The Socialist 18 November 2020 |
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Covid, vaccines, 'big pharma' - and the need for socialism
Syringe in use (Click to enlarge)
Jon Dale, health worker and secretary Unite union EM/NG32 Nottinghamshire Health branch (personal capacity)
News that early results from a Covid-19 vaccine - produced by US-based pharmaceutical giant Pfizer, in conjunction with German company BioNTech - showed 90% effectiveness has been greeted with relief. Another vaccine trial, by US company Moderna, has also shown 95% effectiveness in early results. People across the world desperately hope this means the pandemic's end is in sight.
It has been a terrible year since the virus swept across the globe. By 16 November, the World Health Organisation (WHO) had recorded 54.3 million confirmed cases, with 1.3 million deaths. Many still suffer ongoing illness ('long-Covid'). Many more have been left in pain, disability and anxiety as overloaded health services halt diagnosis and treatment of other conditions.
Vaccination could prevent Covid-19's ongoing spread, allowing normal activities to resume. Computer modelling has shown a vaccine with 80% effectiveness could reduce the peak by 85%, if given to 75% of the population with 5% already exposed to the virus.
1. Early results and safety - the many unanswered questions
Pfizer/BioNTech and Moderna's vaccines are the first of many in development. 90% effectiveness is much better than hoped for. However, these are early results based on 94 and 95 people who developed Covid-19 symptoms seven days after their second dose of either vaccine or a placebo for comparison.
So far, Pfizer/BioNTech have not issued the full data, only a press release. This does not show the severity of illness among those who did not receive the vaccine compared to those who did. The research is answering the easiest question but not the most clinically relevant. The aim of a vaccine must be to prevent hospitalisation and death, not just mild illness.
How long protection will last cannot yet be assessed. Will further booster doses be needed? Might it need repeating annually? Does it protect against asymptomatic infection? If not, individuals who feel fit and well could still infect vulnerable members of their community.
Does it protect the most vulnerable, including the elderly and those with other illnesses, or pregnant women or children under 12? These groups are excluded from this trial.
Vaccine safety is a critical issue. In 2010, five in every 100,000 children in Finland developed narcolepsy, a serious nerve condition. The usual number was one case in 300,000 children.
The 17-fold increase appeared to be linked to the Pandemrix vaccine to prevent swine flu, manufactured by GlaxoSmithKline. The vaccine's development was speeded through as a dangerous pandemic was anticipated, although it turned out less severe than initially feared. The European Medicines Agency recorded 980 adults and children believed to have developed narcolepsy after receiving Pandemrix.
There have been other vaccine-related serious safety issues in the past. But in the midst of a pandemic now causing about 10,000 deaths a day worldwide, the risk from delaying effective vaccines could far exceed the risk from using them while safety evaluation continues.
To have reached Phase 3 clinical trials with about 40,000 participants, vaccines should have completed more limited Phase 2 trials with a few hundred participants, identifying any common safety issues.
As socialists, we demand that all trial designs and results are open to public scrutiny. There should be independent evaluation of the safety and effectiveness of all new vaccines and medicines under trade union supervision. Trade unions such as UCU, Prospect, Unite, and the BMA, the medical professional body (and their international equivalents), have members with the necessary expertise. This would expose any corner-cutting by profit-making pharmaceutical corporations.
Anyone deve-loping a serious side effect from a vaccine should be compensated for full loss of earnings, any care needed and any other loss they suffer - for life if necessary.
2.Fast development, public subsidy and socialism
The speed of Covid-19 vaccines development worries many people. It usually takes ten to 15 years to develop a new vaccine. The first vaccine against Ebola virus was approved last year - 43 years after the virus was discovered. As Ebola is mostly restricted to some of the poorest countries in the world, pharmaceutical companies did not invest in research where they expected no profits would be made.
Covid-19 has caused a massive economic shock to global capitalism. Social and political shocks will follow, and are feared by governments everywhere. To try and end the disruption to their economies, they have placed big orders at very early stages of vaccine development. The market for effective vaccines is therefore huge.
117 vaccine research projects are currently recorded by WHO, of which 65 are recruiting patients. Ten are now in clinical trials. Thousands of scientists, doctors, engineers, data analysts and others have been mobilised across the world. 1,000 scientists in China are reported to be working on Covid-19 vaccines, including from the Academy of Military Medical Science.
Vast sums of government money have poured into this research (see chart opposite). Corporations that usually compete with each other for markets and sales have collaborated to speed vaccine development. This alone destroys the oft-repeated defence of capitalism - that competition drives forward progress.
