“Sentimos que era nosso dever começar a desenvolver esse tipo de alternativa”, diz o professor Kalle Saksela, chefe do Departamento de Virologia da Universidade de Helsinque. “Na primavera, eu ainda pensava que alguma entidade pública certamente se envolveria e começaria a levar isso para a frente. Acontece que nenhuma situação é urgente o suficiente para obrigar ativamente o Estado a começar a buscar algo como isso.”
O time de Saksela possui uma vacina contra Covid-19 sem patente pronta desde maio de 2020, que eles apelidaram de “o Linux das vacinas” em uma homenagem ao famoso sistema operacional de código aberto que também se originou na Finlândia. O trabalho é baseado em dados de pesquisa disponíveis publicamente e no princípio de compartilhar todas as novas descobertas em periódicos revisados pelos pares.
A equipe de pesquisa inclui alguns pesos-pesados científicos da Finlândia, como Seppo Ylä-Herttuala, professor da Academia do Instituto Al Virtanen, um ex-presidente da Sociedade Europeia de Terapia Genética e Celular, e acadêmica Kari Alitalo, membra associada estrangeira da Academia Nacional de Ciências, dos Estados Unidos. Eles acreditam que seu spray nasal, baseado na tecnologia e know-how bem estabelecidos, é seguro e altamente eficaz.
“É um produto finalizado, no sentido de que a formulação não mudará com mais testes”, diz Saksela. “Com o que temos, podemos inocular toda a população da Finlândia amanhã.”
Mas, em vez de explorar o potencial de uma pesquisa sem propriedade intelectual, a Finlândia, como outros países ocidentais, continuou a seguir a política padrão das últimas décadas: apoiar-se totalmente na industria farmacêutica.
Na narrativa principal, as vacinas contra Covid-19 dos primeiros lotes da Pfizer, Moderna e AstraZeneca são normalmente apresentadas como uma ilustração de como os mercados incentivam e aceleram inovações vitais. Na realidade, o fato de que a motivação do lucro é a força dominante que molda a pesquisa médica tem sido devastador – particularmente em uma pandemia global. A vacina finlandesa fornece um estudo de caso notável das muitas maneiras pelas quais o modelo contemporâneo de financiamento baseado em patentes retardou o desenvolvimento de vacinas e como atualmente dificulta a possibilidade de conduzir campanhas eficazes de inoculação em massa.
Propriedade intelectual privada
A necessidade de descobrir o próximo produto inovador patenteado causa muitos efeitos corrosivos na pesquisa. Incentiva as empresas a ocultar suas descobertas umas das outras e da comunidade científica em geral, mesmo às custas da saúde humana. O modelo de “código aberto” livre de propriedade intelectual visa reverter isso e transformar a pesquisa em um esforço colaborativo multilateral, ao invés de uma corrida para inventar ou reinventar a roda.
Quando se trata de Covid-19 especificamente, o impacto estagnante do modelo de financiamento contemporâneo é sentido de forma mais aguda nos estágios finais: obter a aprovação do produto acabado e colocá-lo em uso. O tempo perdido durante os primeiros dias da pandemia devido à falta de colaboração e segredos comerciais, aponta o virologista Saksela, é relativamente insignificante. Na verdade, o desenvolvimento das primeiras doses contra Covid-19 foi direto.
“A pesquisa de fundo foi concluída em uma tarde, o que deu rumo a todos eles”, diz Saksela. “Com base no que já sabemos sobre SARS-1 e MERS, tudo era bastante óbvio – não um triunfo da ciência.” Em vez de introduzir um germe inativo ou enfraquecido no corpo humano, as novas injeções de coronavírus treinam nosso sistema imunológico para responder a uma “proteína de pico” – em si mesma, inofensiva – que forma as protrusões necessárias na superfície do vírus.
O amplo entendimento compartilhado desse mecanismo é anterior às contribuições das empresas farmacêuticas. Isso levanta questões sobre o impacto da pesquisa de patentes no produto final. Até que ponto o trabalho é orientado pela eficácia médica e quanto se baseia na necessidade de manter a propriedade?
“Empresas diferentes de biotecnologia aplicariam a proteína de pico em algum tipo de mecanismo de entrega, fosse tecnologia de RNA ou outra coisa”, explica Saksela. “E, normalmente, a escolha é baseada nas quais têm uma patente, seja a melhor opção ou não.”
O modelo contemporâneo de financiamento da pesquisa farmacêutica está quase inteiramente preso a essa expectativa, e é aqui que um produto médico sem propriedade intelectual se depara com sérios obstáculos.
