How a MacArthur 'genius' fights patents to ensure access to medicines

Early in her career, Priti Krishtel spent much of her time visiting end-of-life care facilities. What she saw would shape her trajectory as a health justice lawyer fighting the global patent system to give patients in low-income countries access to lifesaving medications.

After moving from the United States to India two decades ago and leading a team of lawyers representing HIV-positive clients in court, she saw a pattern repeating itself: a diagnosis was a death sentence. Antiretroviral therapies that were available and affordable in wealthier parts of the world were totally out of reach for her clients. Many parents who were infected would sign over their children to orphanages.

The daughter of a pharmaceutical scientist who worked for drug companies, Krishtel grew up holding the patent system in high regard. But she later learned how drug companies have teamed up with lawyers and lobbyists to “game the system,” finding loopholes in U.S. patent laws to block competition, create patent monopolies for certain medicines, and sell them at high prices both in the U.S. and abroad.

This early work in India “left a permanent mark on my heart,” Krishtel said. “It was personally gut-wrenching for me to know that the drugs had come to market, but they just weren’t getting to the people who needed them, and there was such a huge time lag in making that happen.”

Seeing her clients in India die preventable deaths as a result of this system led her to co-found the Initiative for Medicines, Access, and Knowledge, or I-MAK. Since 2006, the nonprofit has fought for health equity in drug development and access on behalf of low-income patients. She and her co-founder, Tahir Amin, an expert on intellectual property law who formerly represented big corporations, lead a team of lawyers, scientists, and other health experts to take on the patent system.

"The patent system was intended to motivate people to invent by giving them a reward of a time-limited monopoly,” Krishtel said. “But in the last 40 years, that intention has been distorted beyond recognition."

Last month, Krishtel was selected as a 2022 MacArthur Fellow, an $800,000 grant from the MacArthur Foundation that is commonly referred to as “the genius prize.”

She sees it as validation for the work she and many others have done.

“This is the fuel we needed to make the change,” she said. “For the MacArthur Foundation to come forward and say, ‘This movement is worth paying attention to,’ this is going to accelerate our progress.”

Taking on the system

Krishtel’s work to ensure scientific breakthroughs in drugs and vaccines reach lower-income people began in 2003 with the Lawyers Collective, an Indian NGO providing legal assistance to marginalized groups. 

After joining the World Trade Organization in 1995, India was required to enact patent legislation by 2005, and the Lawyers Collective worked to introduce public health safeguards into the country’s patent laws.

Krishtel saw how lives were saved as costs came down for lifesaving drugs including antiretroviral treatment for HIV/AIDS, and learned how to organize on the grassroots level as well as nationally and internationally.

In 2004, she met Amin, who explained how Lawyers Collective might use a legal tool called pre-grant patent opposition, which is a legal challenge to a patent before it is granted.

Some of Krishtel’s colleagues were skeptical they could take on the work of patent intervention, including Leena Menghaney.

“I said, ‘You’re crazy. Have you looked at patents? They’re so complex. How will we challenge them? Pharma has so many resources. We’re just a few lawyers with no background in science,” said Menghaney, a lawyer who is now the India manager and global IP adviser for the Access Campaign at Médecins Sans Frontières.

But Krishtel brought a combined understanding of science and law, Menghaney said. She gave her peers confidence they could take on some of the world’s most powerful corporations.

In 2006, Krishtel joined forces with Amin to fight the patent system globally. After winning cases and clearing the way for cheaper medicines in other countries, in 2016,  I-MAK decided to shift its focus to the U.S. — which essentially exports its patent laws abroad through trade agreements — in order to effect change globally.

“We could go drug by drug, disease by disease, case by case, but it was going to have limited impact,” Krishtel said. “The U.S. is the epicenter of the world for intellectual property and trade.”

I-MAK’s model has also shifted over time. Though its early focus was on litigation, it now focuses on research, education, and policy development, including its latest report Overpatented, Overpriced.

The organization has partnered with patient and community advocacy groups worldwide to reform the drug development system by involving people directly affected by the high cost of medicines and their advocates.

“The system is really completely insulated from the human consequences of how it works,” Krishtel said. “So how do we humanize the system? How do we bring it into more proximity with the people it's meant to serve, and evolve it for the better?”

Momentum for reform

2020 was a pivotal year for I-MAK’s work. The COVID-19 pandemic and global calls for racial justice following George Floyd’s murder in the U.S. awakened people to the need to make all systems more equitable — including the medical system.

“People saw the map,” Krishtel said. “They saw the global south was being left behind.”

For example, the United Nations Committee on the Elimination of Racial Discrimination warned that intellectual property barriers blocking access to COVID-19 vaccine and treatment technologies replicated colonial-era racial hierarchies.

Krishtel saw echoes from her earlier work in India. “I think we saw the kind of public outrage we saw during HIV for who’s getting testing, treatment, and vaccines and who’s not,” she said.

While the pharmaceutical lobby may seem “impenetrable,” inequity in the COVID-19 response brought momentum to the global access to medicines movement, said Fatima Hassan, a South African human rights lawyer and social justice activist, who met Krishtel through their work in this space.

A WhatsApp group of global vaccine equity advocates went into full celebration mode when the news broke of Krishtel winning the MacArthur award, said Hassan.

The award is validation of the access to medicines movement, but it also recognizes “women of color in this movement in the shadow of stronger male personalities,” said Hassan, who founded the Health Justice Initiative in 2020 to fight for equitable public health. The award also confirms the importance of work on intellectual property and patent reform, and shows donors the need to continue supporting it, Hassan added.

Growing the movement

Krishtel, who became a mother just before the COVID-19 pandemic, has spent the past three years working primarily from home in Oakland, California, where she lives with her husband and son. Her husband, a former patent lawyer, launched a coaching practice to help organizations become more inclusive and help employees reach their full potential.

“Our son is a central part of the drive for our work, because both of our work is in service of creating the world that we want him to live in,” she said.

Krishtel said she spends a lot of her time trying to expand I-MAK’s impact, from reaching more people to tapping into the philanthropy sector’s growing interest in making systems more equitable.

“How do we bring more people in, with an invitation to be part of building something, as opposed to tearing something down?” she said.

Increasingly, I-MAK is looking for ways to bring more public voices into the patent system. Its new “participatory changemaking” tool convenes people affected by high drug prices; engages them in dialogue with leaders from government, the private sector, and academia; and creates blueprints for reform.

The main barrier to progress on patent reform, and other systems change, is that historically powerful people don’t always want other people’s voices to be heard, Krishtel said.

“And I think that only changes when more and more people lend their voices to the fight,” she said.