Why Are Pharmaceutical Companies Gradually Abandoning Vaccines?
Health Affairs. 2005;24(3):622-630.
Factors That Would Encourage Vaccine Making
The CDC and the IOM have recognized the importance of finding ways to finance vaccines for the twenty-first century.[25] We discuss several possible solutions below.
Pharmaceutical companies could be encouraged to make vaccines if the federal government provided more assurances that the VFC entitlement program was robust, allowed for a mechanism to increase the fixed price of certain vaccines, offered tax breaks to companies that chose to make vaccines, and supported more testing centers (such as the Vaccine Evaluation and Testing Units [VETUs]) for commercial vaccines prior to licensure. Further, the burden of assuming the cost of creating and maintaining an infrastructure for vaccines by health care professionals could be supported by adequate administration fees through both the VFC program and private insurers.
The cost of making vaccines for pharmaceutical companies could be reduced by strengthening weaknesses in the NVICP—specifically, disallowing opt-out of the program when scientific studies do not support a claim; covering all vaccines; covering the unborn child when a vaccine is given to a pregnant woman; and indemnifying academic medical centers (AMCs) that test vaccines prior to licensure.
The cost of making vaccines could also be reduced by encouraging public-private partnerships for vaccine R&D. The first and best example of a public-private partnership was that between the National Foundation for Infantile Paralysis and polio vaccine manufacturers in the 1950s. Between 1938 and 1962 the foundation raised $630 million; $70 million was spent on research. The amount of money spent by the March of Dimes to understand one disease—ten times more than spent on polio research by the National Institutes of Health during the same period—was unprecedented.[26] By paying for research that determined how to make a polio vaccine and by paying for a large clinical trial that showed that the vaccine worked and was safe, the foundation took the risk out of vaccine R&D. Further evidence for this model for vaccine development is found today in the relationship between the Gates Foundation and pharmaceutical companies for the development of AIDS and malaria vaccines.
Vaccines are difficult and expensive to make and, because they are used once or at most several times during one's life, have revenues that are dramatically less than products that are used every day. As a consequence, many pharmaceutical companies have abandoned vaccines in favor of drugs. However, the technology is in hand to prevent many infections that routinely hospitalize and kill people in the United States and the world. By increasing funding for vaccines through the VFC program; by offering tax breaks to companies that develop less profitable but life-saving products; by supporting clinical testing centers for commercial vaccines; by strengthening protection against litigation unsupported by scientific evidence; and by ensuring that health care professionals are reimbursed for the infrastructure required to administer vaccines, Congress has the power to protect a product that is vital to our nation's health.
The author thanks Edgar Marcuse for his contributions to this paper.
Health Affairs. 2005;24(3):622-630. © 2005 Project HOPE
Paul Offit ( offit@email.chop.edu ) is chief of the Division of Infectious Diseases and director of the Vaccine Education Center at the Children's Hospital of Philadelphia. He is also a professor of pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.
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