The Reverend Martin Luther King Jr. spoke the most fundamental truth of the coronavirus pandemic more than fifty years before the COVID crisis hit. “Of all the forms of inequality,” he said at the second convention of the Medical Committee for Human Rights on March 25, 1966, “injustice in health is the most shocking and the most inhuman because it often results in physical death.”
When COVID-19 struck, King’s words were frequently recalled, as the passing decades had not addressed health inequality. The Reverend William J. Barber II saw the truth immediately, observing in March 2020:
“This moral crisis is coming to a head as the coronavirus pandemic lays bare America’s deep injustices. While the virus itself does not discriminate, it is the poor and disenfranchised who will experience the most suffering and death.”
As the pandemic grew more severe, physicians and scientists filled in the details. The Centers for Disease Control acknowledged that “longstanding systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk” of getting sick and dying from COVID-19. The Lancet observed that the pandemic “has highlighted the equity gap in outcomes for marginalized communities, specifically the Black community, as starkly shown by the disparate morbidity and mortality from COVID-19 in individuals from these communities compared with the majority white population.”
Surely, this was the time to address the racial, social, and economic injustices that had always existed but were now fully exposed. Yet through 2020 and into 2021, injustices persisted—in part because the structures that had been established for responding to health care challenges actually perpetuated inequalities.
There were many explanations for this widening inequality gap, including the Trump Administration’s failure to take the basic steps required to develop a smart and fair program for vaccine distribution in the United States, let alone the world. Much was made of the reticence of particular communities to trust vaccination programs administered by a government with an ugly history of medical experimentation on, and medical neglect of, racial and ethnic minorities.
But not much attention was given to another factor: the way the U.S. economy is rigged to benefit multinational corporations at the expense of common sense and common decency. It’s not just capitalism that is a problem, although the pandemic certainly revealed a great many flaws in the theory that the free market can resolve societal challenges. It’s also the way in which capitalism works in a country like the United States—with its cronyism, corruption, racketeering, lack of oversight, and open invitations to the sort of cozy deal-making that well-serves corporations but ill-serves humanity.
A year of pandemic profiteering gave way to the inevitable vaccine profiteering. While the early reporting on the rollout of vaccines tended to portray pharmaceutical corporations and their chief executive officers as heroic figures, that was always a fantasy. By and large, they were in it for the money. And one company, Pfizer, was in it for very big money. The first company out of the gate with a complex vaccine, Pfizer raced to cut deals with countries around the world that were desperate for doses.
From the start, Pfizer signaled its intention to cash in on the pandemic. In the summer of 2020, long before anyone had gotten a jab, Pfizer Chief Executive Officer Albert Bourla announced that “we do anticipate making a profit on the vaccine.” To those who suggested that Big Pharma forgo big paychecks in order to address a crisis that had already taken so many lives and destabilized so much of the world, Bourla said, “You need to be very fanatic and radical to say something like that right now.”
In fact, several pharmaceutical companies recognized a duty to forgo the most egregious forms of profiteering in order to assure that vaccines got to people that needed them in the smoothest and most efficient ways possible. “U.S. drugmaker Johnson & Johnson, along with AstraZeneca, which is developing a coronavirus vaccine in partnership with Oxford University, have both pledged to make their vaccines available on a not-for-profit basis during this pandemic,” reported The Guardian in November 2020. “AstraZeneca, which is charging governments $3 to $5 a dose, also said last week that low-income countries would receive its vaccine on a cost basis ‘in perpetuity.’ ”
And here’s the twist: The other vaccines, which debuted shortly after Pfizer’s, were also easier to store and distribute. In other words, they were far better suited to a mass vaccination program for people who lived in underserved urban neighborhoods and remote rural areas, and for those who might lack the resources and options to make multiple appointments for multiple shots. But still, Pfizer stuck to its plan to turn an outrageous profit.
How outrageous? Company estimates said the profit per dose could be “in the high 20 percent range.” That sounded substantial. But in a July 2020 note to investors, SVB Leerink analyst Geoffrey Porges estimated that the company’s profit margin for the vaccine could be as high as 80 percent.
Based on a deal reached with the U.S. government in the summer of 2020, Pfizer agreed to supply 100 million vaccination doses, with an option to deliver another 500 million doses. The price tag for the company’s two-shot course of vaccinations would be $39, or $19.50 per dose; in total, the U.S. government shelled out nearly $2 billion to Pfizer for this batch alone. The company would maintain that price in negotiations with other countries.
According to The Guardian, “Pfizer and the German biotech firm BioNTech stand to bring in nearly $13 billion in global sales from their coronavirus vaccine next year, which will be evenly split between the two companies, according to analysts at the U.S. investment bank Morgan Stanley. Pfizer’s half would be more than the U.S. pharmaceutical group’s best-selling product, a pneumonia vaccine that generated $5.8 billion last year.”
