If pharma helps quench the Covid-19 pandemic, what will it want in return?

Make no mistake: The only long-term solution to the Covid-19 pandemic is a safe and effective vaccine. The current focus on identifying effective treatments, while important, serve only as a temporary Band-Aid.

We don’t know yet if hydroxychloroquine, remdesivir, or any of the other repurposed drugs currently being tested in a blitzkrieg of quickly designed clinical trials are going to work and save lives. It’s highly likely that most of them, if not all of them, will fail or be only marginally helpful.

Plasma obtained from people who have beaten Covid-19, filled with virus-neutralizing antibodies, is likelier to be of some help. Quantifying its usefulness and finding a way to scale it up as a treatment will require overcoming a number of logistical and regulatory headaches.

At the end of the day, we want a vaccine. We need a vaccine. Disease prevention always beats disease treatment, both in preventing human suffering and reducing health care costs. I don’t see a way around this paradigm anytime soon.

It’s likely that scientists will develop an effective vaccine to end this pandemic, but it may take a long time to get there. I’m glad that a number of different approaches will be clinically evaluated because creating safe and effective vaccines is actually a difficult process. It’s not rocket science — it’s often much harder. Three decades after AIDS began its march around the world, we still don’t have a vaccine to prevent it. And while there are effective treatments, they’re costly (PrEP, for example, is unaffordable in many countries), come with significant side effects, and do not (in most cases) prevent the further spread of the disease.

By helping quench the Covid-19 pandemic, pharma will have won the lottery. Its ship will have come in with a package bearing the Golden Ticket. Let’s see if the industry can take advantage of this once-in-a-lifetime opportunity to restore the reputation it has spent the past half century sullying. The pharmaceutical industry is hoping that success in developing a vaccine will blunt the public’s righteous anger about high drug prices and a wide variety of other high crimes and misdemeanors. These have led to huge, well-publicized fines totaling billions of dollars, all of which are considered part of the cost of doing business. It’s easy to absorb these costs when you’re selling patent-backed, monopoly-priced products that can’t be obtained from any other source.

In early January, before Covid-19 became a worldwide pandemic, some 215 biopharma CEOs and industry leaders issued a New Commitment to Patients. It outlines a pledge by which the signing companies promise to adhere to a set of core principles and actions. The focus was on two primary areas: ensuring access to drugs and acting with integrity and responsibility. Notably absent from the list were signers from virtually all of the Big Pharma companies.

At the time, critics pointed out that while the pledge sounded good, there was no mechanism for holding the signees accountable for their actions, nor did it bind their organizations to follow their lead. An asterisk, which accompanied the list of signatures, stated, “The signatures above do not necessarily reflect the policies or positions of the agencies, organizations, employers, or companies with which the signers are affiliated.”

I’m not going to be in the room where the pharmaceutical industry extracts a promise from the U.S. government in exchange for the vaccine, nor will I have a seat at the table. I expect the vaccine will be provided either at cost, or with a very slight profit per dose, in exchange for the one thing that will guarantee the industry huge profitability for decades to come: no controls on drug pricing. Period.

This is what the industry’s large cadre of K Street lobbyists have successfully fought for since Sen. Estes Kefauver led congressional hearings on drug pricing in the early 1960s. The same thing they’ve been fighting over this year that was, until Covid-19 erupted, front and center in H.R. 3: The Lower Drug Costs Now Act.

Pharma will come up with a persuasive way of whispering this in President Trump’s ear. They’ll phrase it in a way he can readily understand. “Mr. President, the pharma industry would be happy to provide a vaccine that’ll save the world’s economy, along with many lives, and ensure your future enshrinement on Mt. Rushmore. In exchange, we’d like you to do us a favor.” The conversation will be “perfect.” Don’t expect to see the transcript because it’s going to be stored on a highly fortified government server in a locked safe inside a secure building.

It’s already become clear that Covid-19 is having an outsized effect on the elderly, the poor, and the disadvantaged. Minorities are being especially hard hit. In the Covid-19 era, ensuring that these groups have equal access to any treatments and vaccines that are developed, and supporting only ethical business practices, is going to test the totality of the biopharma industry — and all of biomedicine — to the core. Companies large and small are going to be under the microscope, with every decision and move scrutinized for a whiff of corruption, profiteering, and self-dealing.

My hope is that when all is said and done, the biopharma industry meets the challenge of defeating Covid-19 with a magnificent and historically successful response. The stakes are too high to not get this right; the rewards for solving this problem too great to not rise to the occasion. The invention of the polio vaccine in 1955 elicited great cheers from the public. I’m hoping to hear an echo of those cheers in the raised voices of an uplifted new generation of Americans in the very near future.

Let’s return to the room where the meeting between pharma and Trump will happen. The pharma executives will stride in confidently, enveloped in an aura of corporate invincibility and privilege. Trump will be there, picturing his re-election receding into the distance. Pharma holds the only card that matters in this high-stakes negotiation: an army of brilliant, highly motivated scientists who have waited their entire careers for this moment.

Trump, the former casino owner, holds the weakest hand imaginable. He will forget about his public promise to lower drug prices. Do not bet against the pharma execs walking out of the room clutching their golden ticket.

Given the enormous stakes involved, we are all going to have to be okay with this because we literally can’t live without the vaccine.

Stewart Lyman, Ph.D., is a biotechnology consultant and vaccine advocate who lives in Seattle.