A vacina finlandesa usa um adenovírus para transportar as instruções genéticas para sintetizar a “proteína de pico”. Uma de suas vantagens práticas é que, ao contrário da tecnologia de RNA baseada em nanopartículas lipídicas, ela pode ser armazenada em uma geladeira comum, potencialmente até em temperatura ambiente. Isso torna a logística de entrega mais fácil e barata, sem a necessidade de armazenamento ultra-frio. Além de sua estabilidade e conveniência para aplicação nasal, a vacina pode ter outras qualidades superiores a muitas atualmente no mercado, acredita a equipe de Saksela. “Para interromper totalmente a propagação do vírus e eliminar novas mutações, precisamos induzir imunidade esterilizante”, o que significa que o vírus não se replicaria mais no corpo de uma pessoa saudável. Testes preliminares com animais e pacientes parecem confirmar que o spray nasal faz isso. “Com cerca de metade das pessoas expostas, mesmo que não tenham sintomas, você descobre que o vírus ainda está presente no sistema respiratório superior. Então, mesmo que esteja saindo, ainda pode correr descontroladamente pela porta da frente, tornando seu sistema imunológico uma espécie de parceiro de treinamento.”
Mas se a vacina for tão boa quanto anunciada, o que a impede de circular? Fora da indústria farmacêutica e do capital de risco, poucos mecanismos permanecem para garantir o financiamento para testes de pacientes em grande escala, necessários para levar uma vacina além da linha de chegada. As patentes são monopólios sancionados pelo Estado que prometem retornos potencialmente massivos sobre o investimento. O modelo contemporâneo de financiamento da pesquisa farmacêutica está quase inteiramente preso a essa expectativa, e é aqui que um produto médico sem propriedade intelectual se depara com sérios obstáculos.
Um ensaio clínico de Fase III requer dezenas de milhares de seres humanos e custaria cerca de 50 milhões de dólares. Mas considerando que, apesar do sucesso relativo da Finlândia no controle do vírus, o país já teve que pedir emprestado um adicional de 21 bilhões de dólares para sobreviver, a soma começa a se parecer mais com uma gota no oceano – somando cerca de um quarto de 1% da dívida pública induzida pela pandemia até agora. O número se torna absurdamente pequeno quando comparado com a perda de vidas e a devastação econômica no mundo todo.
O Estado abre caminho para o lucro privado
Essa situação é especialmente absurda quando consideramos que a chamada pesquisa farmacêutica privada é, ela própria, financiada majoritariamente pelo governo. A Moderna recebeu 2,5 bilhões de dólares em ajuda do governo e ainda tentou enganar os compradores com preços exorbitantes. A Pfizer se gabou de não ter recebido dinheiro do contribuinte, mas essa campanha de relações públicas tem pouco a ver com a realidade: a vacina é baseada em aplicações de pesquisas públicas desenvolvidas pela empresa alemã BioNTech, que recebeu apoio adicional do governo no valor de 450 milhões de dólares.
Esses números são apenas a ponta do iceberg quando consideramos o capital que os países investem anualmente em universidades, instituições científicas, educação e pesquisa básica. É assim que o corpo de conhecimento e know-how que controla toda a inovação é construído.
“Por exemplo, temos esses novos tipos de medicamentos biológicos, relacionados às vacinas no sentido técnico-científico, produzidos com o mesmo tipo de tecnologia de DNA, cujo preço é comparável à extorsão”, diz Saksela. “É muito triste. Qualquer que seja o valor que você pode extorquir de uma pessoa ou do Estado dita o custo. E, claro, em última análise, baseiam-se em pesquisas com financiamento público, como é o caso das vacinas.”
Em outras palavras, estamos pagando duas vezes pela mesma injeção: primeiro pelo desenvolvimento, depois pelo produto acabado. Mas pode haver até um terceiro preço, uma vez que os governos concordaram em assumir a responsabilidade pelos potenciais efeitos colaterais das vacinas contra o coronavírus. Esta é uma dinâmica típica entre grandes corporações e Estados: os lucros são privados, os riscos são socializados.
“E, no entanto, quando tentei defender que a Finlândia desenvolvesse sua própria vacina, este é o principal argumento que sempre ouço: que você precisa ter uma entidade com as costas largas o suficiente para assumir o risco”, diz Saksela. “Mas isso tudo é conversa fiada, já que as empresas estão exigindo e recebendo isenção de qualquer responsabilidade.”
O sistema atual baseado no monopólio de patentes é um desenvolvimento relativamente recente, não possui nenhum efeito colateral inevitável do capitalismo. Até o final da década de 1940, os governos financiavam principalmente a pesquisa médica, enquanto o papel das empresas farmacêuticas se limitava principalmente à fabricação e venda de medicamentos. Hoje em dia, os governos apoiam as empresas com vários subsídios e privilégios monopolísticos.