Of course, people in the United States and around the world welcomed the sense of urgency that Pfizer and other pharmaceutical companies brought to the race to develop vaccines. When vaccine breakthroughs were announced, they were widely celebrated. Most observers accepted that the drug companies would benefit financially. What they didn’t count on was the fierce determination of a particular company to maximize its own benefits.
How did Pfizer take advantage of the pandemic? Let’s turn to John A. Quelch, the dean of the University of Miami Patti and Allan Herbert Business School and a professor in the Miller School of Medicine’s Department of Public Health.
“Pfizer’s strategy is simple,” Quelch explained in December 2020. “Be first to market and make a boatload of money by ‘skimming the cream,’ supplying vaccines to those willing to pay.”
In a Tampa Bay Times essay headlined, “Pfizer’s Vaccine Maximizes Profit, Not the Greater Good,” he noted that Pfizer “has cut deals at high prices with about twenty developed countries. Their government agencies can’t reject the Pfizer vaccine as too expensive because they can’t ask their frontline health care workers to wait for a cheaper alternative. They have to act now.”
On December 23, 2020, the U.S. Department of Health and Human Services and the Department of Defense announced plans to purchase an additional 100 million doses of COVID-19 vaccine. This deal included options for the purchase of an additional 400 million doses of the Pfizer vaccine.
Sweet for Pfizer, but tough for U.S. taxpayers. The government would pay for the vaccines and distribute them free of charge to Americans—at immense cost and immense inconvenience, because of the requirement that the Pfizer vaccine be refrigerated at exceptionally low temperatures and distributed in two doses. As Quelch noted, “Pfizer wanted to book a second big order now before the J&J results come in.”
In other words, Pfizer’s strategy was to play on the desperation of people and policy makers for a vaccine that might slow the spread of COVID-19 and save lives. This approach was guaranteed to benefit the bottom line of what was already one of the most profitable pharmaceutical giants in the history of the world. But it was bad practice for the United States and other countries that needed to use their resources to develop and implement comprehensive plans for getting vaccines to the people who needed them most.
Pfizer’s strategy worked. In February 2021, the company announced that it expected to take in $15 billion from vaccine sales during the course of the year—making its product one of the highest revenue-generating drugs in the history of the world. Pfizer predicted that it expected to take in as much as $61 billion in 2021—almost $20 billion more than it had made in 2020.
The COVID-19 vaccine, an entirely new product developed as an emergency response to a crisis, would account for as much as 25 percent of Pfizer’s revenue—nearly as much as the company took in from its next three best-selling products combined.
“Pfizer has vastly exceeded its COVID-19 vaccine sales forecast of $15 billion, and now expects the jab to bring in $26 billion of revenue in 2021,” an industry monitor, Pharmaceutical Technology, reported in May 2021. “It’s possible that even this adjusted forecast will prove to be an underestimate, with Pfizer expected to secure further lucrative supply contracts throughout the year.”
Pfizer CEO Bourla claimed the company’s massive windfall was well deserved, bragging to interviewers that “the private sector found the solution for diagnostics, and the private sector found the solution . . . for therapeutics and vaccines.”
But Pulitzer Prize–winning journalist Michael Hiltzik of the Los Angeles Times poked a great big hole in that assertion with a January 2021 assessment of how pharmaceutical companies were cashing in on the pandemic. It labeled Pfizer’s profits—and those of another pharmaceutical giant, Moderna—“a scandal.”
“The notion that the ‘private sector’ achieved all this entirely on its own is the bedrock of the pharmaceutical industry’s position that it deserves everything it can get,” Hiltzik wrote. “But it’s wrong. None of its diagnostics, therapeutics, or vaccines would exist if the U.S. and other developed countries hadn’t funded research before the companies stepped in to exploit it.” He added, “Patent and IP [intellectual property] rights are worth billions, too, and the taxpayers should get their share.”
Pfizer’s profiteering did not surprise members of the AIDS Coalition to Unleash Power, better known as ACT UP, which got its start in the 1980s when playwright Larry Kramer and other activists formed the grassroots group, engaging in direct action to demand that politicians and corporations respond to the AIDS crisis. ACT UP, which remains active in New York and other cities around the world, has long focused on the nefarious role played by pharmaceutical corporations in creating the health inequality that Dr. King called out decades earlier.
Years before the pandemic hit, ACT UP organized mass rallies outside the Pfizer headquarters in New York, where ACT UP activists aligned with campaigners from other health advocacy groups to deliver the message “Pfizer Greed Kills.” At a 2016 protest, activists warned that the pharmaceutical industry’s “lies and continuous acts of financial greed” were limiting access to treatment and costing people their lives. ACT UP accused Pfizer of price gouging, lying about research and development costs, and killing children by refusing to negotiate lower prices for its pneumonia vaccine.
“The system is not fair; we effectively pay twice for medicines while Big Pharma profits,” Mark Harrington, an activist with the Treatment Action Group, explained at the time. “We need a new approach for making drugs for serious and life threatening diseases—having the public invest in the research at the beginning and then pay again for the drugs at the end, while the profit is privatized in the middle—there is something very wrong with that model.”