I think there's a case to be made for incentive programs for development of key drugs, akin to the way Operation Warp Speed operated for the COVID vaccines. Provide up-front cash for initial research and large guaranteed returns if a drug is approved; in exchange, the drugs become public domain.
Or, just fund government research endeavors with no profit motive. If we can have a JPL for aerospace engineering, why not for pharmaceuticals?
It's a little bit like the state of chip fabrication.
The US has enjoyed a high concentration of R&D talent and funding which has somewhat starved out the desire of the rest of the world to do similar research.
If you are China, for example, why spend the funds to R&D new drugs when you can pull the same research from NIH and FDA efforts of the US and produce those same drugs for cheap.
And that isn't to say China is the only nation doing this. India is pretty famous for doing the same thing.
The issue with these drugs is once the chemical structure is known and proven to work, it's (usually) relatively trivial to spin up manufacturing.
China puts in R&D on products that are hard to manufacture even if the "how" is well known. They do that because China is a country built on international trade. That's why they are a world leader in battery tech.
After the latest round of research cuts to basic biomedical research and hostility towards foreign academics, why not give it 10 years? That's how long it'll take for the current cohort of graduates to find the institutions they'll stay in long-term.
I guess my point of view is, truly game-changing pharmaceuticals should be shared with the world. And there's precedent for that. Jonas Salk did not patent the polio vaccine he discovered, and the world is a better place for it.
Boner pills? Sure, go nuts on patenting those. But HIV prevention? No, it's immoral to patent this.
Or, just fund government research endeavors with no profit motive. If we can have a JPL for aerospace engineering, why not for pharmaceuticals?