Vaccines and vision for the work ahead

5 questions for human rights lawyer and organizer Priti Krishtel

Priti Krishtel is a sneak attack. You know the type—quietly smiling in the corner of a conference room or at a great dinner party (remember those?). Everybody is talking, egos jostling for the most head nods, but she’s not playing the same game. She’s listening. She’s learning. And she’s going to speak when she has something to say. And it will inevitably be gold.

That gold is particularly relevant this week. You see, Priti is the co-founder and co-executive director of I-MAK, an organization building a more just and equitable medicines system. She’s also a lawyer, an organizer, a mother, a friend, and a seeker. My life has been deeply enriched by her friendship and all that she has taught me about one of the most critical issues of our time. Meet Priti…

Courtney Martin: A lot of people were really excited to hear news this week that we may have viable vaccines soon, but you’ve been clear that they’re not a “quick fix.” Can you explain?

Priti Krishtel: I get the excitement around the development of a vaccine. People are suffering, and a vaccine represents hope that an end to the pandemic is in sight. But it’s so important that people understand: a vaccine will not magically solve all of our problems.

For one thing, not everyone is going to get it right away. If the pandemic has taught us anything, it’s that some people get access first, and some people don’t get it at all. Just look at what happened with testing in the early months of the pandemic. Professional basketball players were getting tested daily, but hospitals had to ration tests for frontline healthcare workers. Unfortunately, we have a hierarchy of healthcare that prioritizes access for some people while denying or delaying it for others. That’s not going to change without a wholesale effort to make the medicines system more just and equitable—things like making medicines more affordable, curbing corporate influence and abuse of the patent system, and ending structural racism in research and development.

Every time a pandemic hits, we find ourselves scrambling for a vaccine.

But what if we had a system that incentivized vaccine research all the time, not just when we’re knee deep in crisis? One where disease research was based on public health priorities and not stock market returns? One where Black and Brown people had the same access to life-saving medicines as others?

We would be better prepared not just for this crisis, but the next one and the next one. We need to stop taking a piecemeal approach to pandemic response and instead start looking at the system as a whole. Otherwise, we’re going to be in the same position when the next virus comes around.

So much money has been pumped into vaccine development, but less attention or cash has been focused on creating an equitable distribution plan. What would that look like? Is there any precedent for it? Are there particular appointments in the new administration we should be paying close attention to?

I think the biggest barrier to equitable distribution is the belief that access is a zero-sum game. In the U.S., we’ve seen a stark movement away from the collaborative model of global health that has been painstakingly built over the last several decades, most notably withdrawing funding from the World Health Organization in the middle of a pandemic. That “go-it-alone” approach is a disaster not just from a moral standpoint—rich countries are hoarding vaccine supply at the expense of poor ones—but from an effectiveness standpoint. At least one study has found that we could halve the number of COVID-19 deaths if we took a more collaborative approach.

What makes this situation so frustrating is, it doesn’t have to be this way. The pie could be bigger if we deployed all possible global manufacturing capability toward production of an eventual vaccine. But because of our profit-based medicines system, the company that holds the patent and related technology on a vaccine will have the power to decide how much gets produced and how it’s allocated globally. That’s an enormous amount of power in the hands of a private company (and one that will likely have benefited from public funding). We need to understand that when we prop up the current system, we’re actually choosing scarcity over abundance.

Our biggest public health successes have been because global actors worked together. In the HIV/AIDS epidemic of the early 2000s, we saw unprecedented expansion of antiretroviral treatment because of a massive collective effort by communities affected by HIV, advocates, political leaders, multilateral organizations, the private sector, and others. We all benefited from that because, as we’ve learned, pandemics don’t stop at the border.

As far as appointments, I would love to see a lot more attention focused on the next Director of the Patent and Trademark Office. Unchecked patents are a root cause of high drug prices and a major barrier to medicines access because they give one company the power to price drugs at whim. Part of my work at I-MAK is reimagining and rebuilding the patent system. Whoever runs that office is going to determine to what extent change is possible.

Your human rights work has led you all over the world. What do you think the U.S. has to learn right now about this important window for reform from other countries/contexts?

We’ve been fortunate to work alongside amazing advocates all over the world. I actually started my access to medicines career in India at the height of the HIV/AIDS epidemic. Millions of people were dying because they couldn’t afford treatment. Because of our grassroots movement to change local patent laws, we and other civil society organizations were able to litigate against unjust patents. We challenged some of the biggest pharmaceutical companies in the world and won, unlocking billions of dollars in savings for governments and health systems.

We can’t do that here. Corporations have standing to challenge patents in court but patients don’t. In America, policymaking around medicines is a bilateral negotiation between the government and corporations. The people most affected by the inaccessibility of medicines don’t really have a seat at the table. That’s less true in other countries, where there are relatively more avenues for the public—including people from marginalized communities—to engage in judicial and policymaking processes, whether that’s decisions about patents or the ways in which clinical trials are regulated. Other countries have democratized their medicines system in a way that we have not yet done in America.

Over the next year, my organization will be engaging in a participatory process that brings together all of the different stakeholders in the patent system—patients, pharmaceutical scientists, patent examiners and lawyers, and others—to create an inclusive blueprint for change. Our goal is to build much needed connection and understanding between ideologically, sectorally, and geographically diverse stakeholders, and foster a less polarized, more productive discourse around reform.

A lot of what your organization is putting its energy behind right now is patent reform so that drug pricing can finally be brought under control. Your own father was a scientist who was awarded a patent, so you're not in the business of vilifying innovation. How do you see your work these days as part of a familial legacy?

My dad once got me a wall-to-wall, laminated poster of the periodic table of elements for my birthday. So, yeah, science and innovation were a big part of my story!

But like so many scientists, my dad wanted as many people as possible to benefit from his research. That doesn’t always happen because we have a system that isn’t driven by the potential to help people, but by the potential for profit. That’s not what my dad worked so hard for. He wanted more than anything to save lives and better the human condition. I see my work as a continuation of that mission.

There’s this idea that people who advocate for better access are inherently antagonistic to innovation, but that’s such an oversimplification. I believe that most people in the pharmaceutical industry want the same things I do. We all revere the capacity of humans to push the boundaries of what is possible. We all want to save lives. Innovation and access can co-exist, but it has to be within a framework that’s transparent and fair. A lot of people—my dad definitely included—would agree that innovation without access is meaningless.

You are one of my favorite enneagram mentors. Any predictions as to what enneagram types Biden and Harris might be?

Hmmm...I’m married to a 6 and I’m fairly sure Joe Biden is a 6. He’s a people person who seems to draw energy from groups. Sixes often need reminders to express their own needs. Kamala Harris is a different story. I would bet she’s a 3. Threes are high-achieving and energetic, but they need to be encouraged to pause and ask what life looks like if they aren’t constantly productive. I’d love to see you interview them about this someday!

As always, I’m donating a portion of your membership fees to I-MAK on our behalf. Thank you! And if you want to learn more from Priti, check out her blockbuster TED talk.