“Could You Patent The Sun?”: Access to the HPV Vaccines in A Changing Vaccine Market

Abstract

Cervical cancer disproportionately affects the low-­‐and-­‐middle income countries that constitute the developing world. It is the second most common cancer in women globally, with around 493,000 new cases diagnosed annually. However, of the women dying from cervical cancer, 88% of deaths occur in developing countries, with more than 60% of the women who contract it dying due to late detection. Driving this disparity in cervical cancer mortality is the success rate of Pap smears, a secondary prevention technique, in developed countries; when performed during a routine gynecological visit, cervical cancer can be caught early. Given the absence of adequate secondary prevention in developing countries, the HPV vaccines are a lifebuoy. But, historically, it has taken 20-­‐30 years since vaccine launch in the developed world for a vaccine to reach the developing world. Once of the biggest barriers is the price of the vaccines. This thesis asked whether the current system of vaccine price reduction was sustainable and applicable to reduce per dose prices of the HPV vaccine, given the new vaccine market as a result of changes occurring in the 1980s and 1990s. The validity of the hypothesis was assessed through an analysis of the political economy of the current global vaccine market, in reference to the historical functioning of the global vaccine market. Points of departure between the two markets were used to assess whether the mechanisms of vaccine price reduction are effective at reducing prices in a timely manner. The thesis examined the case study of Hepatitis B vaccines as a successful model showing how these mechanisms can reduce vaccine prices. Findings indicated that the current system of vaccine price reduction is not sustainable, when the global goal is to reduce the time delay for vaccine introduction into developing countries. Mechanisms currently in use to reduce prices, such as tiered pricing, come from an antiquated system, when the global vaccine market was different. A shift from production of traditional Expanded Programme on Immunization vaccines to newer, more complex vaccines, requiring intensive resources and investment, has differentiated the vaccine market into high­‐value high­‐income markets and low‐value low­‐income markets. Part of this shift included a consolidation of vaccine manufacturers on the market, concentrating the ability for innovation in the private sector of developed countries and increasingly excluding emerging manufacturers from the market. Moreover, a more stringent intellectual property rights regulatory environment, which makes it progressively difficult to reduce vaccine prices to affordability targets, magnifies the aforementioned factors. The thesis concludes that trends of globalization have moved pharmaceutical companies and their developed country governments towards bolstering a global order that restricts market access, contrasting with a time of unprecedented global openness. The thesis suggests that for developing countries to ameliorate barriers in access to medicine, especially those concerning price, it is to their advantage to work within the global order. The role of developing country national governments is emphasized in harnessing the advantages of globalization to increase access to vaccines.