Let me start by getting this out of the way: Vaccines are one of humankind’s greatest health care achievements, along with antibiotics, clean water, and good sanitation. There should be no argument about this at all.
Vaccines save millions of lives each year — children and adults — and prevent tremendous personal misery caused by infectious diseases. Some vaccines, such as the one against human papillomavirus (HPV), even prevent some types of cancer from developing in adult women and men.
Despite these enormous successes, vaccines are being aggressively attacked by a number of groups, many of which are well-organized and financed. Some of them have suggested that vaccines are more harmful than the diseases they prevent, which is nonsense.
Why do people oppose vaccinations? There are lots of reasons. The most frequently given one, the raison d’etre of the misinformation campaigns, is that childhood vaccines are dangerous, though I’m still waiting to see a single piece of creditable evidence to support this. One other theme featured prominently in their messaging is that pharmaceutical companies can’t be trusted.
That’s a sad truth: The awful reputation of the pharmaceutical industry is now inhibiting the use of some of its most lifesaving products. Tuesday’s spectacle of seven pharma executives being grilled by the Senate Finance Committee on high drug prices is just the latest example of the industry’s black eye.
Why are so many people suspicious of pharma in general and vaccines in particular? It’s pretty easy to figure it out. The industry has been engaging in bad behavior for several decades, and these self-inflicted wounds have turned much of the public against it.
It wasn’t always this way. In the early 1950s, parents across America feared that the frequent polio epidemics sweeping the nation might leave their sons or daughters crippled, or even worse, confined to an iron lung. The first polio vaccine, developed by Dr. Jonas Salk, eased those fears. Salk was rightly considered a national hero, and was especially lauded for refusing to patent the vaccine.
Pharma companies became among the most admired (as well as the most profitable) businesses in America. In the last half of the 20th century, they brought to market a cornucopia of medicines that combatted previously untreatable diseases. Drugs were developed for heart disease, rheumatoid arthritis, high blood pressure, anxiety, pain, bacterial infections, asthma, contraceptives, cancer. The 1990s brought the first drugs based on recombinant DNA technology, adding a large number of new treatments to fight disease. Pharma companies also developed vaccines.
Then came the scandals. They haven’t involved just one company. Over the past two decades, we’ve seen scores of pharma and biotech companies hauled into court for a variety of serious, and in some cases deadly, infractions. What kinds of high crimes and misdemeanors have poisoned the well of public opinion? Here’s a sample from just the last few years:
- Obscene price hikes on older drugs (Turing/Marathon/AMAG Pharmaceuticals)
- Shorting supplies of cancer drugs in order to raise prices (Aspen Pharmacare)
- Sketchy accounting/business practices to boost sales figures (Valeant)
- Faking cancer drug data (Acerta)
- “Giving” a drug to a Native American tribe solely to protect its patents (Allergan)
- Using university “donations” to boost business (NantHealth)
- Failure to warn about serious drug risks on product label (Roche’s Actemra)
- Losing a patent infringement lawsuit because of unethical behavior (Merck)
- Bungling a clinical trial that led to one death and multiple illnesses (Bial/Biotrail)
- Contributing to and profiteering from the opioid crisis (Purdue Pharma)
- Medicare fraud (Companion DX Reference Lab, Natural Molecular)
- Bribing doctors to prescribe opioids (Insys Therapeutics)
- Profiting from legal insider trading (Seres Therapeutics)
- Bribing health officials in China (GlaxoSmithKline)
- Data falsification in an academic paper (Amgen)
- Seeking favors by hiring Donald Trump’s personal attorney (Novartis)
- Failing to disclose required clinical trial results (multiple companies)
- Deceptive business practices in drug marketing (Astellas)
More widely reported are the stories about drugs pulled off the market due to safety concerns (multiple companies), or ones that reveal how pharma payments influence doctors’ prescribing habits for brand-name drugs (multiple companies).
Finally, let’s look at criminal and civil penalties (both state and federal) racked up by the industry over the last couple of decades. According to a Public Citizen analysis, the industry settled 373 cases between 1991 and 2012, paying $35.7 billion for numerous violations. These cases included illegal off-label marketing, overcharging Medicare and Medicaid, kickbacks, concealing data, and poor manufacturing practices. The largest penalties weren’t levied on obscure companies nobody’s ever heard of. They fell squarely on the shoulders of Big Pharma: GlaxoSmithKline, Pfizer, Johnson & Johnson, Merck, Abbott, Eli Lilly, Novartis, AstraZeneca, Bristol-Myers Squibb, and others. These various offenses have, not surprisingly, led to pharma being portrayed as the villain in numerous movies and TV shows.
The pharma industry has established a solid history of shooting itself in both feet via the number and size of these scandals. I’ve suggested over the years that the industry adopt a set of well-defined ethics policies. The response? Rather than try to repair the damage, the industry has simply decided that its monopoly pricing power provides the ultimate insulation from criticism.
Unlike other companies that have trashed their reputations and then struggled mightily to repair them (Wells Fargo is a good example), drug makers know that people will buy their products no matter how much the public dislikes their companies. You generally can’t purchase medicines from a competing company. You can (sometimes) go elsewhere to buy them, like drug tourism trips to Mexico and Canada, if you’re willing to deal with the hassle and expense. Drug companies don’t have to treat their customers well when they have that kind of leverage.
Though the public can’t do much about it, they have clearly noticed the continuous wave of scandals that has enveloped the industry.
All of this has contributed to the prominent anti-pharma themes voiced by the anti-vaxx crowd. At a recent rally in Washington state to defeat legislation aimed at eliminating personal vaccine exemptions, many in the crowd held “Separate pharma and state” signs. Bernadette Pajer, head of the anti-vaccination group Informed Choice Washington, recently said, “I know vaccines are designed to protect children from infection, but they are pharmaceutical products made by the same companies that make opioids.”
Many people, such as those with diabetes who struggle to pay for their lifesaving medicines, share this antipathy towards pharma. Most people don’t realize that vaccines are the least profitable division of the companies that make them. They’re so unprofitable that many drug makers walked away from producing vaccines years ago.
We’re fortunate that demand from many developing countries has sparked a renewed interest in making vaccines. It’s unclear how many companies would stay in the vaccine business without that large market. And who else has the capacity and technical expertise to make hundreds of millions of doses of complex vaccines every year? Amazon may be thinking about entering the drug-delivery market, but don’t look for it to start manufacturing vaccines anytime soon.
At the end of the day, we’re stuck in a twilight zone of cognitive dissonance: We’d like to stand up against the pharmaceutical industry’s continuing bad behavior, but at the same time we’re forced to acknowledge we can’t live without its products. This isn’t a time when we can “just say no.” The industry knows and relies on this. As long as it maintains profitability, it will continue to view the scandalous headlines, fines, and settlements as simply a cost of doing business.
And so we are left to deal with one of the “externalities” associated with this negative industry messaging: It helps drive vaccine hesitancy. Improving the reputation of the pharma industry might help turn the tide against the anti-vaccine forces, but we can’t count on that happening. Vaccine advocates must focus their messaging on the value that vaccines create. If vaccine supporters fail, we’ll continue to see waves of vaccine-preventable outbreaks of measles and other contagious diseases.
Whatever your personal feelings are about the pharmaceutical industry, the benefits of vaccines are undeniable, despite what the anti-vaccine folks would have you believe.
Stewart Lyman, Ph.D., is a biotechnology consultant and vaccine advocate who lives in Seattle.