In 1986, it cost approximately $100 to vaccinate a child on private insurance. Today, it costs $2,192, and parents are struggling to find pediatricians who offer vaccines—even as we are in the grip of a national crisis of debate over vaccines in the midst of repeated outbreaks of vaccine-preventable disease. The cost of vaccines is skyrocketing, pharmaceutical companies say, because of the increased burden of testing and production, but at what point do you decide that pharmaceutical firms have profited enough and it’s time to think about the good of society?
Such discussions are mirroring larger conversations in the tech world about where the balance lies between profits, public service, and the commons. Vaccines, as some of the most advanced biotechnology in the world (some take as long as two years to produce, involving complex organisms that have to be handled in very exacting conditions), reflect the core of these debates. While we need to protect inventors and developers, to create incentives and provide an environment that rewards innovation, when do we put the need of the public ahead of the individual?
Vaccine-preventable illnesses once claimed millions of lives worldwide and left others with severe impairments; the legacy of polio, for example, still lingers in the handful of people living on iron lungs, who acutely remember the terrible toll of this disease before an effective vaccine was developed. The development of safe, reliable vaccines for illnesses that once caused significant morbidity and mortality was a huge step for society, and thankfully, many of those vaccines either weren’t patentable or were developed by government-funded programs, ensuring that they remained low-cost or free to the public.
That’s changed with the new generation of vaccines, which rely on more complex biotechnology and are being produced on a for-profit basis by major firms like Pfizer. It’s a departure from the historic model that’s being felt at the doctor’s office as costs skyrocket from a few dollars a dose to hundreds of dollars a dose—with vaccination schedules that may require three or more doses for complete immunity.
In the technology industry—which has been caught in a complex discussion about patents, rights, copyright, and related matters—the discussions taking place are very similar to those seen in the pharmaceutical industry. But for vaccines, the stakes are much higher. While patent trolls limit freedom of expression, development, and function in the tech world, biotech companies are insisting that vaccines must be kept on-patent and exclusive, in order to protect their investments. Those investments reflect years of research, development, testing, and production.
Some might argue that vaccine producers shouldn’t be expected to absorb these costs simply because vaccines are beneficial to the public. Others wonder if that’s really the case. In a comment to the New York Times, physician Steven Black notes: “You have to make back your investment and pay your shareholders, but at what point do you say, ‘Look, you’ve had your steak, gravy and potatoes and this is enough?’”
As government funding to health programs decreases and states refuse subsidies that would help them make health care more affordable, patients are paying the price. Parents are struggling to vaccinate their children in an environment where out of pocket costs are rising and some physicians are stocking a limited number of vaccines and restricting their delivery to established patients. Even as physicians across the U.S. condemn the anti-vaccination movement, some pediatricians aren’t supplying all their patients with the vaccines they need, including those required for school.
The high cost of vaccines, in other words, is limiting educational opportunities for children, in addition to exposing them to the considerable risk of vaccine-preventable diseases. This situation has come to pass as a result of the faulty patent system in the United States, which has been heavily criticized by the tech industry for years. In a system that allows firms to continually tweak and revise patents to keep inventions protected, biotech firms can maintain a stranglehold on vital medications—including not just vaccines but next-generation antibiotics, AIDS medications, and more— with little action by the government.
At what point does the government recognize that the patent system is in urgent need of reform to protect the commons, as well as the rights of innovators? In its current state, the system actually directly harms innovators in some ways by making it difficult to exchange information, build on existing inventions to create strengthened versions, and create an environment for discussion.
The tech industry has responded with the open source movement, one which encourages the free distribution of information. From Creative Commons licenses to entire operating systems, the movement stimulates free exchange, discussion, and thought, recognizing that the value of innovation lies in benefiting the commons, not just the inventor. While the beginnings of an open source movement are coming to life in biotechnology, the industry as a whole, especially the heavy hitters, appears reluctant to embrace the ethics of open source, free exchange, and contributing to society as a whole.
Will the rise in vaccine costs, paired with the increase in vaccine-preventable disease, force the government’s hand and compel it to engage in a discussion about reforming biotech patents? Since the industry appears reluctant to address the issue on its own, the matter may be left to representatives with the public good in mind. Such a crucial aspect of public health shouldn’t be available only to those who can afford it, and the free exchange of information about vaccines can only lead to the development of better, more effective vaccines.
As long as biotech firms are allowed to keep production and manufacturing processes secret, researchers are duplicating extant work while they try to develop vaccines for HIV and other modern threats. Biotech must become a part of the open source movement to create a safer world for everyone.