IN A NUTSHELL Author's NoteBetween Profits and Lives: A Historical Perspective Between 1998 and 2003, more than 12 million people died from HIV/AIDS-related causes, despite the availability of life-saving antiretroviral therapy (ART) since 1996–1998. The majority of these deaths occurred in sub-Saharan Africa, where access to ART was blocked by pharmaceutical monopolies protected by international patent laws. This article analyzes the intersection of intellectual property, pharmaceutical profits, and preventable mortality, and extends the critique to cancer therapies, COVID-19 responses, and the shortcomings of the new Pandemic Treaty. It concludes that global health governance continues to structurally reinforce inequality—placing market-driven profits over the lives of the poor
By Juan Garay
Professor and Researcher in Ethics and Metrics of Health Equity (Spain, Mexico, Cuba, Brazil)
The Pandemic Treaty’s Failure to Confront Profit-Driven Injustice in Global Health
By the same Author on PEAH: see HERE
HIV/AIDS: Deaths Amidst a Patent Monopoly (1998–2003)
Despite the discovery of effective ART by the late 1990s, fewer than 2% of people living with HIV in Africa had access to treatment between 1998 and 2003. The annual cost per patient—over $10,000 USD—made access impossible for governments and individuals in low-income countries. Meanwhile, pharmaceutical corporations enforced monopolies on essential medications, including:
AZT (zidovudine) – GlaxoWellcome
3TC (lamivudine) – GlaxoSmithKline
Efavirenz – Merck
Nevirapine – Boehringer Ingelheim
Kaletra (lopinavir/ritonavir) – Abbott
Stavudine (d4T) – Bristol-Myers Squibb
Indian generics producers such as Cipla offered triple therapy for $1 a day by 2001, but patent enforcement limited their global reach. Estimated pharmaceutical revenue from ART during that period exceeded $36 billion USD. This results in a chilling estimate: $3,000 profit per life lost, or $100 per year of life lost—a grotesque ratio emblematic of systemic global injustice.
Cost-Utility Double Standards
According to the World Bank’s 1993 Investing in Health report, interventions under $100 per life year saved were considered “cost-effective” in low-income countries—thresholds often enforced through international lending. In contrast, health systems in high-income countries routinely fund treatments at $30,000+ per disability-adjusted life year (DALY). This cost-utility double standard implies a 300:1 disparity in the valuation of human life between rich and poor.
“A system that values the life of the poor at $100 per year while funding $30,000 per year in rich settings is not a health system—it is a global moral selection machine.”
Cancer: Continued Profit Over Access
Cancer therapies exhibit a similar pattern of exclusion:
New biologics and immunotherapies often cost over $100,000 per patient.
Patent evergreening and regulatory capture delay access to affordable biosimilars.
In many low- and middle-income countries, cancer remains a death sentence—not due to lack of technology, but due to lack of access.
COVID-19: Pandemic Profits Amid Uncertainty
COVID-19 further exposed systemic injustice:
Vaccines were developed with billions in public funding but sold under monopolistic terms.
Pfizer alone earned over $80 billion in COVID-related sales in 2021–2022.
COVAX underdelivered, and equitable access remained elusive.
Regulatory approvals raced ahead of long-term efficacy studies, yet profits soared while many in the Global South waited.
Health Equity and Global Injustice: The Structural Roots
As elaborated in the SHEM (Sustainable Health Equity Movement) webinar series and recent articles on health equity metrics, current global economic structures generate enormous and preventable health disparities. Recent estimates indicate that around 16 million avoidable deaths per year are linked to global economic injustice—primarily driven by the hoarding of financial and natural resources by high-income countries.
Research published in PEAH – Policies for Equitable Access to Health (2025) shows that every $1,000 of per capita GDP above a “hoarding threshold” of $50,000 USD in high-income countries corresponds to the loss of one week of life for individuals living below the “dignity threshold” of $10/day. Furthermore, GDP levels above $20,000 per capita are often associated with diminishing returns in life satisfaction and wellbeing, making this excess a form of “wasted GDP” in ethical terms. These findings underline the structural violence embedded in global economic and health systems and demand a fundamental reframing of global priorities.
Source: PEAH Article – “Health Equity Metrics and the Ethics of GDP Hoarding” (2025)
The Pandemic Treaty: Equity in Name, Inequity in Practice
The WHO Pandemic Accord was meant to address the failures exposed by COVID-19. However, its current draft protects pharmaceutical interests rather than dismantling the structures that caused “vaccine apartheid.”
- Preservation of Intellectual Property Rights
The treaty reaffirms TRIPS obligations, rather than promoting waivers during emergencies.
It relies on voluntary mechanisms like C-TAP and the Medicines Patent Pool, which Big Pharma routinely ignores.
There are no mandates for compulsory licensing or IP sharing, leaving access dependent on the goodwill of corporations.
- Lack of Binding Technology Transfer
Equity and solidarity are invoked rhetorically but not codified.
There are no legal obligations for high-income countries or pharma companies to share data, know-how, or biological materials.
The proposed Pathogen Access and Benefit-Sharing System (PABS) lacks operational clarity.
- Market-Based Supply Chains
Prices are left to market forces.
Without public manufacturing mandates or price ceilings, affordability is not guaranteed.
The same dynamics of delayed access and corporate profit maximization will repeat.
- Public Goods in Name Only
The treaty fails to declare vaccines, diagnostics, and treatments as global public goods.
Public-private partnerships dominate, often reinforcing Western-centric power structures and profit motives.
- Geopolitical Asymmetries
Global South countries are expected to share pathogen samples promptly.
In return, they get delayed, limited, or conditional access to life-saving products.
This perpetuates a neocolonial model where knowledge, production, and profit remain centralized in the Global North.
Conclusion: A Treaty that Protects the Status Quo
The WHO Pandemic Treaty, in its current form:
Upholds monopolies rather than breaking them,
Evades binding equity mechanisms,
Relies on corporate voluntarism,
Ignores health as a universal human right.
Unless radically revised, it risks being a symbolic exercise—preserving the structural inequities that defined past health crises and undermining the very goals of global solidarity, justice, and preparedness.
Main References
- Garay, J. (2025). Health Equity Metrics and the Ethics of GDP Hoarding. PEAH – Policies for Equitable Access to Health. https://www.peah.it/2025/01/14273/
- SHEM Webinar Series (2023–2025). Sustainable Health Equity Movement: Ethics, Metrics, and Action. https://www.sustainablehealthequity.org/webnair
- World Bank (1993). World Development Report: Investing in Health.
- MSF (2001). Fatal Imbalance: The Crisis in Research and Development for Drugs for Neglected Diseases.
- Oxfam (2021). The Inequality Virus.
- WHO (2023–2025). Pandemic Accord Draft Negotiation Texts.
- Knowledge Ecology International (2022). TRIPS Waiver and COVID-19: What Went Wrong?
- CIPLA (2001). Generic ART Pricing Offers.
- The Lancet (2020–2023). Various reports on COVID-19 vaccine access and equity.
- The Lancet (2024). Sustainable Health equity today. Juan Garay and SHEM sterring committee. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01339-4/fulltext
