multi-storied #13: Vaccines

It’s a funny thing, but when you grow fascinated with an idea, you hear its echoes everywhere. For four years, while I wrote my book about J. B. S. Haldane, I thought about the ways in which science is conducted, commercialised and co-opted. Now, even though the book is well behind me, my ears remain tuned to that frequency.

When I first wrote about Covid-19 vaccines, back in March 2020, they weren’t yet real. Scientists were still tinkering with snatches of genetic material or running small trials with mice. Alongside the unrealness of the vaccines themselves, though, I also encountered an unrealness of vision: a sort of idealism about how institutions would rise to meet this global challenge with unprecedented egalitarianism and fairness. The vaccines would be approved; they’d be made and distributed cheaply and widely. Sometimes people would talk about how, if the world managed to get past its own worst habits to beat back the pandemic, it might then find similar spirit to tackle something like climate change.

The vaccine development process embodied so much of the paradox of scientific research. Unlike other disciplines or industries, science is oriented by default towards the public good, its fruits sought after first and foremost to enable humans to live better or longer. But science also has to exist within human society, subject to the vagaries of government or the greed of companies. (Haldane experienced both, notably in his design of air-raid shelters during the Blitz. I wrote about that for Harper’s a couple of months ago.) This contradiction of moral clarity and systemic imperfection is jarring. I reviewed a new biography of Stephen Hawking for the New Republic recently, where I wrote of the book’s disillusioned view of Hawking’s celebrity:

Everything, then, seems to fall short of some presumed ideal: Hawking’s material motivations for finding an audience, the fullness of his readers’ understanding of his work, the tabloids’ sordid fascination with Hawking, the uncerebral tenor of his fame. But all of this amply reflects the nature of science itself. The ideal never exists. Science is a human activity, beset like all other human activities by emotion, money, politics, strife—and, sometimes, devastating disease. Hawking’s life was a reminder that we’re all imperfect beings trying to understand a perfect universe.

So it was, sadly, no surprise when the idealistic vision for Covid-19 vaccines began to fray. When I wrote about India’s vaccine shortage for Quartz, I found a timeline of severe dysfunction: “a period in which government negligence, corporate profiteering, opaque contracting, and the inequities of the global pharma market combined to bring India to this moment of vaccine crisis.” Here’s one example:

In an interview, Adrian Hill, the director of the Jenner Institute at Oxford, describes his team’s progress on a vaccine. He doesn’t believe in exclusive licenses, he says: “Nobody is going to make a lot of money off this.” An open licensing regime is a potential boon for India, which has dozens of vaccine plants across the country. The scientists at these plants are experienced, and the production costs are low. If the Oxford vaccine succeeds in trials and its license is opened up—events that are potentially months away—India can find a way to put all these plants to work manufacturing it.

Days later, though, AstraZeneca announces that it has secured the exclusive license to the Oxford vaccine. Why the plan changed never becomes fully clear, but the Gates Foundation may have had a lot to do with it. “We went to Oxford and said, you are doing brilliant work,” Bill Gates tells reporters a few months later. “You really need to team up, and we told them a list of people to go and talk to.”

In an email to Quartz, Hill denied at first that his plan for the vaccine’s licensing had changed. When his quote from April 2020 was read back to him, he didn’t respond.

The vaccine shortage is the result of other things as well, of course: the Indian government’s shocking inaction, the Serum Institute of India’s lack of transparency, the alacrity with which wealthy countries cornered the market on vaccines and vaccine supplies. All the worst habits of the world, kicking the idealism of March 2020 in its teeth.

Among the very worst of these habits, I’ve found, is the way public good is turned to private profit. As much as 99 percent of the disclosed funding that went into the development of the AstraZeneca vaccine came from public or philanthropic money. In the US, both the Pfizer and Moderna vaccines rely on older scientific breakthroughs paid for by public money and then on fresh infusions of government grants last year.