These fast developments indicate what could be achieved if scientific and medical research was coordinated and planned to meet the needs of humanity across the planet, rather than for the profits and power of capitalists and the ruling elite.
"For decades vaccines were a neglected corner of the drugs business, with old technology, little investment and abysmal profit margins. Many firms sold their vaccine divisions to concentrate on more profitable drugs" (The Economist).
Instead of giant pharmaceutical corporations researching copycat drugs of existing money-spinners, treatments to cure many illnesses that afflict the poorest of the world could be found.
Instead of squandering huge sums of money and scientific talent on researching agribusiness and food products that damage our health, similar effort could be used to grow and produce sustainable and nutritious food for all.
And instead of pouring billions into researching armaments that destroy life, the money and skills could be redirected to mitigating and reversing pollution and global heating.
Socialism, with democratic, working-class control of publicly owned industries, would enable planning of resources for need, not profit. The rapid development of Covid-19 vaccines gives a glimpse of the possibilities of planning to meet needs.
3.Manufacture and distribution
After developing vaccines that work and are safe, manufacturing the billions of doses needed is a major challenge. Pharmaceutical corporations often use contract manufacturers. However, few of these have the capability to produce the active ingredients for mRNA vaccines like Pfizer/BioNTech's and Moderna's, not least because they are unique and patented.
Over the summer, a legal dispute took place between Moderna and Arbutus, a small Canadian company. Arbutus owned the patent to a key ingredient in Moderna's vaccine.
The dispute stems back to another legal fight between the two companies in 2016. Arbutus' patents have since been taken over by Genevant Science - a subsidiary of Roivant Sciences, which is itself Arbutus's biggest shareholder. These complex business schemes and disputes only serve to obscure and obstruct what should be freely available to public scrutiny.
Vaccine manufacture includes packaging into small glass or plastic vials. Pfizer/BioNTech's vaccine needs storing at -70° Celsius, requiring borosilicate glass ('Pyrex') to avoid cracking. The UK's manufacturer of this glass closed its Sunderland factory in 2007, so it needs importing.
As global demand for these specialist glass vials rockets, a repeat of the Personal Protection Equipment (PPE) shortages seen during the spring could take place. Pandemic contingency planning, on a worldwide scale and in Britain, has been woefully inadequate.
Storage and transport at such a low temperature also presents new problems. Domestic freezers, as found in local health centres, only go down to -20°C. The vaccine will need to be kept deep frozen from factory to warehouse to local vaccination centre, requiring a highly specialist logistics chain, including planes and lorries. This does not yet exist.
Whereas PPE could sit in an airport warehouse for a few days and not deteriorate, whole consignments of vaccine could be wasted.
This is a particularly important and difficult problem in large parts of the world, where electricity and roads are at best patchy, and often barely exist. In 2005, WHO estimated up to half of vaccines were wasted globally every year, mainly due to lack of temperature control and logistics to support an unbroken cold-chain.
A more recent estimate puts the annual cost of supply chain issues at $35 billion in wasted biopharma products (IQVIA Institute for Human Data Science).
4.NHS creaking under the strain
Once the vaccine arrives at its destination, health workers need to check each person, give the jab, make a full record, and organise follow-up and repeat doses as necessary.
But years of cuts and pressure from the ongoing drive towards privatisation mean there aren't enough staff, even without any additional Covid-related needs.
37,800 unfilled full-time NHS nursing posts in June - a 30% drop of social care nurses since 2012 - health visitors cut from over 10,000 to 6,600 since 2015 - a 3% drop in GP numbers since 2017. Where will the vaccination staff come from? Will they be taken away from other pressing work?
2021 will be another year in which people suffering with non-Covid health problems are forced to wait for the care they need. Those who can afford it will be tempted to pay for private treatment rather than wait in pain or failing health. The rest will suffer, and some will prematurely die or experience more permanent disability.
An immediate 15% pay rise for all health workers would help get back some of those who left in recent years, unable to afford the 20% real terms pay cut since 2010. New staff could be recruited from those made unemployed elsewhere to carry out tasks like record-keeping and data collection.
Several of the biggest pharmaceutical companies have claimed they are not developing Covid-19 vaccines to make big profits. Indeed, some say they will sell their vaccines at cost price. But who can believe them?
AstraZeneca, partnered with Oxford University to produce a vaccine discovered at the university's Jenner Institute, says it will sell the vaccine at no profit while the pandemic continues. However, it will decide when the pandemic is over and then raise the price, as soon as July 2021. It could then sell hundreds of millions more doses with a hefty profit.
