Bernie Sanders getting indignant about pharmaceutical companies is must-see TV

As someone who has watched United States Senator Bernie Sanders conduct hearings countless times, it is, if nothing else, an amusing display of theatrics, red-faced anger, bulging eyes, and fire and brimstone.

It is the greatest show on Earth (if the Earth were only about public health and health policy).

To wit, at the end of March, Senator Sanders held a hearing of the Senate Health, Education, Labor and Pensions (HELP) Committee in Washington. His invited guest was Stephane Bancel, the CEO of Moderna.

Senator Sanders started out with the usual diatribe related to corporate greed and executives who are grossly overcompensated and who have raked in billions of dollars. He then opined about Moderna’s having received $900m from Operation Warp Speed to help develop the vaccine in 2020 by testing it in partnership with the National Institutes of Health. And amid more haranguing and in furtherance of his verbal tirade, Senator Sanders then proclaimed that he surely must have been “missing something” in thinking “that it’s cruel to make a medicine that people can’t afford”.

As others have pointed out, Moderna developed its mRNA platform over the course of a decade with billions of dollars in private investment. And as I might remind readers, the US government didn’t chip in a single red cent during that time. Additionally, the new proposed cost of $110-$130 for a COVID-19 vaccine is comparable to the cost of other routine vaccinations as well. According to the CDC, the cost of a Zoster vaccine is about $105.00. And the cost of an HPV vaccine is about $165.00. If you want a pneumococcal vaccine, you’re looking at $160.00. We will also forget, for a moment, about the fact that Pfizer (a company that didn’t take any money from the government) is going to charge the same price for its vaccine. And as the Wall Street Journal points out, ‘under the Affordable Care Act, Americans with private insurance won’t have to pay a penny out-of-pocket for the vaccines. Moderna will also offer free vaccines to the uninsured’.  And as Bancel pointed out in his testimony on Capitol Hill in March, the price increase is justified since Moderna now has to take on the onus of supply chain management and distribution, and new packaging requirements, which were previously the responsibility of the federal government.

Does this justify a $130 price tag? Senator Sanders can tell you what he thinks. And I’m also sure that he can tell you what he thinks about the price tag of any drug that was discovered with government funds.

This is about more than cost. It’s about cost in the context of who paid for a portion of the underlying drug development. But don’t be fooled. More than anything, it’s also about the continuously convenient ‘siloed’ mindset of the government. What Senator Sanders and others always fail to bring to bear on these pricing discussions is the downstream cost of reduced hospitalisation and death as a result of these vaccines. They also don’t mention that reduced hospitalisations and deaths result in more critical care beds being available for other (non COVID-19) patients. Or that reduced hospitalisation and deaths could result in fewer healthcare practitioners leaving the profession due to sheer burnout, fatigue and professional disillusionment.

The estimated total cost of COVID-19 hospital stays in Canada (where I live) from April 2021 to March 2022 is estimated at $25,000 per hospital stay. And for those hospital stays that require intensive or critical care services, the cost soars to about $60,000. The US data around COVID-19 hospital length of stay and costs are even higher.

And according to the US Bureau of Labor Statistics, the healthcare sector has lost nearly half a million workers since February 2020. Other sources show that 18% of healthcare workers have quit since the pandemic began, while 12% have been laid off.

For starters, let’s tone down the theatrics and the mock disgust at COVID-19 vaccine prices. It’s difficult to argue that, at $15 or $20 per dose and with front-of-the-line access, the US government did not save billions of dollars in healthcare costs during the pandemic. Let’s also acknowledge that the cost/benefit analysis of a vaccine is a complex interplay of multiple factors within the healthcare system that cannot be conveniently calculated, no matter how much Senator Sanders wishes that to be the case. And finally, let’s acknowledge that the government’s role in funding drug development requires legislative reworking if the goal is to control and/or bring down drug prices.

Otherwise, the greatest show on Earth will continue to roll on.