All these vaccines have a market price. The US pays Pfizer around $19.50 per dose; the EU pays $14.50. The US pays Moderna around $15 a dose. The UK pays AstraZeneca around $3 a dose now, but the company plans to raise the price once this phase of the pandemic has passed in Western countries. India’s state governments pay Bharat Biotech 400 rupees ($5.71) per dose of Covaxin, but in private hospitals, citizens are paying 900 rupees or more.

It’s almost as if these states—and their citizens—are paying for these vaccines twice over: once to bankroll much, or nearly all, of the research itself, then again to buy back the products of this public-funded research. Pharma corporations benefit hugely from this model. Pfizer expects profit margins on its vaccine of between 20%-30% over an unspecified timeframe. On May 6, Moderna declared $1.7 billion in Covid-19 vaccine sales in the year’s first quarter: its first-ever profitable quarter. (Its total revenue in the same quarter in 2020—before the pandemic spread, and before the US lavished money on Moderna’s vaccine candidate—was $8 million.) Moderna didn’t announce its profits this year but, it plans to hike vaccine prices soon. So does AstraZeneca, which posted $275 million in Covid-19 vaccine sales in the quarter, and which stands to multiply that amount by selling its vaccine at a higher price.

In discussions about vaccine intellectual property, companies argue that slackening patent restrictions will be counter-productive. That without the revenues accruing from strict and exclusive patent regimes, companies will have no incentives to develop drugs—and no funds to conduct the research needed. But as these Covid-19 vaccines suggest, often companies don’t fund the research needed—certainly not all of it, anyway. And yet, as a matter of course, these vaccines too have slipped neatly into corporatised, profit-milking mode of our times.

In the Guardian, I reviewed Patrick Radden Keefe’s “Empire of Pain,” his attentive history of the Sackler family—and here too, I ran into the same themes, the same corrosive mix of money, political corruption and manipulated science.

The Sacklers founded Purdue Pharma, which manufactured OxyContin, the drug that touched off a wave of opioid addiction and abuse in the US. OxyContin earned Purdue at least $35 billion, and the Sacklers used their money to not only to grease the palms of regulatory authorities but also to buy themselves social status. The family name adorned sites of cultural cachet: the Sackler Wings at the Louvre in Paris and New York’s Metropolitan Museum of Art; the Serpentine Sackler Gallery in London; buildings at Harvard, Oxford and other universities. And through it all, the Sacklers knew what they were doing:

They knew that OxyContin was more potent than morphine, and they exploited the fact that doctors thought the reverse to be true. (“It is important that we be careful not to change the perception of physicians,” a Purdue official advised.) They claimed OxyContin posed little risk of addiction, even though Purdue had carried out no tests to that effect at all. They knew they were using flimsy literature to reassure physicians about OxyContin’s safety: “not a peer-reviewed study,” Keefe writes, “but a five-sentence letter to the editor by two doctors at Boston University”. They knew the drug could be injected, but they didn’t let on. They argued that OxyContin’s slow-release mechanism was a barrier to abuse, but they knew they also owned another company that made immediate-release oxycodone. Studying their sales data, they maintained a secret list of doctors who overprescribed OxyContin—and did little to alert the authorities to these pill mills, preferring to grow rich off the proceeds instead.

This is all staggering and enraging. But by the end of the book, even a family as egregious as the Sacklers comes to feel almost beside the point. The system they exploited is still very much in place, as we’re learning afresh during the pandemic:

In the past half-year, the seasoned sceptics among us have been advised to unfurrow our brows and soften our hearts—to celebrate the marvel of vaccines developed on the fly, in the teeth of a crisis. These vaccines are brandished as proof of the essential soundness of the medical industry: its patent regimes, its sense of ethics, the might of its corporations, the operations of its markets. None of these champions hangs around very long to listen to the argument that, while the vaccines may bear out the march of science, their distribution suffers from many of the industry’s mercenary habits. The rich prevail over the poor. Taxpayers fund research, only for large firms to cling to intellectual property rights and the revenues they will bring—and for governments to back this opportunism even during a global pandemic. Companies publish dubious data. And those members of the Sackler family who were involved have endured nothing more distressing than a social downfall. Only in a deranged world can the erasure of their names from museum galleries be considered punishment enough for OxyContin.