Big Pharma and the COVID-19 Vaccine
Profit Making and Image Problems
Moderna, a pharmaceutical company behind one of the COVID-19 vaccines, made $529 million in grant revenue and $200 million from early sales of its jab in 2020. Their shares are up 187% over the last 12 months. Pfizer expects sales of the vaccine it developed with BioNTech to reach around $15 billion by the end of this year, with a profit margin of nearly 30%. Back in early December, Pfizer was given indemnity from any legal action related to its new COVID-19 vaccine: a key requirement for securing its early UK roll-out. Much has been made of this – as though Pfizer might be hiding something about the risks or side-effects of the vaccine.
While we shouldn’t read too much into Pfizer’s demands about the vaccine’s safety, their efforts and massive profits should remind us that the pharmaceutical industry is just that, an industry. Pfizer is a business - not a non-profit public service. They are not in it for us, no matter how much we might laud the quickness with which they have produced a vaccine to “solve” the pandemic and no matter how much they might benefit by association from the many testimonials about the altruism of those who volunteered to become test subjects.
At least as a company, their livelihood depends upon profits. It just so happens that in these pandemic times, the two goals of life-saving and profit-reaping neatly overlap. Together, they produce exactly the right blend of altruism and problem-solving that is the pharmaceutical companies’ marketing dream. Indeed, the pandemic has solved an image problem for “big pharma,” which has for at least a century struggled in the murky space between suppliers of necessary treatments and profit-making and motivated entities.
The tensions implicit in pharmaceutical company activities being both life-saving and profit-mongering has a long history. In the early twentieth century, the same pharmaceutical companies that had some of their more reputable drugs accepted for advertisement in the prestigious Journal of the American Medical Association also sold patent medicines, counting on the name recognition of their more legitimate wares to help to sell their dodgier ones. The American Medical Association’s (AMA) subsequent refusal to support health insurance of any kind in the 1930s was in part fed by its alliances with pharmaceutical companies. The lucrative patent medicine market was in danger of being drummed out of business if widespread, affordable healthcare took hold. And this, in turn, threatened the steady stream of advertising dollars upon which the AMA relied.
The more recent history of “big pharma” seems to suggest that these tensions are not only still with us, but have come further out of balance. The industry’s tendency to cut costs and skirt ethical controls by running clinical trials for new drugs in the Global South, for example, is well documented. And the opioid epidemic, which some argue is the cause of a recently unprecedented decline in U.S. life expectancy, has been directly linked to the aggressive marketing of painkillers by pharmaceutical companies.
Pharmaceutical companies have also run afoul of critics for their pricing practices, including the very recent antics of Essential Pharmaceuticals, who threatened a 2600% increase in price for one bipolar medication as a bargaining chip in securing a more modest price hike for another. Martin Skhreli, the CEO of Turing Pharmaceuticals, became a household name when he was convicted of fraud. And his company, now called Vyera Pharmaceuticals, was alleged to have engaged in anti-competitive practices in the manipulation of the market for a drug that treats the life-threatening infection toxoplasmosis.
But to understand the extent and power of big pharma one also needs to understand how far its fingers reach into medical practice. It should come as no surprise that about a third of drug company revenue goes toward marketing (while only a twelfth goes to research and development). Over the late twentieth century, a good chunk of this marketing was directed at doctors themselves in the form of free lunches, free conferences, free flights, free golf holidays, free you-name-it. This very successful strategy was aimed at getting physicians on the ground to adopt and prescribe the particular drug being hawked on the day, whatever its merits or demerits in relation to other possible therapeutic regimes.
In some cases, drug companies have successfully transformed a more or less mundane physiologic tendency into a full-fledged pathology for the purposes of selling a treatment. If you have restless leg syndrome, you can thank GlaxoSmithKlein for your diagnosis. It was their push to get their treatment for the syndrome, ropinirole, on the market that helped to secure it as a diagnosis in the first place.
None of this is new or surprising: it has been well known for some time that this is the (for many of us unacceptable) cost of keeping us healthy. What is surprising, though, is how quickly we have laid this awareness aside, lauding even those pharmaceutical companies whose COVID-19 therapies have been deemed ineffective, thereby allowing them to reap the financial and reputational benefits of merely being in a position to do something.
While we might be grateful for the speed with which pharmaceutical companies have produced a vaccine, this should hardly be marked as a clear-cut win. We should not see in the happy potential of a pandemic-ending vaccine anything like the validation of corporate models and practices that big pharma will see. Of all of the variously problematic constituent parts of our healthcare system, pharmaceutical companies pretty much epitomise everything that we have gotten wrong. This is something we have to talk about, even as we try to vaccinate ourselves out of our current crisis.