The vaccine news is great, but Big Pharma is still fooling us
Heroic work went into the development of the coronavirus vaccines. But that does not mean this industry deserves your affection.
Stephen Buranyi
A Kenyan schoolgirl walking along a railway line in a Nairobi slum after schools partially reopened in October. Pharmaceutical corporations are largely monopolising access to vaccines, which means that millions in the global south may not get the life-saving shot for months. PHOTO: REUTERS
PUBLISHED5 HOURS AGO
It's about as near as science gets to a miracle: A coronavirus vaccine has arrived - and the main reason is that mRNA vaccines, a previously untested technology, appear to work better than almost anyone had hoped.
As recently as this summer, many analysts were pushing their predictions for a vaccine into the autumn of 2021, in line with the timeline of traditional treatments. If these new vaccines perform as well in the wild as they have in clinical trials, the world will remember it as a victory perhaps greater than Salk and Sabin against polio. If this new type of vaccine also goes on to work against other viruses, it will mark an epochal advance in vaccinology, closer to the discoveries of Louis Pasteur and Edward Jenner.
But a strange thing has happened in our celebration of this scientific triumph. While we remember those historic advances as the work of individual scientists or laboratories, the vaccines against Covid-19 are being written instead as a victory for pharmaceutical companies.
The rule in press coverage seems to be that the biggest brand involved gets top credit. And so, every day now there are stories about the Pfizer vaccine (a collaboration between Pfizer and the German biotech company BioNTech); the Moderna vaccine (a partnership between the US National Institutes of Health and Moderna); and the AstraZeneca vaccine (a front-running non-mRNA candidate, in fact created by scientists at the University of Oxford and developed and distributed by AstraZeneca).
It's an incredible public relations coup for an industry desperate to rescue its image. Just last month, Purdue Pharma pleaded guilty and agreed to penalties of more than US$8 billion (S$10.7 billion) after being prosecuted for its role in America's horrific opioid crisis. Pfizer set an earlier record for a drug industry fraud settlement in 2009 at US$2.3 billion, in a case over its fraudulent marketing of a painkiller, an antipsychotic and other drugs for conditions for which it hadn't received approval.
The turpitude of the pharmaceutical industry is so commonplace that it has become part of the cultural wallpaper. The screenwriters of the 1993 movie The Fugitive knew they could find a perfectly plausible villain to menace Harrison Ford in a faceless drug company out to cover up its malfeasance. (The film was a hit.)
In John le Carre's 2001 novel The Constant Gardener, a British diplomat uncovering a pharma giant testing dangerous drugs on poor Africans is similarly easy to swallow: Its plotline echoes a real case involving Pfizer in Nigeria. (The company has denied any wrongdoing and settled out of court the suit brought by the families of children who died during the testing.)
And yet, since the pharmaceutical industry stepped in with the vaccines, generations worth of ill will appear to be melting away. Last year, Gallup polling had the pharmaceutical industry ranked the most disliked in America, below both big oil and big government. By this September - even before the vaccines arrived - the industry's approval rating was already improving.
This isn't lost on the industry itself. A financial analyst recently told this paper that Pfizer's involvement in the coronavirus pandemic was about "as much public relations as it is a financial return". In April, the chief executive of Eli Lilly, the company that put out an antibody therapy for Covid-19, told investors that the pandemic offered "a once-in-a-generation opportunity to reset the reputation of the industry".
We've all been hoping for a vaccine for so long, the moment the medicine is finally being delivered, it seems almost perverse to question the name on the vial. But the industry isn't our saviour. Each of these vaccine candidates is a complex scientific project with many collaborators - and a substantial level of state support. Giving the industry not just plaudits but also control over the vaccines themselves would be a mistake.
Even amid this public relations coup, pharmaceutical corporations can't help but revert to type. They will profit handsomely from these vaccines, even when they claim to be acting selflessly. And they largely are monopolising access, which means that millions in the global south may not get the life-saving vaccines for months.
We've all been hoping for a vaccine for so long, the moment the medicine is finally being delivered, it seems almost perverse to question the name on the vial. But the industry isn't our saviour. Each of these vaccine candidates is a complex scientific project with many collaborators - and a substantial level of state support. Giving the industry not just plaudits but also control over the vaccines themselves would be a mistake.
The mRNA vaccines in which people are now staking so much hope wouldn't exist without public support through every step of their development.
Moderna is not a pharma giant. In fact, it is, in a way, a home-grown success story. The company, founded in 2010 after a group of American university professors acquired support from a venture capitalist, has been working on this technology for years. But Moderna's original work rests on earlier discoveries by scientists at the University of Pennsylvania who have received funding for their research from the National Institutes of Health (NIH).
Once the race for a vaccine began, governments supercharged their efforts. Moderna has received about US$2.5 billion in federal research and supply funding over the past year from the government's Operation Warp Speed programme, as well as shared technology the NIH had developed for previous coronavirus vaccines. The NIH also provided extensive logistical support, overseeing clinical trials for tens of thousands of patients.
