Why Is The Gates Foundation Funding The UK's Medicines Regulator?
Why Is The Gates Foundation Funding The UK's Medicines Regulator?
BY TYLER DURDEN SATURDAY, AUG 28, 2021 - 09:30 AM Authored by Nick Corbishley via NakedCapitalism.com,
Just as
importantly, why is the regulator laying off 20% of its workforce in the midst
of a global pandemic?
On August 13, the UK government published a response to a
freedom of information request in relation to the Medicine and He0althcare
products Regulatory Agency (MHRA) — the UK’s equivalent of the FDA. It was in
response to a question asking whether or not the agency had received funding
from the Bill and Melinda Gates Foundation. The answer was yes:
We do receive funding from the Bill and Melinda Gates Foundation
as well as other sources outside government such as WHO. This funding mainly
supports work to strengthen regulatory systems in other countries…
The current level of grant funding received from the Gates
Foundation amounts to approximately $3 million. This covers a number of
projects and the funding is spread across 3-4 financial years. We are an
executive agency of the Department of Health and Social Care.
The story didn’t attract much attention at the time. In fact,
not a single newspaper or broadcaster even bothered to cover it, perhaps
because they didn’t think there was much worth covering. After all, the Gates
Foundation (GF) is a charitable organization — the biggest of its kind, with
roughly $60 billion in assets — so what could be wrong if it’s donating funds
to an organization in charge of deciding which pharmaceutical products and
medical devices reach the market and which don’t? Well, quite a lot, actually.
Conflicts
of Interest
The Gates Foundation’s roughly $60 billion in assets include, among many other things, shares and other
forms of investments in some of the world’s largest pharmaceutical companies,
whose products the MHRA has to regulate on a regular basis. Those companies
include Sanofi, Merck, Eli Lilly and Company and Abbott Laboratories, all four
of which have developed or are developing covid-19 treatments and/or vaccines
that are yet to receive authorisation in the UK. They also include Pfizer and
its German partner BioNTech, which together have developed and marketed the
most profitable — and arguably shortest-lasting — vaccine ever.
It’s also worth noting that MHRA’s former CEO, Ian Hudson, now works as
a senior advisor at the GF.
When it comes to global healthcare, the GF is anything but a
disinterested third party. Its co-founder, Bill Gates, is as committed as ever
to intellectual property rights. In January we learned that Gates had played a
key role in convincing Oxford University to drop a prior committee to donate the
rights to its vaccine to any drug maker. The idea was to provide medicines
preventing or treating COVID-19 to poorer countries at a low cost or even free
of charge. But Gates persuaded the
British university to sign a vaccine deal with AstraZeneca instead that gave
the pharmaceutical behemoth exclusive rights and no guarantee of low prices.
We have also learnt that Gates was instrumental in blocking
attempts late last year by a coalition of countries led by South Africa and
India to bring a patent waiver proposal to the World Trade Organization’s TRIPS
(Trade Related Aspects of Intellectual Property Rights) Council. A waiver would
allow poorer countries to produce the vaccines themselves. And that would
massively accelerate global take-up of vaccines, which could help in the global
fight against Covid. But Gates argued that poor countries were not prepared to
scale up manufacturing. A waiver would also eliminate incentives for future
research, he said. His argument won the day and even today the TRIPS waiver is still under
discussion at the WTO, going nowhere slowly.
In an article for Wired magazine Mohit
Mookim, a student at Stanford Law School and former researcher at the Stanford
Center for Ethics in Society, asks whether we should be surprised that a
monopolist-turned-philanthropist maintains his commitment to monopoly patent
rights as a philanthropist too?
“Throughout the last two decades, Gates has repeatedly advocated for public health
policies that bolster companies’ ability to exclude others from producing
lifesaving drugs, including allowing the Gates Foundation itself to acquire substantial
intellectual property. This continues through the Covid-19 pandemic.”
Now we learn that the foundation, with its vast holdings in
pharmaceutical companies and substantial intellectual property interests, has
also been helping to fund the MHRA for the past four years. In other words, an
organization that has poured billions of dollars into the research and
development of vaccines, other novel treatments and medical devices has also
been funding the UK agency responsible for approving those vaccines, novel
treatments and medical devices. This is a clear conflict of interest.
The MHRA is not the only public health agency in the UK to have
benefited from the foundation’s largess:
- Public Health England, a health watchdog
set up by the Government in 2013 to protect and improve health and
wellbeing and combat health inequalities, has received an unspecified
amount of money in grants from the foundation. The agency
is set to close in the coming months and will be replaced by the
Orwellian-titled “UK Health Security Agency”.
- Health Data Research UK has received
$3.5 million from the GF since the pandemic began. The
organisation has courted controversy in recent months for its role in
bringing together the health and biometric data of all 55 million of the
NHS’ patients. That data was then supposed to be flogged to any interested
third parties, but the plan was scrapped at the last minute due to public
opposition.
