Biobank donation in search of public benefits and the potential impact of intellectual property rights over access to health-technologies developed: A focus on the bioethical implications

The availability of biomaterials is a key component of health research and the development of new health-technologies (including, diagnostics, medicines, and vaccines). People are often encouraged by biobanks to donate samples altruistically to such biobanks. While empirical evidence suggests many donors are motivated by the desire to contribute towards developing new health-technologies for society. However, a tension can arise as health-technologies whose development is contributed to by donors' biomaterials will often be protected by intellectual property rights (IPRs), including patents. Patents give rightsholders control over how patented technologies are used and can be used in a way that impedes public access to technologies developed. Yet, there are no binding European legal obligations mandating disclosure to donors of how IPRs can operate over downstream health-technologies and how they could impact access to health-technologies developed, nor are there legally binding obligations to ensure public accessibility of technologies developed. Focusing on the bioethical implications posed, this article argues that the current situation can impact donors' autonomy and dignity interests. A more holistic approach is needed for biobank donation, which embeds a consideration of donors' expectations/interests from the point of donation through to how such samples are used and how health-technologies developed are accessed. We put forward avenues that seek to address such issues.

INTRODUCTION: Rethinking Pharmaceutical Policies in Latin America and the Caribbean: An Overview

The demographic and epidemiological transitions are driving pharmaceutical expenditures up in Latin American and the Caribbean, with much of the cost falling on households. The domestic development and manufacturing of bio-similars could make medicines more affordable.

Biopharmaceutical Financialization and Public Funding of Medical Countermeasures (MCMs) in Canada During the COVID-19 Pandemic

BACKGROUND

Analysing the Canadian government's efforts to support the development of COVID-19 "medical countermeasures" (MCMs), this article seeks insights into political economy as a driver of pandemic response. We explore whether Canadian public funding policy during the pandemic involved departures from established practices of financialisation in biopharmaceutical research and development (R&D), including the dominance of private sector involvement in an intellectual property (IP) intensive approach to innovation underscoring profit, and governance opacity.

METHODS

We interrogate public funding for MCMs by analyzing how much the Government of Canada (GoC) spent, how those funds were allocated, on what terms, and to whom. We identify the funding institutions, and the funds awarded between February 10, 2020, and March 31, 2021, to support the research, development, and manufacturing of MCMs, including diagnostics, vaccines, therapeutics, and information about clinical management and virus transmission. To collect these data, we conducted searches on the Internet, public data repositories, and filed several requests under the Access to Information Act (1985). Subsequently, we carried out a document-based analysis of electronically accessible research contracts, proposals, grant calls, and policy announcements.

RESULTS

The GoC announced CAD$ 1.4 billion for research, development and manufacturing of COVID-19 MCMs. Fully 68% (CAD$ 959 million) of the announced public funding was channelled to investment in private sector firms. Canadian public funding showed a consistent focus on early and late stage development of COVID-19 MCMs and the expansion of biopharmaceutical manufacturing capacity. Assessing whether Canada's investments into developing COVID-19 MCMs safeguard affordable and transparent access to the products of publicly funded research, we found that access policies on IP management, sharing of clinical data, affordability and availability were not systematic, consistent, or transparent, and few, if any, mechanisms ensured long-term sustainability.

CONCLUSION

Beyond incremental change in policy goals, such as public investment in domestic biomanufacturing, the features of Canadian public policies endorsing financialization in the biopharmaceutical sector remained largely unchanged during the pandemic.

The Dilemma of Intellectual Property Agreements and R&D in Developing Economies: A Game Theory Approach

This paper models and predicts how the strengthening of intellectual property (IP) protection will impact R&D in developing economies. International agreements such as TRIPs and free trade agreements are enhancing the level of international control on IP. This is changing deeply the R&D environment in developing economies by restraining illegal channels of knowledge accumulation such as imitation, reverse engineering and piracy. An asymmetric and non-cooperative two-stage (R&D-Production) game is proposed to model a developing market where two local firms compete with a more innovative foreign firm. Equilibrium R&D expenditures and profits of the competing firms are compared for different levels of: market technology, technological gaps and IP protection. The proposed model shows clearly that a stringent enforcement of IP agreements will dramatically decrease the innovative abilities of developing economies especially in high technological sectors. The maintain and increase of their R&D skills will not be possible without a reduction of their technological gap and strong incentives to initiate regulatory (or permit tacit) R&D cooperation between local firms.

