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Penicillin the right prescription for Canada in pandemic agreement negotiations

Instead of undermining technology transfer provisions, Canada once played a key role in disseminating breakthrough medical technology

April 30, 2024

5-minute read

Beginning on May 27, the member states of the World Health Organization (WHO) will meet for the annual World Health Assembly, the WHO’s highest decision-making body. It is anticipated—though not yet fully certain—that states will have the opportunity to adopt the finalized Pandemic Agreement, which member states have been negotiating since 2021 and whose goal is to create an “international instrument” under the WHO in order to “strengthen pandemic prevention, preparedness and response” in the aftermath of a lack of coordination in the global response to COVID-19.

Few observers are expecting the agreement to live up to early hopes and expectations, especially when it comes to ensuring equitable global access to vaccines and other health tools. One of the key sticking points in the negotiations has been the issue of transferring technology to ensure that enough manufacturers can produce sufficient quantities of vital medicines and vaccines for the entire world. 

Canada has been amongst the countries seeking to undercut such measures, repeatedly insisting that technology transfer under the agreement should only be on “voluntary and mutually agreed terms” with pharmaceutical companies—even where the products in question were discovered and developed with considerable investment of public funds.

Yet Canada has offered no answer for what happens when no such terms are reached on a voluntary basis. From COVID-19 to HIV, far too many examples demonstrate that relying on voluntary actions by the pharmaceutical industry to ensure access—particularly for lower-income countries, and for lower-income people—simply will not work.

Tech transfer was not always a matter of such contention amongst WHO member states. At the Second World Health Assembly in 1949, member states resolved that “any withholding of scientific or technical information on essential therapeutic and prophylactic drugs, in selling or otherwise supplying nations with the means for their production, or withholding the free exchange of medical scientists, is not compatible with the ideals of the World Health Organization and is against the interests of humanity.” Canada was at the forefront of disseminating technology for the breakthrough medical innovation that underpinned this resolution—penicillin.

While a fair number of people might correctly identify Alexander Fleming as the discoverer of penicillin, fewer are aware he shared his Nobel Prize for its discovery with Howard Florey and Ernst Chain, whose subsequent discoveries were vital for its production on a large scale. Their successful efforts in scaling up penicillin production ultimately required dedication of resources and open collaboration between governments and the pharmaceutical industry extending across national borders. In turn, the resulting technological developments could be shared with still further parties still further afield.

This climate of collaboration came in the context of WWII, where this new wonder drug could, and ultimately did, save untold lives on and off the battlefield. Developing penicillin production was a multinational effort among Allied powers—while Florey was based in the United Kingdom, it was in the United States that efforts towards mass production really took hold. This collaboration spilled over into Canada, closest neighbour of the US and still closely tied to the UK. As a result, by the end of WWII, penicillin production was well-established in the United States, the United Kingdom, and Canada.

By the war’s end, much of Europe was in ruins and in dire need of support of all kinds—including access to this amazing medical discovery. To this end, the United Nations Relief and Rehabilitation Administration (UNRRA), an international relief agency that actually predates but would be folded into the nascent United Nations (UN), included this drug in its assistance to war-torn Europe. The impact of this aid is memorably reflected in the schemes of the villainous Harry Lime, played by Orson Welles in the classic post-war noir The Third Man, which revolve around a black market penicillin ring in the rubble of Vienna.

The need for the first truly effective antibiotic was so great that simply supplying the drug itself was not enough. The UNRRA embarked on a program to transfer the technology to countries such as Italy, Poland and Czechoslovakia that did not yet have the ability to make penicillin themselves.

However, even as one war ended, another conflict was beginning, as the Iron Curtain descended upon Europe. The United States, for both political and commercial reasons, became increasingly reluctant to share technology directly with its wartime ally the Soviet Union and other members of the emerging Eastern bloc.

It was into this void that Canada stepped, asserting an increasing international role under the aegis of future Prime Minister Lester B. Pearson, who had represented Canada while serving as Chairman of the Committee on Supplies of the UNRRA. The result was that the bulk of UNRRA training to transfer penicillin production technology was conducted in Canada.

This training occurred at Connaught Laboratories, most famous as the site of another vital medical discovery—insulin—but also a key producer of drugs and vaccines for both domestic and international use. The impact of its role is reflected in the fact that the facilities ultimately constructed for penicillin production with UNRRA assistance were modelled on the Canadian facility. Thus, Canada played a crucial role in the global dissemination of the production of one of history’s most important medical discoveries.

Unfortunately, the international spirit of treating withholding tech transfer as “against the interests of humanity” did not last. The WHO’s inaugural Director-General, the Canadian Brock Chisholm, remarked upon the split between countries over the ongoing role the WHO should play in ensuring access to tools like penicillin during peacetime. This fracture was a key motivation behind the Soviet Union and its allies withdrawing from active participation in the WHO shortly thereafter (though they returned some years later).

Today, Canada is far from demonstrating the same global leadership it did in the post-WWII era. Canada has been reluctant to even publicly acknowledge, let alone discuss, the position on tech transfer that has been readily apparent in its negotiating positions. But if Canada ever gains the will to reconsider its position, it now also has the means to do so.

For the first time since the 1980s, when Connaught Labs was fully privatized, Canada once again has publicly owned pharmaceutical production facilities. Of course, simply having publicly owned facilities is not enough, as Connaught’s questionable and sometimes controversial tenure under federal ownership as part of the explicitly profit-oriented Canada Development Corporation demonstrated. Fortunately, in this regard, the new Biologics Manufacturing Centre (BMC) in Montreal explicitly has a public good mandate.

Unfortunately, although construction was completed in 2021, and the BMC was fully licensed by Health Canada in 2022, thus far this facility has produced nothing at all. The current model of operation for the BMC, which has been to contract out the facilities to pharmaceutical companies rather than use them to fill the gaps in access, at home and abroad, left by those same companies has been a failure. It would be entirely within the BMC’s mandate to shift gears and take up the mantle of Connaught Labs, not only by producing crucial drugs in the public interest but using the production process to aid tech transfer to ensure the rest of the world can do the same.

Rather than letting these publicly owned facilities sit unused, Canada should reinvigorate the world-leading approach to tech transfer it showed with penicillin—and, much as with penicillin, administer a curative shot in the rear to equitable access.

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