University of California's Role in Global Health Equity

The student gatherings, protests, and encampments occurring across the country demonstrate a clear disconnect between the values of universities and those of their students. Students are challenging their universities to reflect the values they believe matter. Universities play an essential role in the development of new technologies and healthcare; however, the complex business streams that universities use do not always best serve societal interests. Universities and the pharmaceutical industry have become increasingly intertwined, raising complex ethical questions regarding how universities are supporting global health equity. Now is the time for universities to renew their focus on becoming a driving force in ending global healthcare apartheid.

Global health equity refers to the principle and practice of ensuring fair and just access to healthcare resources, services, and opportunities for all people, regardless of their geographic location, socio-economic status, race, gender, or other factors. It aims to eliminate disparities in health outcomes and to provide every individual with the opportunity to achieve their highest possible standard of health. This involves addressing social determinants of health, reducing barriers to care, and promoting policies and practices that ensure all populations receive equitable treatment and support. University research is often the starting point for medical innovation. However, the market consistently under-supplies ‘public goods.’ Between 2009 and 2014 most cancer drugs were priced at more than $100,000 per patient, per year, even though many cancer drugs started as publicly funded research projects at universities (9). In 2024, researchers from Yale and Kings College alongside Doctors Without Borders discovered that Ozempic (Semaglutide), made by Novo Nordisk, could be manufactured for close to $5 per patient, per month, instead of the nearly $1,000 per patient per month which it currently costs without insurance (1). Pharmaceutical companies justify elevated prices, because drug development requires capital-intensive resources over a long period of time before possibly achieving market approval. Although the more cost-efficient method cannot necessarily be applied to all drugs in the marketplace, pharmaceutical companies must deprioritize making a return on investment. The pharmaceutical industry should instead prioritize making medicines accessible to the people who need them the most. The University of Toronto’s exclusive licensing of the GLP-1 hormone, Ozempic’s ‘active ingredient’, to Novo Nordisk displays that universities are failing to collaborate to impose equitable drug pricing. 

Universities that utilize equity driven initiatives promote global health and allow for collaboration between academia, industry, and public health agencies like the National Institute of Health (NIH). The required change is to impose restrictions on the pervasive influence of pharmaceutical marketing, to create sustainable funding models, and for institutions to prioritize social impact over financial gain. Universities should consider ‘patient capital’ as their main priority when licensing their patents. ‘Patient capital’ refers to a long-term financial investment that prioritizes social or environmental impact alongside financial returns, often requiring an extended period for the investment to mature or generate significant profits (4). Addressing the challenges of the for-profit relationship between universities and, specifically, ‘big pharma’ requires a paradigm shift in the values and priorities of stakeholders.

Yale’s handling of the drug Stavudine (d4T) in the 1990s prioritized financial gain over the public good, compromising patient capital for the profit shares of their stakeholders. In the 1980s during the AIDS epidemic, William Prusoff and others at Yale University discovered the anti-HIV properties of Stavudine. Yale patented their research, which gave them exclusive rights to its use. Subsequently, a single drug company Bristol-Myers Squibb was awarded an exclusive license to utilize the patented research in exchange for an undisclosed financial compensation (11). Bristol-Myers Squibb then proceeded to conduct testing, development, and commercialization of the new HIV/AIDS treatment Zerit. In 1992, the US Food and Drug Administration (FDA) granted Stavudine, a unique designation which allowed patients access to the drug before official approval (11). At the time Stavudine was among the few antiviral treatments for HIV available during the 1990s. However, due to its exclusive rights, Bristol-Myers Squibb set a prohibitively high price of $1,600 per patient, per year, for their drug, Zerit (11). Consequently, millions of HIV/AIDS patients were unable to afford this potentially life-saving medication. Tens of thousands died as a result ≥. Médecins Sans Frontières (MSF), Doctors Without Borders, discovered an Indian supplier, Cipla, willing to offer Stavudine in South Africa at $40 per year per patient (6). However, this arrangement collapsed because Yale held a patent for Stavudine in South Africa and refused to grant a license to the Indian generic manufacturer. In solidarity with MSF, Yale students proposed pressuring Bristol-Myers Squibb to reduce Stavudine’s prices in South Africa or grant patent licenses to generic manufacturers. Following public awareness of the issue, Bristol-Myers Squibb announced it would not enforce the medications patent in South Africa and would offer Zerit in sub-Saharan Africa for $55 per year (6). Students and nonprofit organizations were the driving factor in making Stavudine accessible to the patients who needed it the most. Limiting access to medication is not unique to a nearly 80-year-old AIDS medication; Standuvine showcases the role of students that worked with their universities to ensure global health equity.

