Abstract

Universal health coverage has been strongly advocated for and supported for low-cost, high-priority interventions; however, the individual and health system consequences of high-demand but high-cost interventions such as dialysis have not been addressed. Global inequities in access to vaccines and therapeutics for COVID-19 and the large profits associated with sales have raised ethical questions about the obligations of the pharmaceutical industry in global health emergencies. Although not technically an emergency, millions of people die annually because of a lack of access to dialysis. A handful of companies produce dialysis supplies globally, and these companies operate under much secrecy in terms of production costs and individual country pricing. Millions of lives could be saved with better transparency surrounding the procurement/distribution of supplies and affordability of dialysis. Four key obligations of the pharmaceutical industry in global health emergencies have been put forward: production, dissemination, sustainability, and accountability. These four principles are examined for their relevance to dialysis provision in sub-Saharan Africa, to consider the obligations of the dialysis industry given their high profits and the millions globally without access. Fairer and transparent pricing in dialysis has the potential to increase access to a lifesaving therapy that is currently very inequitably distributed across the globe.