What is the cost of COVID-19 vaccines?

Image: Renan Quinalha


A question thatdon't want to shut up

It is one of those questions that usually haunts us given the absence of convincing explanations in conversations and publications, whether academic or broader. In this case, the price of vaccines is not usually mentioned, why? We will explore some hypotheses to begin to understand these silences that I would like to share in this democratic space of the round earth, not least because the edges of the flat Earth are overcrowded.

We observed that during the COVID-19 pandemic, inequalities in access to services, health care and vaccines were highlighted in all countries of the world, it being evident that the most affected are the most vulnerable population groups such as the poor in large cities. cities, Afro-descendants and indigenous populations. This situation of social vulnerability increased these people's disproportionate risk of being exposed to the virus, of becoming ill, of having sequelae, of dying from complications or of not having adequate assistance to treat themselves when they fell ill with this disease, which, we already have evidence, can be avoided. It is worth saying that if you become infected or sick with COVID-19, it does not mean individual fatality or incompetence for these people, but it indicates a predictable collective tragedy that could have been avoided and/or mitigated. Countries like China and Vietnam prove this hypothesis. And, we also know, universal systems, such as the SUS, are essential to guarantee that everyone has access to health services, to the prevention, promotion and recovery of health that are offered at the different levels of the public health care network in Brazil. . In other words, people without access, or with precarious access, to health services are in a situation of programmatic vulnerability, that is, in a situation of inequity. This situation has been well known since the 1990s, following the development of the Brazilian Ministry of Health's care program for people with HIV/AIDS. For those interested in learning more about this point, we recommend the vast literature available that explores the relationship between vulnerabilities and responses to the HIV/AIDS pandemic. We highlight mainly the research of Ayres; France-Júnior and collaborators1.

Since vaccination is one of the main specific protection measures historically available in Basic Health Units of the SUS, and which, demonstrably guarantees the so-called herd immunity, with effective control of communicable diseases and pandemics, why do we observe such inequality in vaccination coverage in this COVID-19 pandemic? It is also worth asking, on the other hand, why Brazil was once awarded for developing an excellent program for the prevention and control of the HIV/AIDS pandemic, and that in 2007 to achieve this success it had as an important measure the “breaking of patents”, in this is currently among the countries with the worst responses to the COVID-19 pandemic?

And here we pose the central question of this essay: why are the costs involved in the development and purchase of vaccines against SARS-CoV-2, some of which are available in Brazil, not disclosed? Could it be that transparency in this regard is not essential to identify the logic that instructs the public power, its policies, strategies or the absence of these actions? Or isn't transparency essential for us to understand and fight any “obstacles” that prevent equity in access to vaccines for the entire population? Would there be any unlawful action that would justify this omission?

We rehearse an answer to this question, and that motivates our reflection: we bet that the lack of transparency in the costs of the production and distribution mechanisms of vaccines against SARS-CoV-2, in reality omits that market rules, embedded in the management of this pandemic, have led and will continue to lead to inequity in access to vaccines, with a consequent increase in the number of illnesses and deaths of people belonging to the most vulnerable populations in Brazil and around the world. In this sense, we agree with public health physician Jarbas Barbosa, deputy director general of PAHO, who says in one of his public statements that “inequity in access is a moral, ethical and health problem”. We need to point out that there is an initiative on the part of WHO/PAHO to try to minimize the inequality of access, the program called COVAX. And, we also highlight here, the attempt by a Brazilian parliamentarian (Senator Paulo Paim, PT), proponent of a PL that seeks to approve the compulsory licensing (“breach of patent”) of vaccines against SARS-CoV-2 in Brazil . We comment on these two initiatives below.

The world press has widely reported that in order to face the health emergency of SARS-CoV-2, governments and scientists managed to develop vaccine platforms based on different technologies in less than a year and that already at the beginning of 2021 a total of seven formulations of vaccines. This response contrasts with the limited interest that the pharmaceutical industry has shown in developing drugs against so-called “neglected diseases”. As they reach very poor populations, such drugs have limited potential for economic exploitation. A survey carried out in 2018 by researchers at the University of Fudan, in China, showed that, between 2000 and 2011, only 5 of the 850 drugs that were registered in the United States and Europe were intended for “poverty” diseases – in all cases , these were new applications of existing drugs. “In the 20st century, no innovative medicine has yet been produced for the XNUMX neglected tropical diseases”, says chemist Adriano Andricopulo, from USP's São Carlos Institute of Physics, who works on the development of drugs against Chagas disease and leishmaniasis.2

In this already complicated scenario from the point of view of the priorities of what to produce on the part of the drug and input industry, the COVAX program was proposed with the objective of seeking to mitigate the difficulty of poor countries in accessing vaccines against SARS-CoV-2. And, at the end of February 2021, Ghana became the first country in the world to receive vaccines against the new coronavirus through the COVAX Initiative. It is a program created by WHO/PAHO together with philanthropic entities that aims to expand the distribution of immunizers to fight SARS-CoV-2 and, thus, ensure that low-income nations are not neglected, according to the doctor. sanitarian Reinaldo Guimarães, vice-president of the Brazilian Association of Collective Health (ABRASCO). “Although it seems like a worthy project, it was not foreseen that a considerable part of the rich countries would reserve a number of doses much higher than necessary for their inhabitants in negotiations directly with the manufacturers”, informs Reinaldo2 Since the beginning of the COVAX initiative, it was already foreseen that, in a first moment, rich countries would be able to buy the majority of doses of vaccines manufactured by the pharmaceutical companies, but it was not understood that some countries would buy practically all the products available.

