COVID-19 – Who Prevents? Who Treats? Who Pays? Who Gets Left Behind?

"Greed, for lack of a better word, is good" Gordon Gekko in the film Wall Street

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I’ve discussed the path to getting a vaccine for COVID-19. See my July 17th 2021? – A Vaccine, Now What? blog. Today, I wrestle with the elephants in the room: availability and economics. We live in nation where money and business trump most everything else. Despite the rhetoric of universal availability when the anti-COVID-19 vaccine arrives (assuming it will), there are some very real barriers built into our entire healthcare system. Fair distribution at a fair price are anything but guaranteed. 

“Multiple lawmakers have raised concerns about the affordability and availability of an eventual vaccine. Sen. Bernie Sanders pointed out in last week’s hearing [early July] with leading health officials that billions of taxpayer dollars are funding pharmaceutical companies in their effort to develop a vaccine. He asked, given the significant of that investment, if every person in the country can expect to have access to an eventual vaccine regardless of their income. 

“All four public health officials present during the hearing — Fauci, Redfield, Hahn, Redfield and Assistant Secretary for Health Adm. Brett Giroir — answered Sanders’ question affirmatively.” PBS News Hour, July 8th. Sounds good… but those are just words without a clear path of implementation. The reality, the battle between and ethical and socially responsible results and the primacy of the profit driver sanctified by the American legal system, could well be quite different. But it just might not be the United States that answers the question. 

Should we be grateful that a seemingly functional vaccine is more likely to emanate from outside the US (where government funding of research has been on a steady decline)? Maybe even China? There are signs that England’s Oxford University, partnered with drugmaker AstraZeneca, seems to be at the forefront of a working vaccine. Under the aegis of Oxford Professor Sara Gilbert, several initial sets of clinical trials are showing the most effective vaccine development we know of. An agreement between the US and UK could make that preventative available here, ready to be manufactured at the end of this year and available in early 2021. We are still finding out how long the immunity lasts, whether there hidden side effects and if the vaccine is generally tolerable. Oxford is unlikely to be a partner in price gouging, and the restraints in Europe and the UK, where national healthcare has existed for a very long time, are consumer friendly. 

But who gets it first here and at what cost? Especially if the price is controlled by a US manufacturer and deployment is as haphazard as our COVID-19 response has been to date. Nicole Hassoun, professor of philosophy at Binghamton University, State University of New York, writing for the July 18th FastCompany.com, tells us: “As COVID-19 surges in the United States and worldwide, even the richest and best-insured Americans understand, possibly for the first time, what it’s like not to have the medicines they need to survive if they get sick. There is no coronavirus vaccine, and the best-known treatment, remdesivir, only reduces hospital recovery time by 30% and only for patients with certain forms of the disease. 

“Poorer people have always had trouble accessing essential medicines, however—even when good drugs exist to prevent and treat their conditions. 

“In the U.S., where there is no legal right to health, insurance is usually necessary for medical treatment. Remdesivir costs about $3,200 for a typical treatment course of six vials, though critics argue its manufacturer, Gilead, could make a profit off much less. Internationally, high drug prices mean that critical medicines are often available only to the richest patients. 

“Access to medicines, in other words, is usually an ethical problem—not a scientific one. And that’s going to complicate the global coronavirus fight. Experts worry that any COVID-19 vaccine is likely to have a high price tag and, as a result, be unequally distributed according to countries’ purchasing power, not need.” Rich counties serve themselves and their political constituents first. Some countries, like Russia, are busy trying to hack their way into the computers of the leading vaccine contenders to shortcut their path to a vaccine by simple theft. 

Usually, what brings the price down to reasonable is competition. Several drugmakers with viable solutions. That could happen here, but the struggle to find even one vaccine with a year to a year and a half – tested, manufactured and deployed – is something the United States has never done before. Hence first in time just might have the ability to price gouge, something Congress is likely to legislate against if it happens… assuming Donald “let the market fix the price” Trump is no longer in office or bends to an obvious need and signs the bill if he is. 

It took years for HIV drugs to reach an economically reasonable plateau. “[By] 1997, most people diagnosed with HIV in Europe and the U.S. were living long and productive lives thanks to antiretroviral drugs… Meanwhile, the disease was still killing 2.2 million people each year in sub-Saharan Africa because pharmaceutical companies claimed it was impossible to lower the US$10,000 to $15,000 annual cost per patient for antiretrovirals. 

“In response, human rights activists galvanized a global AIDS campaign, educating African patients about antiretrovirals, giving them the tools they required to demand treatment, and even suing drug companies. Eventually, mass protests erupted in South Africa and elsewhere, shifting public opinion on access to medicines. 

“By 2000, competition from generic drug manufacturers brought the price of antiretrovirals down to around $350 per patient per year, allowing millions more worldwide to take them… Around the same time, a similar story was playing out with tuberculosis, which had greatly diminished in the U.S. and Europe but remained deadly in many other places. The rise of drug-resistant strains—especially in the former Soviet Union and parts of Africa and Asia—posed a particularly terrible challenge. 

“Conventional wisdom held that people with drug-resistant TB couldn’t be saved. The drugs were too expensive, treatment courses too long, and disease management too complicated… The organization Partners in Health disproved that excuse by successfully treating 50 tuberculosis patients in Peru, then one of the world’s poorest countries. That project helped convince the World Health Organization to endorse multi-drug-resistant TB treatment. Global funding for TB treatment increased greatly, and generic medicines were produced. Today more than 70% of people diagnosed with drug-resistant TB receive treatment… 

“Other examples include the adoption of ‘ring vaccinations’ in the 1960s—a contact-tracing-based immunization strategy pioneered after mass vaccinations failed to stop smallpox—and a 2010 campaign to give children in Afghanistan their polio vaccinations at the circus… Ending the global coronavirus pandemic will require a similar creative resolve. 

“Recently, the U.S. agreed to pay $1.2 billion for early access to a promising COVID-19 vaccine in the United Kingdom and secured first access to another by the French pharmaceutical company Sanofi, enraging citizens of those countries. Such arrangements also harm manufacturing countries such as Brazil, Egypt, and India, whose people have little access to the medicines their factories pump out. 

“Unequal access to COVID-19 medicines isn’t just a moral problem. In a global pandemic, an outbreak anywhere threatens people everywhere.” Hassoun. Indeed, many countries require price controls on pharmaceuticals as a condition of doing business within their borders… or simply grant the government a statutory right to coopt essential vaccines and treatments based on a set pricing procedure. 

But the United States, where for most people healthcare is an option and not a right, other than generic and undefined bans against “price gouging” often at a state level, drugmakers set their own prices. Even under the Affordable Care Act (being challenged by the Trump administration and 20 red states in court), healthcare exchanges were not permitted to use their size and bargaining power to negotiate better prices on prescription drugs. Picture someone gasping for breath willing to die to preserve the unaffordable “capitalistic” pricing system that underpins American healthcare today. It’s time for a ground-up change. 

I’m Peter Dekom, and it is simply time for the United States to join the rest of the developed and much of the developing world and deal effectively with according its citizens with healthcare as a right.