Lessons from COVID reveal how monopoly power in the biopharmaceutical industry is evolving

Matt Sparke professional portrait
Professor Matt Sparke, co-director of UC Santa Cruz’s Global and Community Health Program. Photo: Carolyn Lagattuta

Throughout the coronavirus pandemic, Politics Professor Matt Sparke, co-director of UC Santa Cruz’s Global and Community Health Program, kept a close watch on the global biopharmaceutical industry. Like many others around the world, he was deeply concerned by huge global inequalities in access to testing tools, vaccines, and other biomedical counter-measures.

As a scholar of geopolitics, globalization and global health security, Sparke has studied how the power of the biopharmaceutical industry has grown at the expense of global public health, often leaving people around the world without affordable access to life-saving medications. However, he also believes that portrayals of “Big Pharma” as a political boogeyman obscure an important truth: that the industry is not acting alone. 

In his latest paper, published in the journal New Political Economy, Sparke and his coauthor, Owain Williams, use the case of COVID to demonstrate both the enduring problem of bio-pharmaceutical monopolies and the ways they have been extended and entrenched through complex market-state interconnections. They argue that the global power of the biopharmaceutical industry has, in fact, been built and maintained by a web of corporate, governmental, and philanthropic ties. For the same reasons, efforts to bring the production of medicines back into alignment with the public good will require changes in each of those three realms.

“When you look closely at the pandemic response, you can see a lot of failures, even in some of the things that were narrated as successes,” Sparke said. “And you can also see how the idea of monopoly power that most people have in their minds—of cigar-smoking corporate executives in a back room plotting to fix prices—is really inadequate for understanding the multi-faceted and structural nature of the collusion problems surrounding and supporting the biopharmaceutical industry.” 

Corporate coordination

The paper explains that, in the corporate realm, biopharmaceutical companies can coordinate together in perfectly legal ways that concentrate and maintain the power of the largest companies. Ordinarily, this often comes in the form of mergers and acquisitions that take out potential competitors through so-called "killer acquisitions". In the context of the pandemic, global investment firms that hold shares in the world’s largest biopharmaceutical companies additionally encouraged these companies to work together on coronavirus vaccines and treatments. But the biopharmaceutical giants then maneuvered to lock out participation from smaller companies. 

As an example, the paper points to the large number of patents that Moderna, Pfizer and BioNTech took out related to mRNA, in order to keep that technology held within their inner circle. The paper also discusses how Moderna has consistently failed to share information about their mRNA platform with firms from the Global South, despite promises to do so. And Moderna initially refused to allow the involvement of such firms even in the packaging process for vaccines, during a time when increased capacity was needed, the paper says. 

Governmental enablement

The paper argues that much of the corporate consolidation of power was enabled by government policies. For example, in the United States, Operation Warp Speed invested $18 billion of public funding into private biopharmaceutical companies to accelerate vaccine development, and the initiative was hailed as a success when viable vaccines were produced. But then the Trump Administration allowed the successful companies to privatize the publicly-funded innovations with patents. And that’s where the picture gets more complicated. 

“Through Operation Warp Speed, the federal government ended up giving free license to these companies to take possession of intellectual property that was generated by public investment,” Sparke explained. “That put the vaccine behind a paywall, and as a result, many lives were lost in places like Mexico and Sri Lanka that could have been saved with better access to vaccines.” 

The paper also discusses how the tight control of vaccine-related data by private companies has become a barrier to additional innovation that could potentially deliver a more effective sterilizing vaccine or even stop the spread of disease and further mutations of the virus. Yet governments in many wealthy countries continue to prioritize the intellectual property rights of companies. Sparke and Williams describe how this played out at the World Trade Organization, where South Africa and India led a push to waive intellectual property rights related to the vaccine, but European countries organized to weaken the waiver, even after the Biden administration advocated for it. 

Justification through philanthropy

Governments may feel justified in such actions because the philanthropic sector often presents itself as an alternative for meeting public health goals without waiving intellectual property rights. In this way, philanthropy itself contributes to maintaining the power of the biopharmaceutical industry, the paper argues. 

During the coronavirus pandemic, the COVAX initiative, backed by the Bill and Melinda Gates Foundation and supported by many well-meaning donors, aimed to leverage philanthropic funding to ensure access to vaccines for low-income countries. But, the program fell far short of its targets, leaving massive equity gaps in global vaccine access. The paper argues that COVAX’s approach ultimately prioritized saving intellectual property rights ahead of saving lives. And because COVAX lobbied so hard to become the official global approach to vaccine equity, the competing idea of making the vaccine open access couldn’t get traction, the paper says. 

Consequences and alternatives 

Overall, Sparke says the pandemic showed how big philanthropy, government, and corporations all work structurally on a global scale to preserve the power of the biopharmaceutical industry. And the paper argues that this power dynamic contributed to unnecessary loss of life, public distrust in science, and vaccine skepticism. But there are clear pathways to change. 

The paper discusses some examples from the Biden Administration of how a renewed focus on anti-trust regulation could make a difference, including the Inflation Reduction Act’s efforts to allow the US government to negotiate lower drug prices. Sparke and Williams also argue for the need to reconsider the status quo around intellectual property rights. Sparke says public universities can play a role in that process by making biopharmaceutical advances and providing open access to them, the same way that UC Santa Cruz has led efforts to provide free open and global access to human genome data with its Genome Browser

Sparke hopes that better understanding of the forces behind the biopharmaceutical industry’s power and the available alternatives could help move people toward productive civic action. 

“There were so many conspiracy theories around the vaccines that were all totally untrue, but as social scientists, we still need to ask ourselves why so many people were paranoid about a billionaire philanthropist like Bill Gates being so involved in vaccination efforts,” Sparke said. “Distinct from wacky ideas about him putting microchips in the arms of the vaccinated, there were also underlying concerns about the linkages between governments, biopharmaceutical firms, and philanthropy. And one of the goals of our paper is to offer a vocabulary and framework for people to talk about those problems without falling prey to conspiracy theories.”