In a 2001 campaign at Yale University, students, scientists, and the organization Doctors Without Borders asked Yale to help increase access to the AIDS drug d4t in South Africa. Yale scientists discovered and patented d4t; the university subsequently licensed the drug to Bristol-Myers Squibb, which marketed it for $1,600 per patient per year. Under pressure from students, faculty, and the general public, Yale and Bristol-Myers Squibb agreed to allow generic manufacturers of d4t to compete in certain markets, thus lowering the price of the drug to $55 per patient per year — a 96 percent reduction.
Unfortunately, the Yale-d4t case was an isolated one. In the five years since Yale’s decision, other universities have missed similar opportunities by failing to negotiate prospectively for equitable-access terms in their pharmaceutical licenses. Last year, for example, in a deal with Gilead Sciences and Royalty Pharma, Emory University sold its royalty rights to emtricitabine, an active ingredient in the HIV antiretrovirals Emtriva, Truvada, and Atripla. “Although Gilead’s Access Program promises to supply 97 developing countries, the drugs are only available in a fraction of them,” said Stephanie Doan, a student at the Rollins School of Public Health at Emory.
Expanding access in poor countries does not require universities to sacrifice their bottom line. Because patients in developing countries aren’t currently able to afford the drugs that they so desperately need, they do not factor into pharmaceutical company revenue or university royalties. Meanwhile, Yale has exclusively licensed a compound known as Ed4t to a Japanese pharmaceutical company without any provisions for access. Ed4t is closely related to d4t but in early tests has proved both more effective and less toxic than its predecessor.
More recently, students at Yale and others from more than 35 major research universities in the U.S. and Canada convened in early October at the annual conference of the student group Universities Allied for Essential Medicines (UAEM). There they discussed how to bring about systematic change to pharmaceutical licensing policies across their campuses.
The outcome of this discussion was the adoption of the Philadelphia Consensus Statement, a document that lays out a comprehensive set of policy proposals by which universities can address the access crisis. The Consensus Statement is organized along three main points: (1) promoting equal access to university research; (2) promoting research and development for neglected diseases; and (3) measuring research success according to impact on human welfare.
“For too long, life-saving medical tools that are the fruits of university-led discovery have been denied to poor people in poor countries. If our universities really are to be institutions for the public good, this must change,” said Dr. Paul Farmer, cofounder of the humanitarian organization Partners in Health and Presley Professor of Medical Anthropology at Harvard University, and one of the dozens of initial signatories to the Philadelphia Consensus Statement.
For contextual information on technology transfer, see this 2004 Health Affairs paper by Eric Campbell and coauthors, and this page of references on the Bayh-Dole Act collected by the Consumer Project on Technology.