Social murder: Pandemic profits and vaccine apartheid
First published at Climate & Capitalism.
Amidst the worst pandemic in 100 years, with devastation globally, instead of a freely available public good, COVID technologies largely remain a commodity owned by companies, first sold to the rich — as if it is a luxury handbag!
— Fatima Hassan, founder of the South African Health Justice Initiative1
In 2015, Turing Pharmaceuticals raised the price of a single pill of Daraprim, an antiparasitic drug used by cancer and HIV/AIDS patients, from $13.50 to $750.00. The drug was over 60 years old and Turing didn’t develop it; they had recently purchased the US rights. Responding to critics, CEO Martin Shrkeli said his only regret was not increasing the price even more.
My shareholders expect me to make the most profit. That’s the ugly, dirty truth. … No one wants to say it, no one’s proud of it, but this is a capitalist society, capitalist system and capitalist rules. My investors expect to me to maximize profits, not to minimize them, or go half, or go 70 percent, but to go to 100 percent of the profit curve.2
Shrkeli was subsequently convicted of unrelated securities frauds and anti-competitive activity — crimes against wealthy investors and competitors. He was not charged with profiteering at the expense of desperately ill people. As liberal pundit Robert Reich commented, prosecutors “couldn’t nail him for his escapades as a pharmaceutical executive, which were completely legal — although vile.”3
In fact, as Nick Dearden demonstrates in Pharmanomics, Shrkeli was unusual only in being so outspoken.
Shkreli’s activities are indeed pretty mainstream in an industry renowned for price gouging, for buying up the intellectual property of other people, for acquiring or shutting down competitors, for playing the financial markets, for making insignificant changes to existing drugs and pretending they have made something new and important, and for lobbying for an even more favorable regulatory environment.4
The fundamental contradiction that Karl Marx identified, between the use value of commodities and their exchange value — between their benefits and their prices — are particularly obvious and extreme in pharmaceuticals. Life-saving drugs, essential to the survival of people who have no alternatives, are produced only if they can generate profits that capitalists consider acceptable. The result is social murder — pharmaceutical companies have shown again and again that they will deny life-saving medicines to people who can’t pay.
COVID billionaires
During the COVID-19 pandemic, Big Pharma reaped unprecedented revenues and profits. In 2021-2022, Pfizer, BioNTech, Moderna, and Sinovac collectively made $90 billion in profits from COVID vaccines and medicines. Pfizer netted $35 billion, while BioNTech and Moderna took about $20 billion each.5 The People’s Vaccine Alliance and Oxfam calculated that in 2021, Pfizer, BioNTech, and Moderna had combined pre-tax profits of $65,000 every minute — over $1,000 a second.6
In 2021, COVID-19 vaccines sold by the seven largest private vaccine producers generated a revenue of USD 86 billion and a net profit of USD 50 billion. With a net profit margin of 57% in 2021, COVID-19 vaccines were beating business-as-usual high-profits, even for the lucrative pharmaceutical industry — which is among the world’s most profitable business sectors. Looking at four of the seven companies that made extraordinary profits, Pfizer, BionTech, Moderna and Sinovac, the net profit margins for 2021 are even in the range from 62% to 76%.7
Those profits in essence channeled public money into private pockets. As researchers at University College London write, “US drug companies turn taxpayer-funded innovation into astronomical profits.”
Years before the pandemic began, the US government was a major investor in what would become COVID-19 vaccines. It supplied nearly $350 million to build technologies crucial to mRNA vaccines. Later, as coronavirus infections surged, it spent some $2 billion to support vaccine clinical trials. Ultimately, the US government put more than $30 billion into research, development, and procurement of the vaccines.8
In addition, vaccine makers received at least $86.5 billion from the US government under Advanced Purchase Agreements which did not require them to return any money if they failed to produce vaccines.9
In April 2021, Forbes magazine published its annual list of the World’s Billionaires. Comparing it to the previous year’s list, Oxfam and the People’s Vaccine Alliance found nine new billionaires whose wealth came directly from COVID vaccines. They included the CEOs of Moderna and BioNTech, two of Moderna’s founding investors and the company’s chair, the CEO of a company that manufactured and packaged vaccine, and three founders of CanSino Biologics.
