Mar 18, 2022 7:00 AM

Big Pharma Faces an Ethical Dilemma: Should They Keep Selling to Russia?

Sanctions and boycotts following the invasion of Ukraine have curtailed the export of nearly every product—except medicines. That's up to drugmakers.

In a great corporate exodus, an estimated 400 companies—like Apple, Shell, Starbucks, McDonald’s, and major credit card companies—have severed ties with Russia, suspending or exiting their operations in the country. But one major industry is bucking the trend: Big Pharma.

The pharmaceutical industry is in a tricky ethical spot. To withdraw from Russia would not result in citizens simply losing access to frappuccinos or designer goods. It could mean that cancer patients go without chemotherapy or diabetics without insulin. That is a moral line that so far most drug companies have not been willing to breach.

“Our industry has a unique humanitarian obligation to ensure medicines and vaccines remain available to patients wherever they are. That includes patients in Ukraine, in neighbouring countries, and in Russia,” Andrew Powrie-Smith, executive director of communications at the European Federation of Pharmaceutical Industries and Associations—a trade organization representing the European pharmaceutical industry—told WIRED in a statement.

Put more frankly, “literally if our products don’t get to the patients in need, people will die or have severe consequences,” Joe Wolk, the chief financial officer of Johnson & Johnson, said on March 8 during an investor conference.

Sanctions levied by Western counties—including the United States, the United Kingdom, Canada, and nations in Europe—have targeted Russia’s banks, luxury goods, oligarchs, oil, and gas. But these measures have typically excluded essential goods, such as food and medicine. This means a pharmaceutical company’s decision to boycott Russia is entirely at their discretion. On March 14, Pfizer released a statement that said the company would “maintain humanitarian supply of medicines to Russians,” donating all proceeds to the support of people in Ukraine. To cut off its flow of medicines to Russia would be “in direct violation of our foundational principle of putting patients first,” the statement read. The same day, Bayer released a statement saying the company has an ethical obligation to provide medications—in every country: “Withholding essential health and agriculture products from the civilian populations—like cancer or cardiovascular treatments, health products for pregnant women and children, as well as seeds to grow food—would only multiply the war’s ongoing toll on human life.”

Johnson & Johnson and Roche had previously issued similar statements, and so had US-based drug distributor AmerisourceBergen, which noted its involvement in clinical trials, or tests of new drugs on patients who volunteer. (Ukraine and Russia are both critical centers for such trials, which play an important role in the development of medications and sometimes offer patients a last chance to receive potentially lifesaving treatment.) The company is supporting almost 60 clinical trials in Russia, and it argues in its statement that “immediately halting our operations in the country could, and likely would, amount to punitive action against the most vulnerable.”

Legally speaking, the ball is in pharma’s court, says Emanuela-Chiara Gillard, a senior research fellow at the Oxford Institute for Ethics, Law and Armed Conflict. Companies could choose to pull every type of lifesaving medication they sell from Russia tomorrow, and there would be “no avenue to challenge this as a matter of law because it's at their discretion they choose to trade,” she says.

Tadhg Ó Laoghaire, a researcher in economic ethics at the University of Gothenburg, Sweden, echoes Gillard: “They don't have legal obligations to continue to provide goods to people.” But if they are not technically legally obliged, it’s still the moral thing to do, he continues. Pharmaceutical companies play a very niche role—“it's not like someone else can just step in and fill these human rights.” If they choose to supply essential pharmaceutical goods to Russia, and then pull them away, that's not just letting human rights violations happen, says Ó Laoghaire: “In a very real sense, they're instigating those violations.”

But not everyone thinks the industry has watertight immunity to keep exporting goods to Russia. In a March 11 commentary for industry publication Medscape, Arthur Caplan, a prominent medical ethicist at New York University's Grossman School of Medicine, called for pharmaceutical companies to “follow the lead of other Western companies and suspend their involvement with Putin's Russia.” That means stopping all sales of medicines or therapies, “be they lifesaving or consumer products,” he wrote. “The Russian people need to be pinched not only by the loss of cheeseburgers and boutique coffee but by products they use to maintain their well-being.”

And shortly after the Russian invasion began, hundreds of leaders in biotech (albeit from smaller firms) signed an open letter calling for “immediate and complete economic disengagement” with Russia, including stopping investment in Russian companies, rejecting investment from Russian funds, cutting off collaborative ties with Russian companies, and halting trade in goods with Russian companies. “We must take action to make clear our abhorrence of Russia’s actions,” the letter said.

A few members of the industry have recently announced they will withdraw drugs from export to Russia—but only certain kinds. On March 15, US-based Eli Lilly announced in a statement that it would stop exporting all nonessential medicine to Russia—making the drugmaker the first major pharmaceutical company to restrict the export of certain medicines to the country. What Eli Lilly deems “essential” is up to it to decide. In an email to WIRED, a company spokesperson said essential medicines are treatments for serious and life-threatening diseases like diabetes and cancer; nonessential medicines include Cialis, a drug for erectile dysfunction.

AbbVie, the US drugmaker that makes Botox, issued a statement saying it “has temporarily suspended operations for all our aesthetics products in Russia.” Conformis, a US-based orthopedic medical device maker, said in a statement on March 2 that it was “suspending all distribution operations to Russia and any Russian-based entities” for its products.

Although sanctions typically exclude health-related products, the effects of other economic sanctions, like direct export controls and banking sanctions, are likely to indirectly hamper supplies of medicine. Reports have already emerged from Russia that supplies of drugs such as insulin are running low. Novo Nordisk, a Danish pharma company and one of the world’s largest insulin producers, told Reuters that it will continue to supply medicine to Russia but that its efforts “may be indirectly affected by sanctions in other areas.” In 2019, US sanctions in Iran resulted in allegedly severe restrictions of medicine for Iranian residents, despite exemptions for these goods. So whether sanctions actually carry out their intended purpose—to directly punish the responsible parties while minimizing harm to that country’s citizens—is a bone of contention. “They tend to further entrench political elites,” Ó Laoghaire says. “If resources are scarce, they're going to end up going to the military or the actual elites before they go to ordinary individuals.”

So while the pharmaceutical industry wrestles with its obligations, some ethicists think the answer is clear-cut: Keep the supply lines running. “While I am perfectly happy for Nike not to sell its shoes, I think pharma is in a different place,” Gillard says. “By not continuing to provide medical commodities and equipment, they would, in fact, be punishing the population of Russia, which I think would definitely be very problematic.”