Progress for the privileged: Celebrating innovation, ignoring access

Somewhere in Dhaka, a man in his late forties sat across from an oncologist. The oncologist was calm, almost clinical, as he outlined the treatment plan combining chemotherapy and targeted therapy. Then came the cost estimate. His wife, sitting beside him, did not cry. She simply stared at the paper for a long moment, folded it quietly and placed it in her handbag. That silence said more than tears ever could.

Months later, I came across a headline announcing a breakthrough in cancer immunotherapy: a new drug which had shown unprecedented survival rates in clinical trials. The global medical community celebrated. But I thought of that wife's silence.

We live in an age of extraordinary medical achievement. Gene-editing tools are correcting hereditary disorders. Immunotherapy is transforming cancer treatment. Artificial intelligence is diagnosing disease with accuracy that rivals experienced clinicians. On paper, medicine has never been more powerful. But there is a question that this triumphant narrative quietly sidesteps: for whom does this progress exist?

Medical advancement without equitable access is not progress. It is selective privilege dressed in the language of science.

Consider the economics of cancer treatment in Bangladesh. A single cycle of targeted therapy can cost upwards of Tk80,000 to 150,000, and a full course may require many such cycles. In a country where per capita income hovers around $2,800 and approximately 74% of healthcare expenditure is paid out-of-pocket, this is not merely an expense; it is a catastrophe. Families liquidate savings, sell land, borrow from relatives and still find themselves unable to complete treatment. The patient does not simply fight cancer. They fight a financial war on two fronts simultaneously.

This is a structural failure, not individual misfortune. Bangladesh's public health expenditure remains well below the WHO-recommended threshold, and private hospitals operate on profit logic. More critically, pharmaceutical patents—enforced through global trade agreements—ensure that cutting-edge drugs remain beyond generic production for years after release, by design. The market for medical innovation is calibrated to serve those who can pay. Instruments like compulsory licensing under TRIPS flexibilities exist precisely to challenge this arrangement, yet they remain underutilised by governments too cautious to invoke them against powerful pharmaceutical interests. The architecture of access is political, not merely economic.

There is a philosophical dimension here that economists are often reluctant to engage with. We measure the value of a medical breakthrough by its clinical efficacy: the survival rates it improves, the conditions it alleviates. But what does it mean to have a cure that most people cannot reach? Development economists speak of capability: the actual freedoms people have to live lives they have reason to value. A medical innovation accessible only in the price lists of elite hospitals does not expand capability for the majority. It sharpens the line between those who can afford to live and those who must choose how to die.

The Covid-19 pandemic made this visible in ways that could not be ignored. Vaccines were developed at historic speed—a triumph of global science. Yet for most of 2021, wealthy nations had secured advance purchase agreements worth billions, effectively controlling global supply before the science was even complete. Low-income countries did not simply wait; they negotiated from positions of near-zero bargaining power, dependent on the goodwill of COVAX and the surplus decisions of governments that had long since secured their own populations. Bangladesh, despite a formidable vaccine deployment infrastructure, found itself at the back of a queue it had no hand in designing. The architecture of global health mirrors the architecture of global power. That is not a coincidence.

The inequity runs deeper still. The problem is not only that life-saving treatments exist but remain out of reach; it is that for the poorest populations, meaningful treatment was never seriously pursued in the first place. Neglected tropical diseases—illnesses like visceral leishmaniasis, dengue, and cholera that devastate low-income communities across South Asia and Sub-Saharan Africa—receive a fraction of global pharmaceutical R&D investment, not because they are scientifically intractable, but because the people they kill cannot generate sufficient market returns. The global drug pipeline is not a neutral instrument of science. It is pointed, deliberately and profitably, towards conditions that afflict wealthy, insured populations. A Bangladeshi farmer dying of kala-azar does not merely struggle to afford treatment. In many cases, the treatment barely exists because the market never had adequate incentive to develop it. This is the full shape of the problem: the privilege of progress includes, at its most fundamental level, being sick with the right disease. Innovation was not made inaccessible to the poorest; it was never directed at them at all.

Critics might argue that pharmaceutical companies require strong intellectual property protections and high margins to fund future research. Without profit incentive, the argument goes, there would be no innovation at all. This is not entirely wrong. But accepting this argument in full means accepting that the default mode of medical progress is one that structurally excludes the majority of humanity—and treating that exclusion as the price of admission. That is a moral and political choice, not an economic inevitability.

There is a version of medical progress that we do not yet have: one where advancement is measured not only by what science can do, but by how many people it actually reaches. Tiered pricing models, expanded compulsory licensing, public investment in generic drug production, and binding global health equity frameworks are not radical proposals. They are the minimum requirements for progress to mean something beyond the walls of private hospitals.

Md Safwan Hossain Dibbo is a student of the Department of Economics, University of Dhaka. 

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.