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Are you chicken?

Governments and pharma must face one of their greatest ever moral challenges

Why did the chicken cross the road? (please feel free to insert your own punch line). The truth is, if the forecasts are right, there won't be many chickens, turkeys, pigeons, parrots or birds of any kind, left to cross the road - and certainly not to cross borders, or cross from one country to another. Bird flu is starting to get us into a flap.

Here's the problem: by and large we humans are safe from bird flu. Unless you work in an aviary, a turkey farm or have some secret predilection or a thing for feathers, you are safe. Indeed, if you know someone unfortunate enough to fall victim to bird flu you are still probably safe because this mysterious strain of virus is not proven to be transmissible between humans; at least not yet.

The trouble with this type of virus is that it is as unpredictable as a teenage daughter with a strop on, or a boy racer driving a souped-up Corsa on a motorway. Anything could happen.

The virus could mutate and become a deadly menace and deaths could be counted in the millions.

It would start with the elderly and frail, move to the children and then on to the rest of the population. Working days would be lost in their millions, economies would collapse and public services would be on the precipice of disaster.

A flu pandemic would be the sweeping Grim Reaper that even in our worst nightmares we would not imagine. If this thing gets a hold we have a real problem. Some say the answer is Roche's Tamiflu. In broad terms, it is an anti-viral that might help prevent transmission of the virus.

It is not specific to bird flu because the men and women in white coats do not yet know what a mutated virus looks like.

Let's hope they never have cause to know. We do know, eventually, that an anti-virus will be developed, perhaps based on egg-culture or via the faster method of fermentation. We also know that it will be a close run thing.

Right now, in the midst of pandemic uncertainty, Roche's fortunes are looking up. One day I will write meaningfully on the morality of making a fortune out of other people's misfortunes, as opposed to earning a living out of helping other people to get on with their lives. Right now, I'm not sure I know the answer or can define the line - even if there is one.

We are left with the conundrum: Roche (it was reported and less than convincingly denied), appears not to be able to make enough Tamiflu to satisfy global demand and seems coy about letting anyone else make it with it, for it or instead of it.

One Indian generics house claims to be able to replicate Tamiflu, but who knows whether this is right, safe or even viable.

You can understand Roche's point - it has invested a shed load of money in developing a pretty run-of-the-mill pill and suddenly it wins the lottery. Good luck.

But (there's always a but), if it turns out that Tamiflu is the answer and people die because there isn't enough of it on the pharmacy shelves, it will be a disaster for Roche. It will be a public relations catastrophe from which the firm may never recover; indeed, it may be a public relations debacle that will impact on the industry as a whole.

Big pharma is already tagged as a fat cat that we know is seen as the enemy of hard-pressed health systems unable to pay for the miracle pills demanded by their populations. The industry is always in the middle of a tug of war over budgets, resources and the tax-payer's pound.

Pharma marketers exist to promote the use of products to physicians but arcane rules prevent them from getting their message to the real users, the patients. Big 'P' is doomed, whichever way it turns.

the right thing

Roche wants to protect its investment and its patent and I don't blame it for that. However, there is a wider, moral issue here, not just for the firm but for everyone in the pharma business. Everyone, that is, with the curse of a product that saves lives and is too expensive for healthcare systems to afford, or is in short supply.

Here's a theory, or two: What do you think about this?... The laws regulating intellectual property must serve as means of achieving creative, social and economic ends and not as ends in themselves.

These laws and regulations must serve, and never overturn, the basic human rights to health, education, employment and cultural life.

There's more: the public interest requires a balance between the public domain and private rights. Does that strike a chord? Does that make any kind of sense? Is it too difficult in a capitalist society? These extracts are from the Royal Society of Arts, Adelphi Charter (http://www.rsa.org.uk/acrobat/adelphi_charter.pdf).

It also says: 'Human rights call on us to ensure that everyone can create, access, use and share information and knowledge, enabling individuals, communities and societies to achieve their full potential.'

Where does this leave us? - and more importantly, where does it leave Roche?

in a fix

Should the firm say: 'We have done our budgets and forecasts for this year, we know we are going to make a healthy profit; Tamiflu profits are a windfall we can do without. The needs of humanity are greater, we will create a release of patent'?

Or, governments could say: 'Roche, create a release of patent so we can get enough product stockpiled to be sure no one who can benefit from the drug shall go without. We will make up your shortfall in profits with a special tax break.'

It is one of the greatest moral challenges that industry and governments will ever face and and it's happening in our lifetime, right now. It is rare that an opportunity for leadership and moral guidance should emerge so unexpectedly. Whatever the outcome, it will be part of this industry's history. What would you do?

The Author
Roy Lilley is a healthcare author and broadcaster

2nd September 2008

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