Drug shortages, abusive prices, and stagnating innovation exemplify the serious dysfunctions of the current pharmaceutical system. The commodification of health is fueling both profound suffering and widespread global outrage. Yet, many policymakers, academics, and even activists appear trapped in a neoliberal paradigm that compels them to turn a blind eye to those in urgent need while recycling the same ineffective “solutions”.
In this context, the Johns Hopkins International Conference on Drug Pricing and Affordability, held on February 5, 2025, brought together experts from academia, policy, and industry to discuss critical challenges such as drug shortages, out-of-pocket (OOP) costs, and health technology assessments (HTA). The conference provided a valuable space for dialogue and featured diverse perspectives. However, one crucial topic remained largely absent from the discussions: Public Pharma.
The discussions focused on addressing the urgent need for more accessible medicines, yet often returned to the same fundamental premise: how to improve the system without questioning its core structure. The implicit assumption remained that private sector incentives must be preserved, rather than exploring radical alternatives for research, development, manufacturing, and distribution of health technologies.
The limits of the debate
When addressing the issue of drug shortages, panelists analyzed the vulnerabilities of global pharmaceutical production. They discussed resilience strategies and ways to strengthen supply chains, yet the idea of Public Pharma as part of a structural solution was completely overlooked. Even though one participant raised this issue via the Q&A tool, arguing that public ownership could help “remove the profit motive from what is and is not produced,” the discussion remained centered on adjusting incentives within existing market mechanisms. In general, the panelists emphasized the importance of de-risking private enterprises and persuading private actors to address public health concerns.
Similarly, in debates on out-of-pocket medication costs, the panelists explored strategies to reduce patient expenses, including international approaches to price control and reimbursement policies. However, when the conversation turned to maintaining a balance between affordability and private sector profitability, it exposed a deep-seated issue—the assumption that there is no alternative beyond negotiating within the confines of the current system.
Once again, the proposal of Public Pharma—“as a means to prioritize public health needs, reduce OOP spending, and reduce excessive dependence on the commercial interests of Big Pharma”—emerged from the Q&A box. However, the panelists’ responses were limited to a mix of curiosity, unsubstantiated skepticism, and a clear lack of familiarity with the concept.
Read more: Public pharma infrastructure could give the world access to a treasure trove of medicines
After that, the panelists set out to examine how HTA influences drug pricing and coverage decisions. Prompted by the predominant technocratic tone of the presentations, some of the participants raised questions about the impact of the patent system on HTA. However, the response only reinforced the neoliberal undertone that had characterized the other sessions. The message, in essence, was: “Given that we won’t be getting rid of the patent system anytime soon, we should learn to live with it.” The lack of a more ambitious vision for change reflects the deep-rooted ideological barriers that hinder meaningful progress.
Additionally, when confronted with the outrageous cost of ultra-expensive drugs, the response from panelists appeared largely hopeless. There was an implicit resignation to the reality that certain high-priced therapies will remain inaccessible, with the most optimistic proposals centering on negotiating harder with companies and hoping that, eventually, governments will find ways to provide access to some of these technologies.
Escaping the neoliberal trap
The absence of Public Pharma and the apathetic resignation that shaped the discussion should not be understood as mere oversights. They reflect the neoliberal ideology that dominates mainstream academia, promoting the notion that “There Is No Alternative”. The deeply ingrained belief that public intervention should be minimal and that markets must remain the primary mechanism for researching, developing, manufacturing and distributing health technologies constrains the possibilities for change. This limited vision must be challenged.
That is precisely why the People’s Health Movement (PHM) and its numerous partners have strongly pushed for establishing, protecting, and expanding public pharmaceutical infrastructures worldwide. A recently published position paper outlines PHM’s vision for Public Pharma. Beyond ensuring high-quality standards, sustainability, and transparency, it serves as a means to counter capitalism and imperialism’s harmful effects on global health and society.
In this sense, PHM argues that now is the time for collective political action—through grassroots mobilization, public advocacy, and direct engagement with policymakers—to advance Public Pharma. For example, within the Public Pharma for Europe coalition, we have joined forces with organizations, activists, and academics to advocate for solutions based on solidarity—rejecting a system where access depends on corporate goodwill.
Read more: Public Pharma vs. abusive prices: the case of the latest HIV-prevention drug
As part of the mission to revive Public Pharma as part of the solution to the failures of Big Pharma, we must point out the deliberate neglect of this agenda. Although the Johns Hopkins conference highlighted the deep structural challenges of the current system and sparked an essential debate, it fell short of fulfilling academia’s much-needed imaginative role and failed to explore long-term solutions that genuinely address the immediate needs of the population.
After all, a pharmaceutical system that truly serves public health requires more than just fine-tuning market incentives. Only through cooperation, public investment, and a shared commitment to equity can the constraints of the neoliberal model be dismantled—paving the way for a future where access to health technologies is a right, not a privilege.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here.
