In the past week, medicines shortages in the UK have reached crisis point. Thousands of people, including those suffering with motor neurone disease, diabetes and epilepsy, are now facing anxious waits to secure the medication they depend on. Some of these shortages are potentially life-threatening, yet the government has so far avoided criticism on the issue.
The crisis is driven by a series of complex causes. The Conservatives would like us to believe it’s caused by factors beyond their control, including the war in Ukraine, production issues in key laboratories, and the lingering effects of the pandemic on supply chains. But poor planning from government is a key factor here, along with years of inadequate investment in public manufacturing of drugs and disruptions caused by Brexit.
Another crisis of medicines supplies is brewing, though, and next time the causes could be surprisingly simple – with the effects even larger in scale. It would also be entirely of the government’s own making.
The issue lies in India’s generic medicines manufacturing, a thriving industry that is currently a lifeline for the NHS that provides imports of cheap, effective generic medicines that treat a range of diseases, from cancer to diabetes to heart conditions. But as part of ongoing talks over a new trade deal with India, Rishi Sunak’s government is aiming a wrecking ball squarely at this industry.
India is sometimes referred to as the “pharmacy of the world”, due to its status as the world’s largest supplier of low-cost generics, vaccines and affordable medicines. More broadly, health competition provided by generic medicines producers can cut the cost of medicines by up to 80 per cent, making medicines available to millions in lower-income countries and helping to take pressure off health systems.
The NHS benefits hugely from the success of the country’s affordable medicines industry, importing as many as 25 per cent of its generic medicines from the country’s manufacturers. In the case of Glivec, an important drug for treating some kinds of leukaemia, for years the big pharmaceutical firm Novartis charged the NHS more than £25,000 for a course of the drugs, even as experts pointed out that the drug could be made far more cheaply. A few years later when the patent on the drug expired and generic imports started flowing into the UK, the price fell to just £556 per year: a 97 per cent price reduction.
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However, for the last 18 months, the UK has quietly been pushing India to adopt a series of measures that would, if accepted, trash an industry that has been essential to saving the NHS cash. Where India’s laws only allow patents for truly innovative breakthroughs, the UK is pressing for measures that could enable corporations to slap patents on inconsequential tweaks to already existing medicines – a process referred to as “evergreening”.
Similarly, the UK wants to allow companies to extend patent terms beyond the already generous 20 years currently laid out in global intellectual property norms. Currently, patients and health organisations in India can challenge dubious patent applications before they are granted. Only last year this process was used to cut the costs of the tuberculosis drug, bedaquiline, by 80 per cent. The UK’s demands, if accepted, would end progress like this. The solid foundation on which India’s medicines industry has been built is under threat.
So why is the UK pushing so hard for measures that are clearly self-destructive? An obvious answer would be to look at the role of the lobbyists behind the biggest pharmaceutical companies. Their own statements to parliament have emphasised that the UK’s trade talks with India were a “priority” for an industry seeking to overturn “barriers to obtaining and enforcing [intellectual property] rights”. Ultimately, the success and expansion of India’s generics industry is not just a competitive threat to the giants of the industry; it also demonstrates that it isn’t necessary for countries to bow, scrape and shape their laws to fit around the pharmaceutical lobby’s every demand.
Despite this, our government seems beholden to the demands of the industry, effectively acting as its representative in trade talks, while also caving to the demands of these companies over drugs pricing in the NHS. The NHS drug bill has grown massively in recent years, with our health system now spending around £18bn a year on medicines. Many of these drugs are very useful but hugely overpriced. Others offer dubious advances compared to those already on the market.
The Trade Secretary, Kemi Badenoch, has insisted that the government wouldn’t sign a trade deal that would threaten NHS access to drugs, but her denials appear to be wishful thinking. A chorus of doctors and health organisations, including the British Medical Association and Médicins sans Frontieres, have warned that the UK’s demands threaten the supply of medicines to the NHS and to patients around the world. Experts on intellectual property, health and trade agree.
The current drugs shortages have revealed the uncomfortable truth that under our current system access to life-saving medications is not guaranteed. The anxiety now suffered by patients and their families is bad enough without the government taking an axe to our most reliable supply of affordable medicines. In ongoing trade negotiations, this government must make choices in service of public health – not corporate profit.
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