As the coronavirus that causes COVID-19 spreads in more than 60 countries, the race to develop a vaccine to prevent the illness has taken on new urgency. In a meeting with CEOs of major drug companies this week, President Trump ramped up the pressure, suggesting that vaccines could come to market faster than the 12- to 18-month timeline most researchers think is realistic.

But while the Trump administration is pushing drug companies to meet faster timelines, it hasn’t addressed an equally urgent question: What will be done to ensure the vaccine is accessible for those who need it most?

Last week, for example, U.S. Health and Human Services Secretary Alex Azar was asked whether a coronavirus vaccine would be affordable to all Americans. He was updating Congress about two vaccine development projects funded by the U.S. government, one by Sanofi and one by Johnson & Johnson. Yet despite taxpayer funding of these efforts, Azar speculated that vaccines might not be affordable to all and dismissed the idea of using price supports to ensure that poor people would have access to the vaccine.

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Making vaccines available only to the rich is not just immoral, it’s also bad public health policy. We’ll want everyone, rich or poor, insured or not, to be protected from the new coronavirus. Protecting others helps to protect everyone.

There are several efforts worldwide to develop a vaccine for COVID-19. Outside the U.S., Norway’s Coalition for Epidemic Preparedness Innovations and other groups are also funding multiple development efforts worldwide. These efforts are supported mostly by public money, and each one should be considered as a global public good. Governments can and should insist that, as a condition of getting public funding, companies must make the price affordable. The final price of any vaccine should be one that governments of poor and rich countries alike can afford so all citizens can get it free at the point of care.

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Without price controls, poor countries are unlikely to be able to afford or access enough vaccines to protect their populations. While Azar was speaking about access for Americans, his aversion to price controls suggests the U.S. government may endorse a free-market distribution of the vaccine. On a global scale, that would be a disaster for poor countries — rich countries would essentially be monopolizing the vaccine, leaving the world’s most vulnerable citizens to bear the brunt of this outbreak.

A sad truth we have learned from past global pandemics is that poor people are hit first and worst. Vaccines are most urgently needed where health systems are fragile, and where the effects of this new coronavirus could be catastrophic.

Many countries lack the resources, infrastructure, and health care personnel to mount full-scale efforts to detect the virus and prevent it from spreading, meaning it will move quickly and easily among populations. In these settings, the number of cases is likely to grow exponentially, putting stress on already burdened health care workers and facilities and making it harder to provide timely care for those who are ill. Vaccines will be an important tool for preventing such a catastrophe.

For those with resources — rich countries and rich people — a vaccine would be valuable, one of several tools we will need to prevent the most serious effects of the new coronavirus. But for those who are poor or who live in poor countries, it may be essential. Without it, they will suffer disproportionately and unnecessarily.

We can curtail pandemics if we quickly develop vaccines and make them widely accessible. But without vigorous efforts to secure equitable access, vaccine distribution will follow the logic of the market.

To let a coronavirus vaccine be monopolized by the rich will perpetuate the unjust economics of outbreaks, where the poor always pay the heaviest price. Allowing this to happen would be a moral disgrace.

Gavin Yamey, M.D., is a professor of global health and public policy at Duke University, where he directs the Center for Policy Impact in Global Health. The center has received grant funding from the Bill & Melinda Gates Foundation, which has funded epidemic vaccine development, and from Gavi, the Vaccine Alliance, which funds vaccination in low- and middle-income countries.

    • @ Rocky

      I think it might become a disease that kills mostly old people — regardless of income.

  • @ Snake Pliscon

    You may think it’s “lucky” to die at age 70, but perhaps you won’t think so when you are 69.

    However, I think that you are in general correct — according to a heartless calculus of the costs/benefits ratios.

    > Losing a sad, sick, lonely, painful 15 years of life may not actually be all that much of a loss. Probably for every year we get closer to 85, we experience more people whose diabetes has left them blind, with their feet amputated, and suffering from dementia, locked in a wheelchair in a nursing home.
    To make it worse, if you are 85, your children are around 60 — not really in a position themselves to help you.

    > Those last 15 years of life consume a huge percent of the nation’s health care dollars. If the elderly died in a more timely fashion, the benefits for younger people could be significantly expanded. If there is no need to expand health insurance benefits, the savings can be devoted to other issues that matter more to younger people.

    > These statistics make people conclude that it would be best for everyone — including the elderly people themselves — if old people would just hurry up and die.

    Well, everyone thinks that except the elderly.

  • You can keep the corona vaccine. I would never put some quickly developed garbage into my body in the name of my “health”. Traditional American medicine has lost me for good. I find it quite disturbing that through this whole thing not one word has been mentioned about proper nutrition as a means to protect oneself. The crap that ppl eat is a large reason they have no immune system yet not one person in the medical world has even mentioned it in their lists of protections. People should be doing all these things normally. I don’t understand what ppl were doing before this? Not washing their hands and not cleaning their homes? People are disgusting it’s no wonder we have these outbreaks.

    • Hi. I have read numerous articles relating to the corona virus and what to eat to increase your immune system. I have also read about emergency home preparedness. Both types of articles were in my main stream news feed. You sound angry in your post. That a deep breath and relax.

