March 18, 2020
The New Republic
This week, scientists at the Kaiser Permanente Research Institute in Seattle, Washington administered the first injection of a trial vaccine for the coronavirus. As The Associated Press reported it, the mood was optimistic. “We’re on team coronavirus now,” said Kaiser’s Dr. Lisa Jackson. The recipient of this first dose, 43-year-old Jennifer Haller, offered tones of civic pride: “This is an amazing opportunity for me to do something.” These are just the first steps in what would be, in the best case scenario, a 12 to 18 month wait for a medical breakthrough. All over the world, similar efforts are ongoing, the hope being that this vital work can be carried out without interruption or interference.
Naturally, we have also recently received a reminder of the extent to which our dreadful politics might provide the impediments necessary to blunt the efforts of vaccine researchers. Word leaked out this week that Donald Trump had apparently tried to lure a team of German researchers to the United States, so that they could carry through cutting edge research on developing a coronavirus vaccine here. (The European Union is now responding to try to keep its researchers there.)
It’s not clear exactly what Trump hoped to gain if his efforts succeeded. There was speculation that he had planned to make the vaccine available exclusively for people in the United States, although as a practical matter, it is difficult to envision how this could have been accomplished. Perhaps Trump was just hoping for bragging rights, that the United States had developed the first effective coronavirus vaccine. (In a best case scenario, it will be at least a year until one is widely available, an inconvenient truth for those who are currently endeavoring to engineer the president’s re-election.)
While it is not worth a lot of effort unraveling Trump’s thinking, we should be doing some serious thinking ourselves about the development of a coronavirus vaccine and biomedical research more generally. The situation we see today is that many top-notch researchers, in Germany, China, the United States, and elsewhere, are racing to develop a vaccine that can enter the testing process. The problem with this picture is that they are working in competition, not collaboration. This means that they are not widely sharing information with each other, since they don’t want to give their competitors an edge.
In normal times, this would be understandable. Each team of researchers hopes to be able to gain a patent on an effective vaccine. This could in principle lead to an enormous payoff, as they will have a monopoly on a vaccine that protects people from a potentially deadly disease. But these are not ordinary days. The coronavirus pandemic cries out for an alternative approach. Instead of competing, these teams of researchers could be working in cooperation with each other, sharing new findings quickly and fully.
There is a good model for this sort of collaborative research. The Human Genome Project, which mapped the human genome in the late 1990s, was governed by the Bermuda Principles. Under these principles, results were shared as soon as possible, ideally being posted on the web nightly. The idea was that this was a common project that was supposed to benefit all humanity. By sharing results, they hoped to advance the project as quickly as possible. There is no reason to not apply a similar approach to developing a coronavirus vaccine. We should want research teams throughout the world to have access to the latest discoveries by their colleagues elsewhere. They can learn from failures, so they don’t waste time making the same mistakes, and build on successes.
When a successful vaccine is developed, it can be placed in the public domain, which means that it can be sold as a cheap generic from the first day it is approved by the Food and Drug Administration. This would mean that we don’t have to worry about begging a drug company to make its vaccine available at an affordable price. Drugs are almost always cheap to manufacture and distribute. If there were no patent monopoly, drug companies would not be able to charge high prices.
The pharmaceutical industry argues that it needs patent monopolies to recover its research costs, but in this case, the research costs are already being largely covered by the government. Rather than giving out patent monopolies so that they may recover additional private expenditures, it would make far more sense just to have the government pick up the rest of the tab for the research and testing so that the companies would have no research costs to recover. This would be the best route to ensure the quick development of an affordable vaccine.
If we could go the route of advance government funding for this vaccine, as opposed to relying on government-granted patent monopolies, it could set an incredibly valuable example. The patent system for financing pharmaceutical research is an archaic relic of the medieval guild system. It survives by inertia; it is almost inconceivable that anyone would propose a system like this if we were designing one from scratch in the 21st century.
In addition to encouraging secrecy in research, patent monopolies also create the problem of high-priced drugs. Companies can charge tens, or even hundreds of thousands of dollars when they have a monopoly on drugs that may be essential for people’s health, or even their lives. We can use negotiations or price controls to bring these prices down, but without the patent monopoly, we wouldn’t have a problem of high-priced drugs in the first place.
Patent monopolies also encourage drug companies to mislead doctors and the public about the safety and effectiveness of their drugs. This is just basic economics. If a drug company can sell a drug for thousands, that costs the company $20 or $30 to manufacture and distribute, it has an enormous incentive to market it as widely as possible. This means pushing the drug for conditions where it may not be appropriate and concealing evidence that a drug may be less effective than claimed, or even harmful. The most dramatic example of this sort of drug pushing is with the opioid crisis. Perdue Pharma and the other leading manufacturers would have had much less incentive to mislead doctors about the addictiveness of their drugs, if they were all available as cheap generics from the day they entered the market.
If we looked to replace patent supported bio-medical research with public funding, the government will need criteria in determining which companies should get the funds. Military contractors provide a good model here. While there is much waste and abuse in the Defense Department’s contractor system, at the end of the day, the United States does get good quality military technology. Moreover, we would have an enormous advantage with biomedical research. In the case of military research, there are good grounds for secrecy: We don’t want ISIS to have access to the plans for the Pentagon’s latest weapons system. By contrast, we want coronavirus research results shared quickly and widely. If a contractor was using a grant for, say, lavish vacations to far-flung islands, that would quickly become apparent. (I describe this sort of system in somewhat more detail in chapter five of Rigged.)
It is also important to recognize that there is a huge amount of money at stake. We will spend close to $500 billion on prescription drugs this year. If all these drugs were sold as generics, without patent protection, we would almost certainly spend less than $100 billion. The difference of $400 billion is equal to roughly 1.8 percent of GDP. It is more than five times the size of the annual food stamp budget. We routinely have huge battles in Washington over sums that are less than one-tenth this size. This $400 billion in savings would have to replace roughly $70 billion annually in patent financed research now being done by the pharmaceutical industry. It is very hard to envision scenario where we don’t come out way ahead.
The case for breaking out of this system has long apparent; the current crisis only presents its underlying logic in stark relief. If we go the route of publicly supported open research, we will not only grease the wheels for the eventual development and distribution of a coronavirus vaccine, we can end the problem of high priced drugs forever. And, in terms of other minor inoculations, we will also eliminate the opportunity for President Trump to play ridiculous “America First” games in the middle of a pandemic.