Billions worldwide, including in India, cannot access affordable medications. In the U.S., nearly one in three citizens struggles to afford prescription drugs. Pharmaceutical companies often delay the launch of new products in Europe due to the region’s efforts to control drug prices. The impact of the COVID-19 pandemic and rising living costs has intensified scrutiny of the pharmaceutical system as prescription drug prices soar. However, discussions about the causes and potential policy solutions frequently overlook the “rules” underpinning these challenges and the necessity of breaking free from them.
The newly published book Pharma Monopoly: The Battle for the Future of Medicines, co-authored with Rohit Malpani, examines how the neoliberal political economy and the western pharmaceutical industry have utilized concepts like “free markets,” “competition,” and “innovation” to create a facade of a “rules-based” order. This order has facilitated the globalization of trade and the intellectual property (IP) system under the World Trade Organization’s (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement.
Over recent decades, the global IP framework has granted pharmaceutical corporations substantial control. Consequently, global health initiatives and philanthropic efforts often seek industry permission to access medicines rather than addressing the structural injustices and failures within the system.
India has historically resisted the “rules-based” TRIPS order, maintaining its role as the “pharmacy of the poor.” The country demonstrated leadership by introducing provisions such as Section 3(d) in its amended Patent Law (2005) to counteract the western pharmaceutical industry’s practice of extending patent protections unjustly. India co-sponsored a waiver of IP rights under the TRIPS agreement during the COVID-19 pandemic. Despite these initiatives, India’s policies over the last two decades have increasingly aligned with the neoliberal ideologies it once opposed. Many generic manufacturers now comply with the “voluntary” patent licenses prescribed by pharmaceutical firms to avoid straining relationships with the Global North.
As the United States—historically a proponent of neoliberalism—shifts away from globalization, the power dynamics are revealing themselves without the facade of a rules-based order. In this context, countries, particularly those in the Global South, are reconsidering their positions and seeking new alliances.
Despite the uncertainties ahead, this moment presents an opportunity for countries like India to create a trade system reminiscent of the New International Economic Order envisioned in the 1970s, which prioritized economic justice.
Ultimately, communities, civil society, and governments must cease relying on the pharmaceutical industry and existing power structures to reform themselves. Instead, they need to forge a new path that prioritizes access to medicines for all. It is critical to avoid the allure of incremental changes that detract from achieving systemic reforms that can enhance public welfare. The long struggle toward a future where everyone has the right to access medicines must be embraced.
—Tahir Amin, Co-Founder and CEO, Initiative for Medicines, Access & Knowledge