    • @ Trish

      I’m afraid that it’s likely to be true that some vaccinated people will still be susceptible to the disease.
      Most vaccinations are not perfect (some are nearly perfect.)

      But besides that, there are always going to be unvaccinated people everywhere — newborns, for example, or the people who live in places where their society has not been organized to provide for public health.

      But I think the real fear is that immunizations may weaken as we age, so that the risk of everyone who turns 65 or so starts to increase, bumping off more and more elderly the older they grow.
      In a couple of decades, we could see the average life expectancy in developed countries drop to 70 or 75.

      There is another grave danger as well.
      With a serious virus circulating in a population of the unvaccinated, there is a lot of fear that it will mutate regularly, like the flu does now every year.
      That means that no vaccine is going to work for anyone, and everyone is going to end up killing their own grandparents.

      I think that advanced governments, and the WHO, the CDC, and so forth have a hope that we can just eliminate the virus, just exterminate it like we did with smallpox.

      The authorities are using “quarantine and containment” like they did to eradicate polio. They want it to just disappear from human populations, and not to end up as another flu that circulate every season.

      In the case of this virus, however, it is all too likely to kill anyone over 65, so it’s worse to have it circulating than the regular flu.

  • Some benefits of society have to be everywhere or they might as well be nowhere.

    An example is “paved roads” in a city.
    If the streets don’t go everywhere because only the rich can afford to pay for them, then they are useless to the rich. If there are not paved streets everywhere, the rich won’t be able to do much more than drive back and forth in front of their own houses.

    In Nazi Germany, the authorities were vigilant about typhus among the prisoners in the concentration camps, but not because they cared about the prisoners.
    If there is typhus anywhere, it can spread everywhere. A typhus epidemic will eventually leak out of its confined area and attack everyone.

    The same is true for the corona virus, and smallpox, and polio.
    The rich had to pay to immunize the poor because if there is smallpox anywhere, it can go everywhere.

    Vaccinations for the rich are not enough of a guarantee.
    There is no perfect safety anywhere until it is defeated everywhere.

    • So if I get a vaccine I’m not protected unless people around me get it too? I thought gettting the vaccine can keep you from getting sick. If it doesn’t protect me then I dont see the point…

    • Anna Greystone says “In a couple of decades, we could see the average life expectancy in developed countries drop to 70 or 75.”
      And this is a bad thing? we should all be so lucky….

  • Companies often charge domestically and give away in poor countries where there is no chance of revenue. HIV drugs are a good example.

    • I believe covid-19 vaccine will be free for poor because this virus has to be killed from the earth otherwise rich or poor nobody is safe and having vaccine is meaningless. US China and others don’t avoid their responsibility whatever they need to do. Definitely they will make they world safe place..

  • The clearest solution to making sure a Covid-19 vaccine is affordable is simply to simply have the federal government pay for the vaccines. It’s clearly in the public good, and there’s no risk of abuse and over-prescription. That’s a lot more straightforward than trying to extract a promise from drugmakers to keep it “affordable” that will A) be difficult to define and B) disincentivize companies to develop the vaccine in the first place. The government doesn’t necessarily have to pay the entire cost: they can simply set a price they are willing to pay, and pharma will no doubt go along with it, because what’s their alternative? But the key, which Azar understands, is you don’t try to enforce this before a vaccine is developed. That would be shooting yourself in the foot.

    The real long term answer should be for the government to build a vaccine development capability and not reliant on the private sector.

    • In the US, the government is extremely leery about founding businesses that compete with private enterprise.

      No business can outcompete the essentially infinite resources of the government. If the government sets up a competing manufacture, private businesses will just fade away.

      That is an outcome that is undesirable on many levels.
      > It will create a monopoly, which is never a good business model
      > The government is notorious for being a bad business proprietor — wasteful and not innovative
      > The government wants the country to be full of tax-paying corporations, not tax-consuming lame businesses

    • “No business can outcompete the essentialy infinite resources of the government”
      This is the problem, if you make it too difficult for companies to produce, you’ll have no other option than to depend on the government to produce said drugs. The problem is that the government has a finite amount of resources that come from where? Taxpayers. A reasonable solution would be to give Profit incentives (I.e. tax breaks) to companies that produce the drugs and equipment that can combat an outbreak like the corona virus

    • @ Big dill

      I think the idea is that the “profit incentive” that corporations must have in order to exist should not come from a “tax break” but instead from their actual “profit.”

      Then the government compensates individuals who cannot afford the costs with entitlement programs such as Medicare.

      One of the reasons for this is that the voters/taxpayers are a lot more sympathetic to being taxed for the poor and elderly than they are in behalf of giant corporations.

      In addition, the government prefers to have the country full of tax-paying profitable corporations rather than weak, unprofitable corporations that we have set up to consume money in the form of handouts — tax payers rather than tax consumers.

      It’s better for everyone to let corporations pay dividends to their shareholders and pay taxes on the profits they earn by their work.

      Then we simultaneously maintain (by entitlement payouts) an income floor below which no citizen is allowed to fall.

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