Despite hundreds of millions of taxpayer dollars flowing to private drug companies for vaccine development, top health officials coordinating the Trump administration’s COVID-19 response indicated to Congress on Wednesday that they cannot guarantee universal access to vaccines for the highly contagious disease once they are developed.
Speaking remotely over videoconference during a widely anticipated Senate health committee hearing, Sen. Bernie Sanders (I-Vermont) pressed the officials to guarantee that a vaccine would be available to everyone in the U.S. for free — or at least to those who need it most, regardless of their income and ability to pay.
“Uh, Senator, I certainly hope so,” replied Food and Drug Administration (FDA) Commissioner Stephen Hahn, adding that his agency is “very committed” to ensuring that “all populations” including those “most vulnerable” are included in clinical trials for a COVID-19 vaccine.
“Sir, that’s not what I’m asking,” Sanders interrupted. “What I’m asking is, if and when the vaccine comes, it won’t do somebody any good if they don’t get it, and if they have to pay a sum of money for it, in order to profit the drug companies. That would not be helpful.”
Sanders asked again if Hahn could guarantee that a vaccine would be available to all people, regardless of income. Hahn said that “vaccine payment” is not the FDA’s responsibility, but he shares the senator’s concern and believes that a vaccine should be available to “every American.”
Sanders turned to the rest of the panel, which included Brett Giroir, President Trump’s assistant health secretary and COVID-19 “testing czar,” and Anthony Fauci, the top infectious disease expert at the National Institutes of Health (NIH) who has become the face of the nation’s public health response. There was a moment of silence before Sanders addressed Giroir directly, asking him whether he thinks vaccine should be available to all regardless of income, or if “poor people and working people should be last in line.”
Giroir said all “segments of society” should gain access to a vaccine as well as therapeutic drugs for treating COVID-19 regardless of their ability to pay and other “social determinants of health,” but he cautioned that he does not control drug prices. Giroir pledged to advocate for universal vaccine access, but like Hahn, could not guarantee it.
How to pay for and distribute a vaccine once developed has become a major point of contention for policymakers as the nation reels from a deadly pandemic and pro-business forces push to reopen the economy. The government is working directly with private pharmaceutical companies in the race to develop a vaccine, and those companies want a return on their investment and compensation for the costs of experiments that did not result in a marketable drug.
However, the public has also invested heavily in vaccine development, through their taxes, and advocates for lower drug prices say the public should have a say in how much vaccines cost. Public-private partnerships established to develop vaccines and therapeutic drugs are funneling public research and hundreds of millions of taxpayer dollars to more than a dozen private drug companies, but advocates for affordable medicine say this funding and support does not come with strong provisions requiring drug makers to make vaccines affordable once they are developed.
“We know that the HEROES and CARES Acts allocate billions in taxpayer dollars for research that will help lead to the development of a new vaccine, treatment, or cure for COVID-19,” said Juliana Keeping, communications director for Patients for Affordable Drugs, in an email. “Once government-funded research identifies a vaccine or treatment, under current policy, a drug corporation will bring that product to market at any price — and without regard to the taxpayer’s integral role in its discovery.”
For example, one of the most promising potential COVID-19 vaccines is being developed by Moderna, a biotechnology company based in Massachusetts. The vaccine was the first to enter clinical trials in the U.S., but Moderna did not accomplish this alone. Like other drug makers working to develop vaccines and treatments for COVID-19, Moderna has received substantial help from the NIH and the federal government’s Biomedical Advanced Research and Development Authority (BARDA).
Moderna’s vaccine development efforts are supported by $480 million in taxpayer funding along with crucial scientific research and development provided and funded by partners at NIH. Previously, the company received $100 million in federal BARDA funding to develop technology for a Zika virus vaccine, and that technology is now being used to develop the COVID-19 vaccine, according to research by Patients for Affordable Drugs, a nonprofit group that advocates for lower prescription drug prices. Clinical trials for Moderna’s vaccine are also funded and conducted by the NIH.
“As patients, we are cheering for Moderna and scientists all over the world as they strive to invent a COVID-19 vaccine. But we are concerned that the funding given to Moderna fails to include provisions to ensure a fair price,” writes David Mitchell, a cancer patient and founder of Patients For Affordable Drugs, and Sarah Kaminer Bourland, the group’s legislative director. “The government must make sure that corporations don’t cash in on a crisis.”
As Truthout has reported, much of the pharmaceutical industry has neglected vaccine research and development for years, focusing instead on lifestyle drugs and treatments for chronic conditions that generate long-term profits. Drug companies substantially decreased their investment in treatments and vaccines for emerging infectious diseases over the past decade, and in 2018 only 1 percent of the global pharmaceutical industry’s research and development spending focused on emerging infectious diseases, according to the Access to Medicine Foundation.
Developing vaccines is financially risky for for-profit companies, which routinely complain that expensive experiments and clinical trials often fail to produce a marketable drug for generating revenue. Many antibiotic and antiviral drugs are only administered to patients for a short period of time and therefore do not produce blockbuster sales over the long-term. So, the U.S. government and its scientists, along with wealthy foundations across the world, are covering some of the cost of developing a COVID-19 vaccine and providing other incentives to drug makers.
Congress has appropriated $1.8 billion for the NIH for coronavirus research since the pandemic exploded in the U.S., and the next stimulus package from Congress is expected to include additional funding. The pharmaceutical industry now claims that at least 660 clinical trials for COVID-19 treatments and vaccines are underway across the world, including more than 120 in the United States. American taxpayers had already invested $700 million in publicly funded research on coronaviruses and vaccines since the SARS outbreak in 2002, largely through the NIH.
Sanders did not have time to ask Fauci himself what Trump administration officials are doing to ensure that COVID-19 drugs will be available to everyone regardless of their ability to pay. In his testimony, Fauci said he is “cautiously optimistic” that a vaccine will be developed, although there is no guarantee. He hopes that more than one will be approved to provide “global availability,” and researchers will know whether at least one vaccine is on its way by fall or early winter.
Fauci also highlighted the public-private partnerships at the NIH. Policymakers agree that such partnerships are necessary under the current conditions of our health care system for rapidly developing critical medicines in this time of crisis, but advocates for change argue that vaccine production should be nationalized to ensure widespread distribution. Under the current system, it remains an open question whether the results of these efforts will be quickly available to everyone, or only those who can afford them.
“We believe that unless appropriate regulatory guardrails are established, drug companies will turn public investment in COVID-19 vaccines and treatments into potentially massive and unjustified private profits, as they have with so many other drugs,” Keeping said.