Between them, the nine new billionaires, have a combined net wealth of $19.3 billion, enough to fully vaccinate all people in low-income countries 1.3 times. … In addition, eight existing billionaires — who have extensive portfolios in the COVID-19 vaccine pharma corporations — have seen their combined wealth increase by $32.2 billion, enough to fully vaccinate everyone in India.10
Forbes itself, using a broader definition, reported that forty of the new billionaires on its list had “ties to companies battling the Covid-19 pandemic.”11
That corporate and individual wealth was a direct result of gross overcharging for essential medicine. Independent experts from Imperial College London calculated that mRNA COVID vaccines could be produced for as little as $1.18 per dose, but Big Pharma was selling them for four to twenty times as much.12
Who gets the medicine?
At the United Nations in September 2020, sixteen pharmaceutical corporations, including AstraZeneca, Johnson and Johnson, and Pfizer, signed an agreement to develop COVID-19 vaccines. They promised to “bring large quantities of safe and effective innovations to countries around the world for broad distribution as early as possible, no matter their income level” and “to make products we are developing or supporting affordable in lower-income countries.13
They lied.
The first vaccines were delivered in December 2020, and from the beginning, profit drove distribution. As the graph below shows, high-income countries began vaccinating immediately, reaching 1 dose per 100 people within the first month. Low-income countries remained effectively at zero until March 2021, and did not reach 1 dose per 100 until June 2021.
COVAX, a public-private bulk-buying agency, had aimed to provide low-cost or free vaccines to poor countries, enough for one dose for 20% of every country’s population. It failed to reach half of that modest goal. The pharmaceutical industry sold most of the vaccines directly to rich countries, where the most profit could be made, leaving the people of poorer nations at the mercy of the virus.
As People’s Vaccine campaigners wrote:
The COVID-19 vaccines, funded largely by the public, have been privatized and monopolized leaving pharmaceutical corporations the power to set prices as they like. Some are charging wildly varying prices to different buyers that suggests there is no discernible relationship to the actual cost of production. And some rich country governments appear to have willingly paid higher prices than necessary to push their way to the front of the vaccine queue, thus contributing directly to vaccine scarcity in low- and middle-income countries.14
By September 2021, 60% of people in rich countries had received at least one dose, compared to 3% in the Global South.15 Nick Deardon identifies the cause of that gross inequality:
The bad news was that this vaccine technology was in the hands of just three corporations, all of them committed to turning a substantial profit. The reality was that, even by 2022, for every dose of mRNA vaccine delivered to low-income countries, fifty-six were being delivered to rich countries….
The general rule was clear: the richer you were, the more likely you were to have vaccines—and, at the top end of the wealth spectrum, you’d likely end up with many more than you required. This would be a problem not only for those countries at the lower end of the spectrum: it would make ending the pandemic much harder.16
It has been credibly estimated that equitable sharing of COVID vaccines “would have prevented 295.8 million infections and 1.3 million deaths worldwide (as a direct result of COVID-19) by the end of 2021.” Under a “full sharing scenario” there would have been more than 13% fewer COVID deaths worldwide.17
In addition, dealing with large unvaccinated populations forced governments to divert resources from other public health programs. According to the World Health Organization, the pandemic “reversed years of progress in providing essential TB [tuberculosis] services and reducing TB disease burden.” Globally, more than a million fewer people received tuberculosis treatment globally in 2020 than in the previous year. That led to 500,000 additional TB deaths, making the total second only to deaths caused directly by COVID.18
+ + + +
The British Medical Journal described the drug companies’ actions as vaccine apartheid and a violation of the Universal Declaration of Human Rights. Rich countries had more vaccines than they needed, poor countries had little or none.