Restrictions On US Global Health Assistance Reduce Key Health Services In Supported Countries

The 2017 expanded Mexico City Policy prohibits non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. We study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President's Emergency Plan for AIDS Relief (PEPFAR) via a primary survey in all recipient countries and key-informant interviews in South Africa and the Kingdom of Eswatini (May-November 2018). Survey results showed that 28 percent (56 of 198) of organizations reported stopping or reducing at least one service in response to the policy. Reported service reductions included reducing the delivery of information about sexual and reproductive health, pregnancy counseling, contraception provision, and HIV testing and counseling. Interview data highlighted how these reductions were often a result of decreased patient flows or implementation of the expanded policy beyond what is required. Reductions disproportionately harmed pregnant women, youth, and key populations such as sex workers and men who have sex with men. Reduced delivery of sexual and reproductive health services has the potential to negatively affect many intended beneficiaries of PEPFAR funding, especially in areas with high HIV prevalence. Policy makers must respond to disruptions in service delivery and end any implementation that undermines US investment in high-quality HIV and sexual and reproductive health services.

The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. We used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar beneficiaries who remained enrolled in fee-for-service Medicare plans (fee-for-service controls). We then compared three-year mortality and twelve-month utilization rates. Compared with fee-for-service controls, SNP enrollees had lower mortality and lower rates of utilization across the care continuum. These findings suggest that SNPs may be an effective alternative care financing and delivery model for patients with ESRD.

Mapping CRISPR-Cas9 public and commercial innovation using The Lens institutional toolkit

CRISPR-Cas9 is a revolutionary technology because it is precise, fast and easy to implement, cheap and components are readily accessible. This versatility means that the technology can deliver a timely end product and can be used by many stakeholders. In plant cells, the technology can be applied to knockout genes by using CRISPR–Cas nucleases that can alter coding gene regions or regulatory elements, alter precisely a genome by base editing to delete or regulate gene expression, edit precisely a genome by homology-directed repair mechanism (cellular DNA), or regulate transcriptional machinery by using dead Cas proteins to recruit regulators to the promoter region of a gene. All these applications can be for: 1) Research use (Non commercial), 2) Uses related product components for the technology itself (reagents, equipment, toolkits, vectors etc), and 3) Uses related to the development and sale of derived end products based on this technology. In this contribution, we present a prototype report that can engage the community in open, inclusive and collaborative innovation mapping. Using the open data at the Lens.org platform and other relevant sources, we tracked, analyzed, organized, and assembled contextual and bridged patent and scholarly knowledge about CRISPR-Cas9 and with the assistance of a new Lens institutional capability, The Lens Report Builder, currently in beta release, mapped the public and commercial innovation pathways of the technology. When scaled, this capability will also enable coordinated editing and curation by credentialed experts to inform policy makers, businesses and private or public investment.

Open Source Seed, a Revolution in Breeding or Yet Another Attack on the Breeder's Exemption?

The Open Source Seed Initiative was initiated in 2012. Following concerns about the concentration in the seed sector and the rise of patenting, the initiative is "dedicated to maintaining fair and open access to plant genetic resources worldwide in order to ensure the availability of germplasm to farmers, gardeners, breeders, and communities of this and future generations." Inspired by the debate on the anti-commons and the open source software movement, the initiative wants to create a viral system to "free" genetic resources: the use of "freed" genetic resources is made conditional to any materials derived from them being made available under the same "open source" conditions. This would be achieved under a "pledge" (in the USA) or a license contract (in Germany). The objective of this paper is to analyze whether these open source seed initiatives may deliver their goals. We compare the concept with the open innovation character of the plant breeder's rights system, exemplified by the breeder's exemption, and the major other open source initiative in the sector, BiOS. We also present other ways to limit negative impact of the patent system on plant breeding. We conclude that national sovereign rights on genetic resources may challenge the open source goals and that the German initiative may contribute to legal complexities in the seed sector. The open source movement may even contribute to the trend that openness (through the breeder's exemption) is challenged despite the intentions to the contrary. In fact, the initiatives not only free the genetic resource but also treat seeds as a common good. We question the sustainability of the business models for that approach and thus the societal benefits that can be expected from plant breeding, which may illustrate the tragedy of the commons.

