There’s never been a more lucrative time to be a vaccine. Or, I should say, there’s never been a more lucrative time to be the head of a pharmaceutical company that is at the forefront of developing a vaccine, and who then gets to decide how much a person might be willing to pay to stay alive. Last week, the U.S. government made yet another giant bet on biotech giant Pfizer and its partner BioNTech, investing a collective $1.95 billion in their efforts, according to Yahoo! News.
This comes a few weeks after the Trump administration announced the payment of $1.6 billion to vaccine maker Novavax to expedite the development of a coronavirus vaccine. “The deal would pay for Novavax to produce 100 million doses of its new vaccine by the beginning of next year — if the vaccine is shown to be effective in clinical trials,” reports the New York Times. “That’s a significant bet on Novavax, a Maryland company that has never brought a product to market.”
For good measure, the government also gave a cool $1.2 billion of taxpayer dollars to biopharmaceutical company AstraZeneca for potentially 300 million doses of its vaccine candidate that it’s working on with University of Oxford researchers. To date, the U.S. government has spent well over $5 billion on a potential coronavirus vaccine.
That’s good news, right? I mean, we desperately need a vaccine. Also, what is a vaccine again?
Yes, we need a vaccine, which, per the CDC’s website, contains the same germs that cause disease but that have “been either killed or weakened to the point that they don’t make you sick.” “A vaccine stimulates your immune system to produce antibodies, exactly like it would if you were exposed to the disease,” per the CDC. “After getting vaccinated, you develop immunity to that disease, without having to get the disease first.”
So the fact that a vaccine is being invested in is, technically, great, but we also deserve to know how our money is being spent on developing said vaccine, and as things currently stand, we don’t. “It’s a black box,” Peter Maybarduk, the director of the global access to medicines program at Public Citizen, a public interest group, told the New York Times. “This could be one of the most important medical technologies of our time, and we know very little about how that money is being spent, and what conditions are being placed on it.”
Kevin Schulman, professor of medicine and economics at Stanford University, agrees, telling me, “There isn’t a lot of disclosure on contract terms related to vaccine pricing from the federal contracts that have been issued.”
That doesn’t sound good. But what does that mean for me? Will I be able to afford a vaccine?
I sure hope so, but as things currently stand it’s impossible to know for sure. According to Schulman, for COVID, the major issue is that the “value” of the vaccine to society is enormous. “If there is a shortage (say when the vaccine is first launched), the manufacturer will have significant leverage to set a high price,” he says. “If there is a difference in vaccine efficacy (say, response in the elderly), there could be an advantage to one vaccine over another and a price difference.” Hopefully, there ends up being “multiple equivalent vaccines on the market,” that way, based on increased market competition, we’re more likely to get the vaccine at a lower price.
You’re not answering my question. How much will the COVID-19 vaccine cost me?
That really depends on whether you have health insurance and whether your provider is a private insurer or public one. “There are two health systems in the country — the public system and the private system,” says Schulman. “We started doing testing exclusively through the public system, but when we ran out of capacity in the public sector we turned to the private sector.” In the private system, for patients who are privately insured, there is no national fixed pricing mechanism that I am aware of.
Schulman points to the way prices for COVID lab tests have varied so greatly as one example of how the price of vaccines might differ for each person, depending on their insurance. “There are two prices for people with private insurance — the price the manufacturer charges, and the price charged by the provider,” says Schulman. “We’ve seen huge variation in the pricing of COVID lab tests, and we could have the same for a vaccine.”
Please just tell me the price. How much will the coronavirus vaccine cost?
Again, this all still fairly speculative, but according to Schulman, the Pfizer contract seems to “suggest a price of $19.95 per dose.” According to Forbes, “Pfizer put its flag in the pricing landscape by announcing that it has come to an agreement with the federal government to provide by December 100 million doses of vaccine for $1.95 billion, or $19.50 a dose,” per the report. “Americans would then receive the vaccine for free.” To be clear, it’s likely the Pfizer approach would require two doses and therefore the full price of the vaccine would likely be around $40.