- The GF has also partnered with the UK
Government’s UK Research and Innovation (UKRI), which began life in 2018 with a budget
of £6 billion, ostensibly to support science and research in
the UK.
Funding
Crisis
As I wrote last week, the UK Government is ramping up its plans
to privatise the NHS. This is leaving many parts of the health system starved
of funds, which in turn opens up fresh opportunities for private-sector
companies. The MHRA, like the FDA, is primarily funded by the “user fees” it
charges its “customers” (i.e., the companies it regulates). Again, this creates
a huge, huge potential for conflicts of interest.
In the US, user fees fund
account for around 65% of the FDA’s operating budget for
regulating prescription drugs. In the case of the MHRA, 100% of its budget for
regulating medicines comes from user fees. Its other activities are funded by a
combination of private and public sources. The MHRA’s regulation of devices is
primarily financed by the Department of Health and Social Care (DHSC), with
approximately 10% of its revenue derived from fees. The National Institute for
Biological Standards and Control (NIBSC) raises around half of its revenue from
fees charged for services.
Nonetheless, the MHRA is facing a funding crisis. And it’s
largely a result of Brexit. Before the UK’s departure from the EU, in January
this year, the MHRA formed part of the European system of medicines approval.
Under that system, national regulators can serve as rapporteur or co-rapporteur
for any given pharmaceutical application, providing most of the verification
work on behalf of all members. It was an important source of fee-income but now
it’s dried up. And the government is not replacing it.
As a consequence, the regulator has announced plans to lay off
between a fifth and a quarter of its 1,200-strong workforce as part of
cost-cutting measures. According to the
FT, the goal is to transform how the MHRA operates by redeploying staff to new
areas of regulation and science. Documents leaked to the British Medical Journal reveal that the
MHRA is offering early redundancy packages to staff from its divisions on
vigilance and risk management of medicines (not exactly comforting), licensing,
devices, inspection enforcement and standards (also not comforting), as well as
its committee secretariat. The document, marked “official sensitive,” also
notes that the MHRA’s income is forecast to fall by 15-20% in the next
financial year and beyond.
Despite the drastic downsizing, the MHRA says it wants to still
serve as a world-class regulator that delivers positive outcomes for patients
while modernizing the services it provides to industry. With 15-20 percent less
operating income and 20-25 percent fewer workers, that’s likely to be a tall
order.
A
Principal-Agency Problem
In a 2017 blog post for
the BMJ,
Joel Lexchin, a professor emeritus at the School of Health Policy and
Management at York University, warned that the widespread introduction of user
fees had created a principal-agent problem.
When the FDA’s operating budget used to be funded exclusively by
the government (between the date of its founding, 1938, and 1992), you
essentially had one principle and one agent. Their roles were relatively clear.
The principle needed something done (in this case, patients needed effective,
safe medicines to be approved and ineffective and/or unsafe medicines to be
blocked) and the agent (in this case, the FDA) was contracted to do the task.
However, since the introduction of user fees a new principal has been added
(the pharmaceutical industry) and now the regulatory agency has two principals
with directly competing values:
In the case of the public, the primary value is to have
effective and safe drugs, but in the case of the pharmaceutical industry, its
primary goal is to get its products through the approval system as quickly as
possible and to sell those products to as wide an audience as possible. At
times, it seems that regulatory agencies prioritize the latter at the expense
of the former. Shortly after Canada introduced user fees, the head of the part
of Health Canada that regulates prescription drugs issued a memo in which he
said that “the client is the direct recipient of your services. In many cases
this is the person or company who pays for the service.” The one page document
focused on service to industry and relegated the public to the secondary status
of “stakeholder” or “beneficiary”…
User fees are reauthorized in the US on a five year cycle. When
they came up for renewal in 2007, a number of prominent American commentators,
including Marcia Angell, a former editor of the New England Journal of Medicine and
Jerry Avorn, a leading pharmacoepidemiologist, opposed its
reauthorization and instead called for increased Congressional appropriations in
order to allow the FDA to undertake its responsibilities free from any apparent
conflict-of-interest.
“Safety in a world of user fees” is of paramount concern,
concluded Lexchin. That was back in 2017. Four years on, we are in the biggest
health crisis of our lifetimes and the tasks performed by medicines regulators
are more important than ever. New experimental vaccines and therapeutic
treatments are rolling off the line in record time. But they’re also being
authorised in record time — in some cases despite scant evidence of benefits
(e.g., Remdesivir). And they’re earning record profits for their
manufacturers. At the same time, promising repurposed off-patent medicines that
do not offer lucrative financial returns are largely being ignored or are even
being demonised by our medicines regulators.
In its quest to remain globally relevant as it loses money and
staff and in the absence of increased government support, the MHRA will need to
raise even more funds from the companies it regulates. Further handouts from
the likes of the Gates Foundation will also be welcome, one can imagine. But
that, one can imagine, will come with even more strings attached.
https://www.zerohedge.com/geopolitical/why-gates-foundation-funding-uks-medicines-regulator
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