Johnson & Johnson has made a similar claim - to sell their vaccine "on a not-for-profit basis for emergency pandemic use." Who will decide when the emergency is over?
Pfizer's chief executive, Albert Bourla, said the company "will make a very, very marginal profit at this stage." He has also said he doesn't agree with those who say Covid-19 vaccine developers should forgo profits. "You need to be very fanatic and radical to say something like that right now. Who is finding the solution? The private sector" (Barron's, a US financial magazine).
Bourla was paid $17.9 million in 2019, clearly not enough for him as he 'earned' a further $5.6 million selling Pfizer shares on the day the company announced its vaccine had been 90% effective. His income this past year is probably enough to supply over a million free doses in a poverty-stricken country.
But while adopting a 'holier-than-thou' stance over vaccine profits, big pharma has been mute over the stratospheric rise of company stocks. US pharma and biotech companies stocks have risen by 630% in the last year. Novavax, which received $1.6 billion in government funding, has seen its stock rise by 2,000% - big bonuses for directors and shareholders!
Earlier this year, a bidding war developed among wealthy nations over PPE supplies, driving prices upwards. This also happened in 2009 with the swine flu vaccine. The same could now occur for the most effective vaccines, leading to potentially astronomical prices. Middle and low-income countries would be priced out.
But if parts of the world continued to be Covid-19 reservoirs, it would be a matter of time before the virus mutated and spread back to those parts of the world where high vaccination levels had been achieved. There would be no guarantee this would protect against a new strain of the virus. Recently, fears have been expressed over mink farms in Denmark spreading a mutated Covid virus back to humans.
All big pharmaceutical corporations need to be taken out of the hands of profiteers and into public ownership. This global industry shows how vital internationalism is for socialism.
As a start, a workers' government with a socialist programme would need to nationalise the big companies in its own country, with compensation for small shareholders in genuine need, including workers' pensions. But it would also need to appeal to workers elsewhere to take similar measures, as the industry is organised on a global scale.
Medicines and vaccines could then be planned to meet the needs of all. But to give everyone a chance of living healthy lives, we also need well-paid jobs with safe working conditions; good housing, education, health and social care; healthy food; clean air and water; and action to halt global heating. Vaccines can't achieve these but socialism can.
'Socialising the risk, privatising the profit'
At the beginning of the pandemic, 'big pharma' was reluctant to invest in a vaccine, given the lengthy time and failure rate of vaccines for diseases like Zika and Sars, with research being 'parked' as these diseases retreated.
However, huge sums of public money made available by governments have greased the wheels of the pharmaceutical industry (see chart below).
Now, 202 companies are involved in developing inoculations. Of these, 47 potential vaccines are undergoing clinical trials.
"Hundreds of millions [of dollars] were thrown at several of these companies in a way that took their breath away," says Peter Hale, executive director of the Foundation for Vaccine Research in Washington.
And according to David Mitchell, founder of the US campaign group Patients for Affordable Drugs, companies such as US-based Moderna are having all their costs covered by the government.
"That means anything over the cost of goods is pure gravy for these companies," he said. "Their oft-made claim that they need to charge high prices because of the risks that are involved in developing new drugs is no longer valid."
"We're socialising all the risk and privatising all the profit," he added.
Governments' Covid-funding of pharmaceutical industry
- AstraZeneca/Oxford University $1.7 billion+
- Johnson&Johnson/Biological E $1.5 billion
- Pfizer/BioNTech $2.5 billion
- GlaxoSmithKline/Sanofi Pasteur $2.1 billion
- Novavax/Serum Institute of India $2 billion-
- Moderna/Lonza $2.48 billion
Tory cronyism rules
The Johnson government has dished out secretive, unscrutinised pandemic contracts worth billions to private companies, using emergency powers. Many of these contracts, as shown by the test-and-trace fiascos, have been costly disasters. A multimillion pound contract for testing kits was given to Randox Laboratories without even going through a public tender process. Tory MP Owen Paterson just happens to be a paid consultant for Randox.
Government pandemic appointments showing connections to Tory MPs are well documented. Former managing director at private equity firm SV Health Investors and now chair of the government's vaccine taskforce is Kate Bingham. Coincidentally, she is married to Tory MP and old Etonian, Jesse Norman.
The much panned ex-chief of TalkTalk, testing and tracing boss Dido Harding, also happens to be married to a Tory MP, John Penrose. In 2014, the then PM David Cameron elevated her to a peerage in the House of Lords.