Still, all of this assumes that the FDA approves the vaccine, which may not happen, considering Pfizer is taking a unique approach to their vaccine development. “First, no vaccine has been successfully developed using the mRNA technology it is employing,” per the same Forbes report. “While early data are promising, the durability of such a vaccine as well as the safety won’t be known until Pfizer completes a 30,000 patient trial later this year.”
The good news here is that unlike other vaccine deals signed by the government, Pfizer isn’t going to collect payment until their vaccine proves to be safe and effective.
Free vaccines sound pretty good to me!
Sure, but that’s only one pharmaceutical company. What’s concerning is just how much money is being made based purely on speculating which pharma company is first to a vaccine. “The market cap of Moderna, a small Boston area company that has partnered with the National Institutes of Health in the vaccine race, has tripled since February 20th, to $23 billion from $7 billion, turning its chief executive into an overnight billionaire,” reports the New York Times. Worse still is the fact that unlike Pfizer, Moderna has yet to agree that they will provide the vaccine at cost. In fact, it’s the exact opposite: “We will not sell it at cost,” Stephen Hoge, the president of Moderna, told the New York Times in a different report.
Hypothetically, what would happen if not everyone can afford the vaccine, or some people decide to forgo the vaccine altogether?
That’s a great question. There’s a variety of reports that suggest that anywhere between 23 percent and 50 percent of the U.S. population is unlikely to get the vaccine if and when it becomes available, which is a problem since early estimates suggest that at least 70 percent of the population will need to develop immunity to the coronavirus to achieve herd protection. According to MidLinx.com, the 2019 measles outbreak — where 75 percent of cases occurred in people who hadn’t been vaccinated — is a good indication of what would happen if half the population rejected a vaccine. “At the very least, the virus could remain an ever-present problem for years,” reports MidLinx.com. “Social distancing and wearing masks in public could become the new norm. Students may continue to attend schools and universities only online. Cities and counties may try to reopen, but if infections and deaths resurge — much like we’re currently seeing in South Korea and China — new lockdowns would ensue.”
That sounds like a nightmare. But I’m skeptical of a vaccine, too — I’m not an anti-vaxxer, but like, don’t these things typically take a few years to develop? I don’t know if I trust one that’s been rushed.
For comparison, according to Healthline, “during the 2002-2003 SARS outbreak, it took about 20 months for a vaccine to be ready for testing in people.” Typically, it can take anywhere from two to 10 years to develop a vaccine. But because this particular vaccine is of global importance, naturally it’s being fast-tracked.
The pharma companies in charge of developing these vaccines have said they’re able to move so quickly without risking the quality of their research by conducting the scientific work “in parallel, rather than sequentially.” “Larger trials are being run before smaller ones wrap up,” reports BioPharma Dive. “Billions of vaccine doses are being made ‘at risk,’ without proof they work. But the same quality of data will be accumulated, they contended.”
In his article for Forbes, health writer Steven Salzberg argues that one way to build public trust in the fast-tracked vaccine is by publishing all the numbers from the vaccine trials. “A just-published study in [the New England Journal of Medicine] on the Moderna vaccine (the RNA vaccine) provides exactly these numbers, and they look very good in terms of both safety and effectiveness,” he writes. Although there were some side effects — “including fever and chills, but all were graded as mild or moderate” — he reports that these side effects were greatest in the highest dose, but that the antibody response worked just as well in the lower doses. “So the next phase of testing, already underway, is using the lower dosages,” adds Salzberg.
So we’re good, then — this nightmare is almost over?
I’m sorry. Really, I am. But unfortunately we’re not as close to the vaccine as the pharmaceutical companies or the government would have you believe. According to a report in The Atlantic, “Biologically, a vaccine against the COVID-19 virus is unlikely to offer complete protection.” Not to mention: “Logistically, manufacturers will have to make hundreds of millions of doses while relying, perhaps, on technology never before used in vaccines and competing for basic supplies such as glass vials.”
And if the government’s handling of the pandemic is any indication of things to come, it could be a long time, maybe even several years, before you’re sitting in the stands of a baseball game again.
Andrew Fiouzi
Andrew Fiouzi is a staff writer at MEL.
