In the article, "The Price of Prevention: Vaccine Costs Are Soaring" Elisabeth Rosenthal goes into detail about how vaccines' costs have been increasing to a point where doctors are debating whether to offer shots. Vaccines have been a surprisingly hotly debated topic but they are still one of the most important things that benefits our public health safety. This article dives into all of the different influences that go into pricing, demand, and availability of vaccinations and how they all tie in together. Rosenthal strategically highlights stakeholders from each party effected by this conundrum to demonstrate how this is happening and what the long term effects could be. She points out pharmaceutical manufacturer Pfizer and their popular vaccination Prevnar 13, pediatrician Dr. Lindsay Irvin, San Antonio mother Breanna Farris, and government agencies like the Center for Disease Control and Prevention and Advisory Committee on Immunization Practices. All of these stakeholders play a roll in how vaccines are priced and give you insight to another part of the healthcare system that is not working correctly.
When the polio vaccination was invented it was a joint investment of funds between the federal government and different foundations. Pharmaceutical manufacturing companies have changed the way vaccines are made, patented, and sold through the privatization. Rosenthal points out that since 1986 the cost to vaccinate a child up to age 18 under private insurance has rose from $100 to $2192. Now, it should be pointed out that these costs may be explainable because of the added regulations and hurdles these companies have to go through to get vaccinations produced. There were measures to change the number of subjects mandatory for a vaccine trial from thousands to tens or even hundreds of thousands subjects. Added to the fact that making vaccines is a risky market to get into, these factors may explain some o the rising costs but definitely not all of it. Manufacturers have historically experienced small losses on vaccines because of the public health benefits forcing the companies to make them easily available but now are turning profits. The article points out how the cost for Prevnar 13 has been rising about 6% ever year since 2002 although the vaccine has not changed much. These rising costs should definitely be looked into by the government to decide whether there needs to be a correction to the market.
Government agencies play a large roll in the way demand for vaccines has caused some of the price increases. Rosenthal outlines how most pharma companies look at the FDA approval to be the most important thing for their drugs success but it is different for vaccines. The Advisory Committee on Immunization Practices is the most important government entity for vaccines because they give out mandates or strong recommendations to parents to get a certain vaccine. If the committee decides a vaccination should be mandatory for schools then the parent has no choice but to get their child vaccinated. These decisions may have direct influence on the price of the vaccine as pointed out by this article. In Singapore, Prevnar 7 was being evaluated for school mandate use. Before the committee made it mandatory it was selling at about $80 per shot but after it shot up to $120. These mandates, although beneficial to public health, can cause unforeseen price increases as well.
Finally, it is all tied together through the pediatrician Dr. Lindsay Irvin and San Antonio mother Breanna Farris. Due to the increasing price, Dr. Irvin tells us that she loses money on every shot she gives. The article states that insurance companies are supposed to cover all out of pocket cost because of the Affordable Care Act but in reality they cover on average about 40-100% of the cost. They rarely cover all 100% when overhead is taken into account so family doctor offices must make the terrible choice whether or not to offer immunizations. All of these decisions and factors come down to the direct stakeholder, Breanna Farris a mother from San Antonio. When her and her two kids moved to Texas, they were told when they entered school that Farris's daughter needed extra vaccinations because of the school mandate. She called 10 different pediatricians to find someone that was offering immunizations and was covered by her insurance but no luck. Her daughter missed a week of school trying to find the vaccine. They ended up being forced to go to a public health facility and lie that they didn't have insurance so they could get the vaccine.
When it comes to children's lives and the public health safety for all, making profits should be the last goal of these pharmaceutical manufacturing companies. This article really opened my eyes to all of the various factors that go into the pricing of these crucial vaccines and how it is a similar problem for many parts of healthcare. Rosenthal does a great job pointing out all of the different roles and how they tie in and can cause some horrible consequences.
Hey Avaneesh,
ReplyDeleteFantastic write up. Of the write-ups I've read through today, this might've been the most eye opening. It's great you mention the polio vaccine. Dr. Jonas Salk made sure that the vaccine could not be patented, even though he stood to gain a lot of money from such a patent.
One man who is not so great is Martin Shrkeli, who buys pharmaceuticals and raises prices by 5,000% (https://www.scientificamerican.com/article/martin-shkreli-who-raised-drug-prices-5-000-percent-heads-into-fraud-trial/). Good thing he may be heading to prison. I know that doesn't tie directly into vaccines but it is relevant I feel to the way the industry as a whole is working currently.