Amid the worst pandemic in 100 years, instead of a freely available public good, vaccines remain a commodity owned by companies and sold to the rich. Instead of hoarding one billion ‘excess’ doses this year, rich nations could give them to Covax. While such ‘charitable donations’ are a first step, they are not enough. Donations are a vestige of colonial injustice and reparations are long overdue. The current ‘trickle down’ colonial charity model has failed….
Covid-19 global vaccine allocation is based on power, first mover advantage, and the ability to pay. This moral scandal, enabled by corporate and political permission of mass death, is tantamount to a crime against humanity….
Global vaccine inequity is toppling all our successes in rapid vaccine development and is needlessly prolonging the pandemic. Ongoing inequity is a direct consequence of commercial greed and political self-interest. Under the cover of serving humanity, and with a blind eye turned towards the innumerable deaths in disadvantaged nations, corporations aided by their political allies are once more doing what they do best: making a killing.19
There is no better term for that than social murder.
This is a draft chapter from Ian Angus’ next book, with the working title Social Murder: Capitalism’s Assault on Our Health and Survival.
- 1
Fatima Hassan, “Vaccine apartheid is racist and wrong,” PLOS Global Public Health, May 23, 2022
- 2
Quoted in Nick Dearden, Pharmanomics: How Big Pharma Destroys Global Health, Verso 2023, xii.
- 3
Robert Reich, “Martin Shkreli is just one example of excess in a rotten system,” Christian Science Monitor, December 23, 2015.
- 4
Nick Dearden, Pharmanomics, xiv.
- 5
Esther de Haan and Albert ten Kate, Pharma’s Pandemic Profits: Pharma profits from COVID-19 vaccines, SOMO Centre for Research on Multinational Corporations, February 2023, 4
- 6
“Pfizer, BioNTech and Moderna making $1,000 profit every second while world’s poorest countries remain largely unvaccinated,” Oxfam International / People’s Vaccine Alliance, 16 November 2021.
- 7
De Haan and ten Kate, Pharma’s Pandemic Profits, 4.
- 8
Travis Whitfill and Mariana Mazzucato, “ARPA-H Could Offer Taxpayers a Fairer Shake,” Issues in Science and Technology, Summer 2023.
- 9
De Haan and ten Kate, Pharma’s Pandemic Profits, 5.
- 10
Oxfam International, “COVID vaccines create 9 new billionaires with combined wealth greater than cost of vaccinating world’s poorest countries,” Press Release, May 20, 2021.
- 11
Giacomo Tognini, “Meet The 40 New Billionaires Who Got Rich Fighting Covid-19,” Forbes, April 7, 2021.
- 12
Zoltán Kis and Zain Rizvi, How to Make Enough Vaccine for the World in One Year, Public Citizen, May 26, 2021; Anna Marriott and Alex Maitland, The Great Vaccine Robbery, The People’s Vaccine, July 29, 2021.
- 13
“Life Science Companies and the Bill & Melinda Gates Foundation: Commitments to Expanded Global Access for COVID-19 Diagnostics, Therapeutics, and Vaccines,” Joint Communique, September 30, 2020.
- 14
Anna Marriott and Alex Maitland, The Great Vaccine Robbery, The People’s Vaccine, July 29, 2021.
- 15
De Haan and ten Kate, Pharma’s Pandemic Profits, 27
- 16
Dearden, Pharmanomics, 120-1, 124.
- 17
Sam Moore et al., “Retrospectively modeling the effects of increased global vaccine sharing on the COVID-19 pandemic,” Nature Medicine, October 27, 2023.
- 18
Global Tuberculosis Report 2021, World Health Organization, 2021.
- 19
“Profiteering from vaccine inequity: a crime against humanity?” Editorial, British Medical Journal, August 16 2021
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