O dano vai muito além da escassez e dos preços altos. Por exemplo, parar uma doença que avança é um mau negócio. Em um caso famoso, a empresa de biotecnologia Gilead viu seus lucros caírem em 2015-16 como resultado de seu novo medicamento para Hepatite C – porque acabou curando totalmente a maioria dos pacientes. A mesma estrutura perversa de incentivos sabotou os esforços para criar vacinas preventivas, apesar das chamadas urgentes de especialistas em saúde pública nos últimos vinte anos.
Ao investir em pesquisas preditivas, o surto poderia ter sido interrompido na China. Em uma entrevista para o New York Times, o professor Vincent Racaniello, do Departamento de Microbiologia e Imunologia da Universidade de Columbia, disse isso sem rodeios: “A única razão para não termos feitos isso foi porque não havia apoio financeiro suficiente.” O ecologista de doenças e especialista em saúde pública Peter Daszak concorda: “O alarme disparou com a SARS e apertamos o botão de soneca. E então pegamos de novo com o Ebola, e MERS e com Zika.”
Infelizmente, ainda não há muitos sinais de que os líderes políticos estão acordando. Há uma escassez desesperada de vacinas, enquanto as empresas farmacêuticas lutam para acompanhar suas próprias estimativas de produção. Este é um resultado direto não apenas da santidade das patentes, mas de como o jogo é manipulado contra soluções criadas fora de um sistema voltado para o lucro. Como as vacinas só podem ser produzidas em laboratórios de proprietários ou autorizados pelos detentores de patentes, a maioria das fábricas farmacêuticas do mundo está ociosa. Uma solução de emergência proposta pela Índia e África do Sul, apoiada na Organização Mundial do Comércio (OMS) por uma maioria de governos do mundo, buscou suspender os direitos de propriedade intelectual sobre as vacinas contra Covid-19. Os países ricos, liderados pelos Estados Unidos e pela União Europeia, recusaram categoricamente.
Enquanto isso, as nações ricas fizeram a maior parte de todas as encomendas de vacinas. Ética à parte, esta é uma forma catastrófica de combater uma pandemia. Para começar, quantidades inadequadas de vacinas estão sendo produzidas e distribuídas com base na riqueza, e não em uma política de saúde pública. Até mesmo os países ricos acabam dando um tiro no próprio pé, já que o vírus continua se espalhando e se transformando em quase todo o globo.
Dentro dessa hierarquia global, a Finlândia está entre os países mais privilegiados. Mas o gargalo na produção de vacinas está tendo um efeito adverso em todos, inclusive neles mesmos. Como o professor Saksela enfatiza, é crucial começar a levar a preparação a sério, tanto em nível nacional quanto global. O mundo está longe de controlar a pandemia atual e o triste fato é que a próxima é apenas uma questão de tempo.
“O fato de tudo depender das forças do mercado é um sinal dos tempos atuais”, diz Saksela. “Se essa é uma abordagem totalmente sabida, deve ser pelo menos cuidadosamente considerada.”
Paraíso social-democrata?
A Finlândia é retratada frequentemente na mídia internacional como a terra nórdica dos sonhos. Durante a pandemia, seu novo governo de esquerda impulsionou ainda mais a imagem progressista do país. Espera-se que tal governo seja o defensor mais óbvio da tecnologia de vacinas financiada publicamente e livremente compartilhada. Mas as últimas décadas – a era do neoliberalismo – mudaram drasticamente o cenário.
Espelhando uma tendência geral entre seus homólogos, o Partido Social-Democrata, que está no poder, começou a se remodelar na década de 1990 após o Novo Trabalhismo de Tony Blair e os Democratas da era Clinton. Em 2003, o programa nacional de desenvolvimento de vacinas foi interrompido, após 100 anos em operação, sob um ministro da saúde social-democrata, abrindo caminho para empresas farmacêuticas multinacionais.
Embora a vacina tenha recebido muita atenção na mídia finlandesa, com uma oposição muito mais hostil ao setor público do que aos partidos no poder, há pouco debate sobre ela com os políticos do establishment. Em vez de financiamento estatal direto, Saksela e seus colegas receberam um conselho do Ministério de Assuntos Sociais e Saúde: que estabelecessem uma startup e começassem a cortejar capitalistas de risco.
Saksela ainda tem esperanças de que eles possam garantir o financiamento necessário. Mas significou abraçar, pelo menos em parte, a lógica confusa de pesquisa científica orientada para o mercado: por melhor que seja o seu produto, a menos que você pretenda ganhar dinheiro, será muito difícil sair do papel.
“Um teste de Fase III ainda renderá propriedade intelectual em torno de nossa vacina, que acreditamos ser potencialmente lucrativa”, diz Saksela, “mesmo que ela não tenha um lucro para ser explorado”.
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