Map of life expectancy at birth from Global Education Project.

Wednesday, November 02, 2005

The Boy Scout motto

So the CinC claims to have read a book (hah!) about the 1918 flu pandemic, which made him realize that maybe he needed to think about emergency preparedness in terms other than suspending the Fourth and Fifth Amendments, setting up an international network of torture centers, and declaring martial law.

It appears, for a change, that he has decided to actually believe some scientists. His plan involves investing in new methods of manufacturing vaccine in cell cultures instead of chicken eggs -- a good idea, previously advocated here, but it won't come to fruition for another five years at best.

He also wants to limit liability for vaccine manufacturers, claiming that it is fear of lawsuits which have driven companies out of the business. The Pharmaceutical Manufacturers Association, by way of their former Congressional catamite and now Executive Director Billy Tauzin, applauds the move.

Not really. As Paul Offit, writing in the May/June issue of Health Affairs, explains:

During the past fifty years, the number of pharmaceutical companies making vaccines has decreased dramatically, and those that still make vaccines have reduced resources to make new ones. Pharmaceutical companies are gradually abandoning vaccines because the research, development, testing, and manufacture of vaccines are expensive and because the market to sell vaccines is much smaller than the market for other drug products. Congressional action could assure both a steady supply of existing vaccines and the promise of vaccines for the future.

The cost of liability insurance is part of the cost of selling vaccines, of course, and irresponsible plaintiff's lawyers, such as the despicable Robert Kennedy Junior, have contributed to the problem by bringing lawsuits based on bogus science. (Yes, it happens.) These suits, even if they are without merit, can be expensive to defend. On the other hand, there have been real instances of defective vaccines, or vaccines marketed with insufficient safety testing, in which lawsuits were merited. Liability is a cost of making all pharmaceutical products, and it exists for good reasons. The problem with vaccines is not that there is anything special about the liability risk associated with them, but that the market for them is small.

And why is the market small? Doesn't everybody get a shot? Yes, but that's exactly the problem -- they get one or two, and in most cases, never another for the rest of their lives. People may get an influenza shot every year, but it's always a different one, so it's comparatively expensive to manufacture, while there is strong political pressure to keep the cost down. Drug companies would much rather make pills for chronic conditions that don't cure people, but that have to be taken for a long time, preferably until death do us part. That's why they love cholesterol and blood pressure medications, allergy meds, heartburn meds, and psych meds. They aren't terribly interested in antibiotics, which you might take for ten days. In other words, the drug companies want us to be sick, they don't particularly want to keep us healthy or cure us, unless the cure is very expensive (as in cancer chemotherapy). Vaccination, by the way, is also not profitable for physicians and clinics, who receive very low reimbursement, often below the cost of administration.

Offit's recommendations (sorry, subscription only) put a minor emphasis on liability. There is already a federal program to limit companies' exposure in the case of childhood vaccines, the National Childhood Vaccine Injury Compensation Program, which has worked pretty well. He recommends expanding it to cover adult vaccines as well, and making it harder for plaintiffs to opt out and sue, rather than accepting the standard compensation.

But more important, he recommends beefing up the federal Vaccines for Children program, which purchases vaccines for uninsured kids and is the largest single purchaser of vaccines in the U.S. It underpays, and creates a functional cap on prices. He also urges finding ways to get public and private insurers to raise their reimbursement rates for vaccines. Finally, he urges more public investment in vaccine R&D. But all that requires spending money, which we don't have, because we have bigger prioties like abolishing the death tax and killing people in Iraq.

Next: Actual, reality based emergency preparedness, and the "plan."

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