fixed supply, thereby lowering the price from what it would otherwise have been.
OK, but I guess I’m not inclined to compensate them for this “lost opportunity to gouge.” Nor do I buy the argument that the reduction in incentive will have a significant effect on future drug research. As others have pointed out, the possibility of a huge windfall from a very low-probability pandemic probably is not a major factor in drug company research planning. Other projects are not guaranteed to be profitable, as you say, but the differences in the probabilities do matter.
And just out of curiosity why are the two options for dealing with avian flu either 1) government confiscating property from drug companies or 2) government confiscating money from taxpayers. Where’s even the suggestion that there might be a market oriented solution?
One of the Blogs above mentioned how Australia has got its act together. Well let me tell you something, I reside in Australia and this country is far from having its act together. Like other countries there has been a run on Tamiflu and subsequently no one can get aacess to it any more, other than doctors and scientists who are stocking up for their own families.
Given we have run out of the drug, you would think the Government would be stockpiling for its own citizens but no. They gave away 40 million tablets to Indonesia on the premise that it may stop the virus from spreading. How perfectic. As we know, Tamiflu, or any other viral drug cannot stop the virus from spreading. Why the hell give away tablets to another counbtry when its own citizens cannot gain access to it.
Worse, my wife had a doctor refuse her a script for it on the premise that the drug isnt getting to those in current need of it. Well guess what, my family needs it just as much as anyone else! Just who the hell do people think they are in determing who can have it and who cant. Who the fuck is playing god here.
We know the real score on this when/if it comes to the crunch – those who are connected will grab it first and the rest can fend for themselves. Fortunatly, our family now has the scripts for it after visting other practitioners. Now its just a matter of holding up a chemist!
John Stewart on Avian Flu, in quicktime and MP3
http://www.onlisareinsradar.com/archives/002518.php#002518
“Intangible property is fundamentally of the same kind of property as real estate.”
If you happen to believe the philosophies of Ayn Rand and the good Dr. Greenspan. The above statement is an opinion and a dangerous one at that. Assuming the market can take care of things like epidemics and their consequences is also another untested, hypothetical fallacy.
No wait, it’s not untested, millions of people are dying of REAL epidemics every year in Africa and Asia because drug companies see their intellectual property rights as more important than peoples lives. The market fails them because it is simply too unprofitable to sell or develop drugs for these people.
Patents, like all intellectual property are a croc and should be consigned to the dustbin of history before millions more die for want of treatment.
“In the U.S., patent monopolies raise annual prescription drug expenditures by approximately $150 billion above what they would be if drugs were sold in a competitive market.”
And what does the FDA, or even *having* prescriptions, do to the cost of drugs?
Why is it that anyone accepts that a government has the moral authority to determine what people may or may not put in their bodies?
How many years and millions of dollars did Roche spend jumping through various government hoops to get Tamiflu approved for use in Switzerland, the U.S., and elsewhere in the world?
It’s interesting that any economist would complain about the high costs of prescription drugs, but seemingly not question at all whether governments have the moral legitimacy to tell people what they can or can’t put in their bodies.
As David Kessler, when head of the FDA, admitted: “If individual patients and doctors made medical decisions on their own behalf, then the rationale for the FDA would cease to exist.”
http://www.cato.org/pubs/regulation/reg18n2c.html
Why does anyone support NOT allowing individual patients and doctors to make medical decisions on their own behalf?
P.S. Here’s the way I’d come up with the “number of lives saved” (that determines the size of the reward):
The federal government and Roche would sign a contract agreeing on the dollar reward per life saved, and then the number of lives saved would be determined by a pre-selected panel of 11 experts–essentially an epidemiological jury–who would each be given $1 million for coming up with the final, binding number.
The government and Roche would be given 30 days to address the jury/panel, to present their cases for what the number should be, and then the jury/panel would be given six months to further research the matter, before rendering the (binding) verdict.
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