Pfizer, meanwhile, likes to say that it eschews federal money to maintain independence. But it is co-producing and distributing a vaccine from BioNTech, a company that received more than US$440 million in funding from the German federal government. The vaccine is based on BioNTech's technology, with Pfizer stepping in to speed up development and manufacturing.
Pfizer had never produced an mRNA vaccine, but it retrofitted several factories to do so. In effect, it traded its immense capital and logistics network for branding rights. Moreover, the US government claims that by placing a nearly US$2 billion order before the vaccine's final clinical trials started, it removed significant financial risks for Pfizer.
The development of these vaccines involves a patchwork of academic research, biotech firms, public institutions, public money and Big Pharma. This has always been the case, but in the past, governments and academic scientists were able to have far more control over their contributions. Both Salk and Sabin made their polio vaccine discoveries patent-free. At the time, Pfizer was among the main manufacturers and distributors of the Sabin vaccine - making a tidy profit for providing this service, but rightly acknowledged as a small part of a larger whole.
What do these kinds of partnership get us today? The US government negotiated bulk pricing for both the Moderna and Pfizer-BioNTech vaccines, US$15.25 to US$19.50 per dose over several different contracts. This is significantly less than the US$25 to US$37 Moderna says it will charge governments in the rest of the world, but analysts suggest that even US$19.50 could yield Pfizer a 60 per cent to 80 per cent profit margin. Moderna has announced it won't enforce its patents, but the company hasn't forgotten about the profit opportunities.
Whenever it looks as if we're getting a good deal, it turns out to be an even better one for the drug companies. Even ostensibly selfless actions might very well turn out to work to the industry's benefit.
True, Oxford's deal with AstraZeneca included a commitment to at-cost pricing for developing countries for now. But the Financial Times has reported that an agreement the company has signed with at least one manufacturer indicated that this particular deal could end as soon as July. (The company has said it will seek expert guidance as to when it can declare an end to the pandemic.) And AstraZeneca's deal with Oxford, according to the Financial Times, still allows for a healthy profit margin of up to 20 per cent.
This isn't surprising. The ship has long sailed on the idea that the giants of American capitalism would help anyone without extracting a fee. Even in this disaster, even after the untold sacrifices that millions of ordinary people have made. The real issue is not the price - we'll pay, obviously - it is about access.
With control over the production of these vaccines, these companies will largely provide them on their own schedule, using their own factories or licensed producers - while other facilities around the world sit idle. Governments will almost certainly order more of the approved vaccines in the weeks and months to come, but the production capacity for each company is limited. Companies should pledge not only to waive their patents but also to share all their technical knowledge so that other manufacturers can help produce the much-needed vaccines.
As it stands, most people outside high-risk categories likely won't get vaccinated until "later in 2021", according to the US Centres for Disease Control and Prevention. Many countries in the global south are expected to be able to vaccinate at most 20 per cent of their populations by the end of next year. Project the current daily death toll onto that timeline and despair.
It doesn't have to be this way. The especially galling thing is that mRNA vaccines were supposed to be a disruptive, liberatory technology. They can be produced faster and more simply, in smaller and cheaper facilities - basic laboratories, even - compared with traditional vaccines. Scientists envisioned a world where vaccines could be produced quickly, anywhere, for a small fraction of the traditional vaccines' cost.
That was before the industry stepped in.
Nations across the global south are demanding a suspension of patent rights for coronavirus vaccines, and last month, American academics and activists - including Ms Chelsea Clinton on behalf of the Clinton Foundation, hardly a revolutionary outfit - called for a similar plan, including sharing patents on vaccines and allowing worldwide manufacturing to begin. This would probably mean not just poorer nations but you - the person reading this - would get vaccinated faster because more vaccine doses would be produced. None of this is likely to happen.
I recall feeling, at the start of this pandemic, both horror at the unfolding calamity, and also a small sense of hope that as in other times of hardship, people would find ways to change the world for the better. There was talk of community support, mutual aid and the rediscovery of the positive powers of the state to protect its citizens. Much of that has dimmed now, and it often seems that we simply want relief - to go back to the way the world was before, and as soon as possible.
We have to get back to that place. Yet this may be the best chance in our lifetimes to break the hold of an industry that, until recently, was rightly vilified. The public is following these developments closely, and the state support that underwrites pharmaceutical profits couldn't be more obvious: Operation Warp Speed alone has dispensed over US$10 billion to the industry.
Pay it to make the vaccine, sure. That's a service. But we shouldn't be afraid to demand more: Public support should mean a public vaccine, one that reaches people as quickly as possible - profitable or not. The pharmaceutical industry wouldn't be able to rake in its profits and restore its reputation without funding that comes from our tax dollars. We shouldn't let Big Pharma forget it.
NYTIMES
• Stephen Buranyi is a science journalist in London and a visiting lecturer at the European Business School.
