The frantic global effort to develop a Covid-19 vaccine has been overwhelmingly bankrolled by the public sector, but the pharmaceutical companies involved still managed to secure intellectual property protections in the form of patents that mean they get to decide who gets access, and at what price.
It’s a grim re-run of the AIDS crisis, during which Big Pharma prevented developing countries from buying generic HIV treatment: yet again, the majority of the world’s population are losing out on access to a vital medical technology because vaccines go to those with the deepest pockets, not the greatest need.
Monopolies have a deadly track record of undermining our right to health. But they’re great for corporations: sales of Covid vaccines could hit $40bn this year, according to some industry analysts, and drug company execs have already been cashing in shares boosted by positive vaccine trial news, with Pfizer CEO Albert Bourla alone making $5.6m in a single day.
So we should be deeply concerned to learn that Amazon, the gargantuan tech company that doubled the wealth of its CEO during the pandemic to over $200bn, is mulling a further expansion into healthcare in the UK – setting up to supply prescription medicines in competition with your local pharmacy.
Jeff Bezos became the world’s richest man thanks to the monopoly position Amazon holds in the online retail space and its ruthless approach to workers’ rights. They were well positioned to profit from Covid as the world locked down and shops closed. But the firm’s power increasingly comes from the data we generate about ourselves and share with it every time we engage with its products and platforms – so this move into the pharmacy market should spark concern on multiple levels.
At perhaps the simplest but most tangible level, local, independent pharmacies – already struggling to survive on high streets across the country – will fear that the scale, convenience, and deep pockets of Amazon mean a further devastating decline in their business. The loss of a pharmacy from a high street isn’t just about the economic costs for all involved, it’s the loss of a key part of the health infrastructure communities rely upon to get confidential and professional advice about their health without having to see a GP. Vulnerable groups like the elderly and people who use drugs will feel this loss most keenly.
But Amazon is not simply adding another category of products to its online store. They have already made in-roads into the healthcare market in the UK and US, exploring a range of overlapping services, products, and functions. Each gifts them another data set by which to hone their algorithms, which are used to encourage us to hand more of our cash over.
Amazon has a number of existing agreements with the NHS, including controversial free access to NHS information that allows users of its voice-activated AI assistant to get NHS-written advice by asking: ‘Alexa, should I be worried about this lump on my chest?’ The deal—which excludes patient data—also allows Amazon to share the information with third parties and use it to develop its own commercial products.
But while this deal didn’t transfer patient data from the NHS to Amazon, it has made it easier for them to gather huge amounts of highly sensitive health data directly from individuals. Combine that data with all the other information Amazon holds on us, and add in whatever it might glean from the medicines it delivers to our door, and we begin to see the value of the information they are accruing about our health – information that could help them to sell products or tailored health insurance to us, or guidance on who should and shouldn’t get access to a health service based on their risk profile to the government.
Amazon is also helping the NHS to handle our Covid data – another controversial agreement which the government only revealed information about under threat of legal action from digital rights group Foxglove and openDemocracy. It also has a raft of investments in diagnostics and health-focused AI firms and technologies in the US and around the world. Search ‘Amazon revolutionise healthcare’, and you get page after page of hits detailing their grand, transformative plans to shake up how health technology is developed, how care is delivered, and how health systems are organised and paid for.
It would be wrong to say that this is without hope – we could see important benefits for patients and NHS staff from some of these new technologies. But we are in the Wild West of health, big data, and tech. Artificial intelligence promises much but has so far delivered relatively little outside reasonably straightforward analysis of diagnostic scans. Nonetheless, fantastic amounts of money are being invested by huge players like Amazon as they race ahead of regulatory oversight. Decisions are being made with far-reaching consequences about the level of involvement and control they have within our NHS, with virtually no public understanding or accountability.
The ethical considerations of this big tech takeover are complex – from personal data rights through to racist algorithms that reinforce societal prejudice. But having witnessed the cruel consequences of drug company monopolies on patients in the UK and around the world for decades, we should be extremely concerned about allowing new monopoly players to establish themselves within the heart of the Health Service, which they may well transform. As Cori Crider of Foxglove said, once they get in, ‘it will be harder and harder to get them out of there.’
That’s why Just Treatment is calling for the creation of a series of new safeguards for our health data as part of a New Deal for the NHS – a set of demands crowdsourced from patients across the UK in response to the Covid crisis. The NHS should be building its capacity to develop and implement these technologies itself, retaining ownership and control, and establishing health data trusts acting in the interests of patients – not Jeff Bezos and Amazon’s shareholders.
The ease of Alexa sorting a next-day delivery of a repeat prescription may be irresistible for many – but the package is likely to be a Pandora’s box for the NHS that is best left unopened.