An email from an organization promoting progressive foreign policy extolled the development of effective COVID-19 vaccines and went on to demand these treatments be free and accessible to everyone, both in the United States and abroad. What a gift that would be!
It is a lovely idea for the vaccine to be free to everyone. Vaccines are most effective when all are vaccinated and become immune to the disease; when large numbers of people in the population aren’t vaccinated, the disease can still spread, as we have seen with measles in recent years. There are some who may resist—for whatever reasons—the COVID vaccine. Any out-of-pocket cost is likely to exacerbate that problem, thus a free vaccine may help encourage vaccination. Moreover, making the vaccine freely available to the entire world population could further protect Americans from future outbreaks that result from travel abroad or by foreigners visiting domestically.
I have no doubt that a free vaccine for everyone is a wonderful thing, but I wonder: How do you make something free? Perhaps the organization that emailed earlier means they want the government to pay for the vaccine so everyone in the world can receive it free of cost. But the government is funded by taxpayers, so instead of paying out of pocket, it would be paid by us through taxes. While making the vaccine free to the world sounds nice, making the vaccine globally available while Americans foot the bill may not sound quite as attractive (well, not to some Americans, anyway).
The idea of the vaccine manufacturer making a profit from their efforts may seem unseemly, if not dirty or despicable. But can the manufacturer make the drug free, when there are production, distribution, and development costs? If the manufacturer pays, the stock holders of the company would bear the cost, including anyone who has the company’s stock in their retirement portfolio, such as members of teachers unions. Free sounds great in theory, but it doesn’t exist in practice as far as I can tell.
Why am I on such a rant? In this issue, we discuss the treatment pipeline for urticaria (page 24), examine a rare cutaneous malignancy (page 46), and cover hair loss therapies (page 49). We have such great drugs now to treat these diseases in our patients, but many are costly. We want our patients to have unencumbered (free) access to whatever treatment we feel is best. That would be great, but somebody is going to pay the cost. It may seem free to patients if insurers are paying, but insurers do not print money. They get money from premiums, they add overhead, and they pay. Ultimately insured individuals—through the premiums they pay or the lower salaries they accept when their employer pays the health care premium—are paying the bill. Maybe being at least a little cost conscious when we make treatment decisions wouldn’t be a bad idea.