Intellectual Property and biodiversity: interplay

Potentially divergent objectives and thereby obligations under the Convention on Biodiversity and Trade-Related Aspects of Intellectual Property Rights Agreement are also reflected in respective domestic legislations in India. The review article focuses on Biological Diversity Act, 2002 vis-à-vis Patents Act, 1970 of India with intricacies involved thereunder. Authors have analyzed the obligations under these domestic legislations. The article goes on to make a few suggestions to aid effective implementation of both the statutes. The scope of this review article is limited in two aspects; first, it speaks only about Indian landscape and second, it discusses about interplay of biodiversity law only with respect to patent law instead of all the domestic Intellectual Property enactments of India.

Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement

OBJECTIVE

The Trans Pacific Partnership Agreement (TPP) is a recently concluded free trade agreement involving Australia and 11 other Pacific-rim nations, which has the potential for far-reaching impacts on public health. A health impact assessment (HIA) was carried out during the negotiations to determine the potential future public health impact in Australia and to provide recommendations to mitigate potential harms. This paper explores the findings and outcomes of the HIA, and how this approach can be used to provide evidence for public health advocacy.

DESIGN

A modified version of the standard HIA process was followed. The HIA was led by technical experts in HIA, trade policy, and health policy, in collaboration with advocacy organisations concerned with the TPP and health. The HIA reviewed the provisions in leaked TPP text in order to determine their potential impact on future health policy. As part of this process, researchers developed policy scenarios in order to examine how TPP provisions may affect health policies and their subsequent impact to health for both the general and vulnerable populations. The four policy areas assessed were the cost of medicines, tobacco control, alcohol control and food labelling.

RESULTS

In all areas assessed, the HIA found that proposed TPP provisions were likely to adversely affect health. These provisions are also likely to more adversely affect the health of vulnerable populations.

CONCLUSIONS

The HIA produced relevant evidence that was useful in advocacy efforts by stakeholders, and engaging the public through various media platforms.

Getting nano tattoos right - a checklist of legal and ethical hurdles for an emerging nanomedical technology

The nano tattoo represents a nascent technology designed to be implanted in the skin to provide continuous and reliable glucose detection for diabetics. Its potential benefits are compelling not only for its ability to prevent diabetic complications and decrease related social costs, but also for its ease of use and relative patient-user comfort. This Note aims to articulate a checklist of fundamental intellectual property, bioethical and system design issues that are appropriately considered in the pre-clinical, pre-commercialization phase of nano tattoo development. Early and regular consideration of these factors can increase the odds of a societally beneficial dissemination of this device by engaging relevant researcher, medical, patient-user and patient-advocate communities concerned with its appropriate application, as well as policymaking communities focused on effectively managing diabetes-related healthcare costs. The checklist of factors includes fundamental issues and is generally applicable to nanomedical inventions.

FROM THE CLINICAL EDITOR

This paper presents a comprehensive list of fundamental intellectual property, bioethical, and system design issues to be considered in the pre-commercialization phase of nanomedicine development, through the specific example of nano tattoo development. Nano tattoo is designed to be implanted in the skin to provide reliable glucose monitoring for diabetics, enabling enhanced prevention of complications and decreased socioeconomic costs.

Does Intellectual Property Restrict Output? An Analysis of Pharmaceutical Markets

Standard normative analysis of intellectual property focuses on the balance between incentives for research and the static welfare costs of reduced price-competition from monopoly. However, static welfare loss from patents is not universal. While patents restrict price competition, they may also provide static welfare benefits by improving incentives for marketing, which is a form of non-price competition. We show theoretically how stronger marketing incentives mitigate, and can even offset, the static costs of monopoly pricing. Empirical analysis in the pharmaceutical industry context suggests that, in the short-run, patent expirations reduce consumer welfare as a result of decreased marketing effort. In the long-run, patent expirations do benefit consumers, but by 30% less than would be implied by the reduction in price alone. The social value of monopoly marketing to consumers alone is roughly on par with its costs to firms.

Patents, priority disputes and the value of credit: towards a history (and pre-history) of intellectual property in medicine

In recent years, intellectual property in medicine has generated much debate, becoming one of the most significant issues in modern day medical ethics and linking in with wider discussions about the commercialisation of medicine and the commodification of the human body. Recent high-profile cases in the USA have centred on gene patenting, that having been enthusiastically practised by universities and biotechnology companies, is now having its legality questioned. The unexpected March 2010 ruling of a federal court against Myriad Genetics, which invalidated the company's patents on the BRCA1 and BRCA2 genes, has highlighted the complexities that now govern the ethical and legal tenure of asserting property rights over biological material.