The government’s focus on the acquisition and production of more ventilators to treat COVID-19 patients may have been a little too singularly focused.
Ventilators do not work alone. They need medical staff to operate them and to administer medications.
Typically, a patient on mechanical life support will need paralytics, sedation, blood pressure medications and other ICU drugs. Having enough ventilators will not be enough without the accompanied medications.
Unfortunately, COVID-19 is burning through drugs faster than expected and beginning to create drug shortages.
Pharmaceutical companies typically only keep a few months of supply on hand and many injectables require significant amount of time to manufacture.
While these drugs are cheap to make, they have a low level of profitability. Thus, only a few companies produce them domestically. These supply chain issues can potentially lead to price hikes.
The fear of rapid rising drugs prices is nothing new.
According to a 2015 Kaiser Family Foundation poll, one-in-four American cannot afford their prescriptions, with 72% of respondents saying prices are unreasonable and 74% believing that drug companies put profits before people.
Most Americans are familiar with the outrage over the rapid increase in the cost of EpiPens and insulin.
EpiPen, which is used as a lifesaving medication by countless families for asthma attacks and severe allergic reactions, saw a 400% increase in price from 2007-2017.
Insulin, on the other hand, was discovered over 100 years ago and is cheap to manufacture. Yet, in recent decades, prices have been creeping up faster than inflation. Some diabetics who pay out of pocket are having to ration their supply in order to afford their medications.
None of this sits well with the middle class, which has repeatedly watched drug companies rebrand old drugs and then charge exorbitant prices.
For example, Turning Pharmaceuticals purchased the rights to Daraprim (a drug approved to treat Toxoplasmosis) and raised the prices 5,000% overnight. Turning was not alone.
Other companies like Rodelis Therapeutics did the same thing when, in 2015, they bought the rights for Cycloserine (an antibiotic used to treat tuberculosis) and raised a month’s supply from $500 to $10,800.
The fear is that as COVID-19 continues to wreak havoc on our economic and health care systems, that the pharmaceutical industry will take advantage of its ability to raise prices.
We still are one of the few countries that allows pharmaceutical companies to charge what they want for prescriptions. Drug price gouging is not controlled by federal law unless the Defense Production Act is applied to the industry.
To date, this has only been applied to a few drugs and the pharmaceutical industry has shown an unwillingness to self-regulate rising prices or implement cost containment.
There is a growing fear that once a COVID-19 vaccine is developed that the American public will not be able to afford it.
These fears were stoked when Health and Human Service Secretary Alex Azar was unable to affirm that a coronavirus vaccine would be affordable when he said, “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest.”
The implication is that drug companies will not invest without profitability no matter how much the U.S. government invests in vaccine development or for the primary purpose of reducing the rising death toll.
Granted, vaccine development is expensive. A 2018 study by Lancet illustrated that vaccine development can cost an excess of $1 billion to get a product to market. Other drugs can cost hundreds of millions of dollars in development alone.
So, it is understandable that companies who risk a lot in pharmaceutical development will want a reward once the product hits the market. This is why governments will offer tax-payer research dollars to encourage vaccine and drug development and offset the risk to companies
One advantage of government-funded research is that the government can attach price controlling measures to the funding, but this does not always happen.
In the recent $8.3 billion coronavirus spending bill, drug industry lobbyists were able to fend off legislators attempt to assert the government’s ability to control future vaccine and treatment prices.
Some of the funding packages have left the door open for pharmaceutical companies to have exclusivity for these new products. Exclusivity allows a company to have a virtual monopoly on their product.
In March, Gilead Sciences Inc. was granted seven years of exclusivity by the U.S. Food and Drug Administration for the experimental drug Remdesivir to battle COVID-19.
Gilead ultimately waived its exclusivity agreement after public outcry, but these types of tactics cause the public to worry about the drug industry’s intentions. Are they more interested in public health or profits?
Since the SARS epidemic of 2003, the U.S. government has spent hundreds of millions of dollars on coronavirus research, but it has not always insisted upon affordability once a drug hits the market.
Without some measure of affordability, the government will be forced to supplement the cost of new coronavirus drugs.
This seems like a double burden for taxpayers, who are funding drug development and then having to pay for the high-priced drugs either through government subsidies or out of pocket.
As the country moves forward in the process of finding a treatment for COVID-19, two things need to happen: pharmaceutical giants need to step up and place people ahead of profits, and the government needs to take a serious look at how it funds vaccine and drug research.
If the public is funding drug research and development, then it should receive the benefit of this investment in the form of affordable prices.
Monty Self is the Senior Staff Chaplain and Clinical Ethicist for the Baptist Health Medical Center Little Rock.