The patenting of research by universities presents an ethical dilemma with significant implications for global health equity. Patents confer exclusive rights to universities, allowing them to monetize their research through licensing agreements with pharmaceutical companies (9). This results in high-priced medications that are inaccessible to millions of patients, particularly those in low- and middle-income countries (LMICs). This scenario exemplifies the tension between profit-driven motives and public health imperatives. To create lasting and impactful change, universities should selectively seek and enforce research patents primarily in high-income countries. Specifically, when licensing research to a drug company, universities must opt for non-exclusive agreements or restrict licenses to high-income nations. For example, in LMICs where patent or licensing restrictions are absent, particularly in regions such as Madagascar and India, generic pharmaceutical companies can manufacture new treatments at substantially reduced costs (2,12). Patent licensing exclusivity is not an advantageous approach for any research institute, because patent exclusive licensing decreases scientific creativity while simultaneously limiting scientific investigation. Patenting was created to not only protect the inventor’s right to their intellectual property (i.e. claim an invention), but also as a means for enabling inventors to disclose their creations. The dual function of patents encourages other inventors to create while simultaneously encouraging access to information.

It is crucial for universities to fully support social benefits to the public sector and help contribute to the enhancement of overall population health. Strategies aimed at enhancing treatment accessibility necessitate a direct approach, including the implementation of “Dual Markets,” restructuring the value chain, reducing domestic research and development costs, as well as ensuring a public return on investment ‘ROI’ for drugs already supported through taxpayer-funded development. Dual markets refer to a strategy in which pharmaceutical companies create two distinct pricing models for their products: one for high-income countries and another for LMICs. This approach makes essential medications more affordable and accessible in poorer regions while maintaining profitability in wealthier markets. The dual markets strategy recognizes the differing economic capacities of various regions and seeks to balance commercial interests with the need for equitable access to healthcare. Restructuring the value chain involves optimizing the development, manufacturing, and distribution processes of pharmaceuticals to reduce costs and enhance efficiency. This approach includes streamlining research and development, improving manufacturing scalability, refining supply chain logistics, partnering with generic manufacturers, and adopting innovative pricing models, ultimately lowering market costs, and increasing access for patients, especially in low- and middle-income countries. However, in places where local medicines can be grown, there is typically a population that is predominantly composed of subsistence farmers (12). Thus, there is a reduced motivation to grow medicinal plants rather than subsistence crops. The drive for profit appears to be universal but comes at the expense of the welfare of populations who do not have access to essential medicines. Universities that accept funding from the NIH should act in the interest of promoting public health since citizen taxes sustain NIH funding. Between 2010 and 2019, the NIH provided funding for 354 out of 356 drugs approved by the FDA, accounting for 99.4% of the total brought to market (5). This funding amounted to $187 billion, with an average of $1344.6 million per target for basic research on drug targets, and $51.8 million per drug for applied research on products (5). It is unfair that people who need medications still need to pay for them both indirectly and directly; often at a price that is inflated by pharmaceutical companies. It is in the best interest of universities to ensure that equitable measures are being practiced when licensing technology or healthcare. 

Dr. John C. Mazziotta, CEO of UC Los Angeles Health, spearheaded the implementation of an equitable licensing practice in early 2020 within UCLA’s Technology Development Group (UCLA TDG) (15). Dr. Mazziotta and his colleagues created a provision in patent license agreements for UCLA’s biopharmaceutical innovations which required licensees to develop and implement an “Affordable Access Plan” (AAP) (15). The AAP provision aimed to encourage licensees to support affordable access to UCLA patented drugs in LMICs upon receiving FDA approval, potentially through collaboration with governments and non-profit organizations. UC Berkeley followed UCLA’s lead by also adopting the “Affordable Access Plan” in April of 2023 (2). The end result of these initiatives is millions of patients in developing regions are empowered. These ethical policies are therefore more likely to align with the values of the students attending these universities. This is a result of the kind of socially responsible actions that should be taken by all universities. The significant socioeconomic benefits stemming from these endeavors are remarkable and are the type of actions that students are pleading for their universities to take. UCLA and UC Berkeley are shining examples of the action students want to see their universities taking. These equity health measures would produce more of a global impact if they were also adopted by all UC schools but especially those that have medical campuses, like UC Irvine, UC San Francisco, and UC San Diego.

Now is the time to work with our universities to renew the emphasis on maximizing social returns and ensuring equitable access to healthcare innovations. Universities must lead by example in ethical business practices. The public needs universities to be a driving force in ending global healthcare apartheid. Global health equity is essential to preventing and stopping the next pandemic as well as to lifting millions of people out of poverty. The entire University of California system must adopt a universal UC Patent Policy that ensures equity when making patent agreements. Universities must play a role in enhancing global health accessibility and should ensure that their values are in line with those of their student population. Universities can mitigate the potential for future student unrest by actively embodying and promoting the principle of universal health and well-being.