So, are we dealing with an unsolvable problem in our world of globalized economy? In Guimarães' view, with which we are in line, a way of “circumventing” the problem would be “compulsory licensing — erroneously called 'patent breach'. The maneuver consists of temporarily suspending the exclusive right of the owner of a patent to allow his item to be manufactured and sold by third parties during a global emergency. In theory, this would increase the amount of doses available and lower prices.” In this same sense, we defend that the global patent policy established on the basis of intellectual appropriation of a private nature should be modified in view of the ethical horizon of international solidarity, essential for all people to have universal access to vaccines and all measures to control the COVID-19 pandemic. Especially because, if the erratic vaccination in force in Brazil is extended, for example, the virus may mutate and perhaps become resistant to the immunobiologicals already available at that time. This scenario seems to us to be quite worrying in terms of controlling the pandemic, further increasing illnesses and deaths among the most vulnerable populations.

Finally, we consider that the COVAX initiatives and efforts to “break patents” are commendable in the sense that they seek to mitigate the inequities of access to vaccines, but do not answer the question about the actual costs involved in the production and distribution of these immunizers by governments and producers. pharmaceutical companies in any country in the world!

A possible explanation is quite simple, prices are omitted because they are, so to speak, secret, but this is an open secret, because when a country buys millions of doses, the costs become evident, both for those who spend and for those who receive. Here comes a second argument: the health of the population is priceless. Like this? Of course there is, but who should pay and where does all that money come from? In the supposed liberal paradise, pay those who can, those who cannot, die. Public money ends up being the way, of course, and then poor and rich are treated as equals. But the question persists: why don't the values ​​appear, do vaccines all cost the same? The third explanation that perhaps makes some sense to explain the lack of information on the costs of vaccines – the probably astronomical profits of the companies that produce them, information that is all the more shocking as the growth of hunger in that part of the world that does not produce vaccines. A fourth path, already well trodden here in the earth is round and in other democratic channels, it is the criticism of the ever-updated commitments of the mainstream media in hiding the backstage of the pandemic; in this media we see at most statements of sadness at the half a million people killed and some criticisms have been published, now less veiled, to the obviously genocidal mismanagement. This hegemonic media coexists more or less well with the fact that more black and poor die than white and rich, after all because the former are weak and have somehow failed in the search for saving wealth, while the latter are strong and successful.

In any case, costs have been overlooked, both by producing companies and by purchasing countries, and contradictions persist. There are news of attempts at an obvious way out, the breaking of patents, an evidently fertile path in countries with industrial capacity installed in public bodies such as the Butantã Institute and Fiocruz in our country. Is the government waiting for the privatization of these institutes so that they can eventually compete with the multinational giants like Pfizer, Johnson&Johnson, Astra-Zeneca and some others? Sweet illusion that reveals the low understanding of what development means in a globalized world4.

The timid repercussion of attempts to “break the patents” of anti-COVID vaccines, in addition to evidence of the embarrassing silence that plagues us, also reveals a weakness of the opposition that has been limited to cultivating the government’s grotesque attitudes. Our pandemic CPI is running a serious risk of becoming a humorous program if it does not approve strong punishments for lies when investigating the crimes of the current government.

*Luiz Menna-Barreto He is a professor at the School of Arts, Sciences and Humanities at USP.

* Angela M. Machado de Lima Hutchison is a professor at the School of Arts, Sciences and Humanities at USP.


1The concept of vulnerability and health practices: new perspectives and challenges / The vulnerability concept and the practices of health: new perspectives and challenges. Ayres, José Ricardo de Carvalho Mesquita; Junior France, Ivan; Calazans, Gabriela Junqueira; Saletti Filho, Heraldo Cesar. In. Czeresnia, Dina; Freitas, Carlos Machado de. Health promotion: concepts, reflections, trends. Rio de Janeiro, FIOCRUZ, 2003. p.117-139, tab.

2 https://saude.abril.com.br/medicina/o-que-e-a-iniciativa-covax-contra-a-covid-19-e-como-ela-funciona.

3Article available at https://www.nexojornal.com.br/externo/2021/04/11/Uma agenda for forgotten diseases?fbclid=IwAR0zgtbZTay9rrer8dAYEOqNKt0heRMwJqJeYp f277Cd64BM9OiQKgL7G4

4see “The development of underdevelopment”, article by Andre Gunder Frank reproduced recently in A Terra é Redonda (issue of March 28, 2021, based on the original published in Monthly Review, v. 18, no.o. 04, September 1966.


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