Last week, the Department of Health and Human Services said commercial sales of coronavirus vaccines, previously distributed by the US government and offered at no cost to those who wanted them, could begin as early as 2023. . Some treatments, which were also largely free, are already making the transition to the commercial market; Others will follow early next year.
What does a commercial market for COVID products mean for companies, consumers and the health of the country?
As Bloomberg Intelligence’s Sam Fazeli points out, the already low demand for vaccines could further falter. And getting the drugs can be hardest for those who need them most: those at highest risk of serious infections. This could put the US behind other high-income countries in its COVID response.
Lisa Jarvis: During the pandemic, COVID vaccines and treatments were free in the US. What can a commercial market mean for individual consumers?
Sam Fazeli: It will be tough for the booster campaign. If people were reticent to get a booster shot when the vaccine was free, what happens when they have to pay?
About 8% of the US population with no health insurance will be the worst affected. This group is at higher risk of infection because they work in jobs where they are repeatedly exposed to the virus. And the rates of obesity and other health issues, which predispose individuals to more severe COVID, are higher in this population.
Even people with health insurance will have to pay some out-of-pocket expenses, which is a problem at a time when the cost of living is rising rapidly. So it’s quite possible that the percentage of eligible people rolling up their sleeves for another booster shot will be less than the 34% of eligible people who got their fourth shot.
Even if there is a major new wave of infections, unless the severity of the disease is proving to be worse, I don’t think people will be more motivated to take boosters.
LJ: How does all this factor into what Pfizer-BioNtech and Moderna may charge for their vaccines? Will consumers pay more per shot than the government, which is between $15 and $30 per dose, depending on the type of vaccine?
SF: If we are correct and demand will be less than the current low, companies may be tempted to raise prices in the private market for less quantity. But this may backfire not only from a PR perspective, but also because it is likely to lead to a further fall in demand.
LJ: In discussing the updated COVID boosters last week, both FDA and CDC officials compared the way flu vaccines are updated each year. Will the demand for Covid vaccines eventually resemble the flu?
SF: Many people use the flu as a blueprint for their modeling of future demand for COVID vaccines. But there is a drawback here. Flu vaccines are updated because the strains of the circulating virus actually change every year, meaning that our immune systems may not have encountered certain strains recently. As with SARS-CoV-2, the same virus is still evolving. The virus can become more contagious because it evades the front-line antibodies that prevent infection and the levels of those antibodies drop over time. But it has not yet become more lethal because older vaccines still hold up very well against serious infections. Right now, there is little evidence that the updated booster offers significant benefits compared to the original vaccine.
LJ: Given all this, what do you anticipate the size of this market will be for Moderna and Pfizer?
SF: Obviously this will depend on several factors, including the number of boosters recommended during the year, the cost of those shots, and adherence by different age groups. If we imagine a scenario in which about 50% of eligible age groups get their shots and they cost about $30 net discount, we could see a US market of about $5 billion in 2023, and globally of over $20 billion. But these are very optimistic assumptions.
In a Bloomberg Intelligence survey a few months ago, we found that 50% of our respondents said they were unwilling to pay for a vaccine, while 30% said they were willing to pay more than $25 out of their own pocket. .
Moderna has a steep learning curve when it comes to selling vaccines in the private market, while Pfizer has been in the game for decades and has long-established relationships and channels.
LJ: Does a commercial market make it more difficult to test and approve new, better-than-expected COVID vaccines?
SF: This is a really good question, and I think the answer should be yes, that makes it harder. The issue for any new vaccine, especially one that uses a different platform or route of administration, is that efficacy against infection and serious disease cannot be ascertained using cheap immuno-bridging studies. is – those that show only a similar antibody response. Approved Vaccine. Take the new flu vaccines, for example. To approve mRNA vaccine manufacturers, regulators want full-blown clinical trials with control arms that use current vaccines. This is what I would expect for the new covid vaccines. No small lab or biotech company would want to take it.
LJ: We have mainly focused on vaccines, but of course the treatments for COVID are also becoming commercialized. The demand for monoclonal antibodies has remained low despite the government providing them free of cost. Do you have an idea of how widely these will be available to those who need them going forward?
SF: This would be the biggest disadvantage, as they cost much more than a vaccine shot. The list price for Eli Lilly’s bebetalovimab, which was launched on the commercial market last month, is $2,100 per dose. People with Medicare may still be able to afford them as they are often given in a hospital or outpatient setting, but they may be out of reach for uninsured people and even people with private insurance. May also decide that they are too expensive. Sadly, antibodies may be the best way to manage the effects of waves of infection, especially in more vulnerable populations.
LJ: In the US, vaccinated people under the age of 65 are able to get prescriptions for Pfizer’s antiviral PaxLovid, with little evidence that the drug helps them. Do you think doctors will weigh cost versus benefit more carefully if patients are paying for it themselves?
SF: In a group of people who already have a very low risk of hospitalization, it is difficult to generate data proving the benefits of a drug that lowers your risk of hospitalization. So the drug should probably never be used in fully vaccinated people younger than 65 years old. Recent data from Israel shows an 85% reduction in the risk of hospitalization for people over 65, but no effect for those aged 40 to 64.
LJ: It all sounds like people in the US may have a much harder time accessing drugs and vaccines – much to the detriment of those who seek them. Where does this leave the country in terms of its ability to respond to this virus?
SF: If the vaccination campaign goes the way we think it should, i.e. fewer people get their shots than in the fourth dose last spring, there is a considerable risk that the US will fall further behind the rest of the world where the shots were taken. are free. This could mean far more infections in the US, if not hospitalizations and deaths. This of course assumes that attitudes toward booster shots remain strong in other countries, which is a big deal. Of course, if this happens, the irony is that all major COVID drugs and vaccines were developed in the US.
Lisa Jarvis is a Bloomberg Opinion columnist covering the biotech, health care and pharmaceutical industries. Prior to this, she was the executive editor of Chemical and Engineering News.
Sam Fazeli is senior pharmaceuticals analyst at Bloomberg Intelligence and director of research for EMEA.
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