A coronavirus vaccine should be for everyone, not just those who can afford it

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.

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.

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.