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The Case for Free Vaccines

(Ted S. Warren/AP Photo)

“In the meantime, perhaps given their impressive track record, free-to-consumer vaccines are something we can all get behind.”

The United States federal government entered into a deal last week to purchase 100 million doses of a yet-unfinished Coronavirus (COVID-19) vaccine being developed by Pfizer and BioNTech. The vaccine entered late-stage human trials on July 27th, with the hope that it will be approved before the year’s end. If and when it obtains Food and Drug Administration approval, the vaccine will be delivered at no cost to the consumer, regardless of insurance status.

Some commentators have pointed out that this seems like a curious play for a Republican administration—something we might expect from Canada or European countries, where governments play a larger role in the purchase and distribution of medical services. Others have been more forthright in leveraging this move to critique the current health care system. As Vox co-founder Matt Yglesias put it on Twitter: “I wonder if there are any true atheists in the foxhole who think a Covid vaccine should be distributed globally purely according to ability/willingness to pay?”

Whether and to what extent the federal government should provide medical goods and services for citizens is a hotly contested issue in American politics. The debate is more complicated than many are willing to acknowledge, encompassing issues of morality, philosophy, and economics that have no clear-cut answers.

There are also fundamental questions about health care that are less settled than the average person may believe, such as: Does it actually improve health? (The evidence gleaned from the best experiments is pretty underwhelming.) There is a widespread belief among doctors that Americans are, in fact, overconsuming health care. A survey of over 2,000 physicians  found that two-thirds believed at least 15% to 30% of medical care was unnecessary. Likewise, doctors have observed that most patients seem to be doing “just fine,” despite abstaining from visiting the doctor during the pandemic.

Given the uncertainty of the “benefit” side of the equation and the massive costs involved, it is understandable that the debate over establishing a national health care system has been slow and grinding. (Personally, this is why I hesitate to embrace the idea.) I do believe, however, that vaccines present a compelling exception, an unambiguously strong case for free-to-consumer health care.

For starters, vaccines are wildly effective when compared to other types of medicine. Vaccination famously allowed for the global eradication of smallpox, previously one of the deadliest diseases, and it may soon lead to the elimination of polio. In the case of other diseases such as rubella, measles, and diphtheria, the United States has achieved a near 100% reduction in deaths following the deployment of vaccines.

We have much less success with diseases that cannot be treated by vaccines, such as chronic diseases, which are responsible for the largest chunk of our health care spending. There are lots of reasons for this. One is that patients simply are not great about adhering to long-term pharmacotherapy regiments. Approximately 50% of patients do not take their medications as prescribed, to which the Centers for Disease Control and Prevention (CDC) attributes 125,000 annual deaths and 30% to 50% of chronic disease treatment failures. Additionally, risky behaviors—sedentarism, poor nutrition, and smoking, for example—contribute to the exacerbation of these illnesses, making treatment a more complicated process that can involve a big commitment on the part of the patient.

Second, vaccines are pretty cheap, especially considering their efficacy. The 100 million doses of coronavirus vaccine the federal government has ordered will cost $1.95 billion, an average of about $20 per dose. Assuming they work as intended (the government will not pay if they do not), this is a small price to pay to save tens of thousands of lives and get the economy back online.

As advocates for a single-payer health care system like to point out, governments are often able to secure more favorable prices for medications than private sector buyers. This is true with vaccines as well and could be more so the case under a true monopsony. (Of course, a more rigorous consideration would have to weigh this benefit against the potential drag on innovation.)

Third, the efficacy of vaccinations is partially a function of vaccination rates. This is known as “herd immunity,” a concept popularized during the current pandemic. As more people are vaccinated against a disease, it reduces the disease’s ability to spread and reproduce itself. This has the second-order effect of providing some protection for people who cannot get vaccinated—very young infants, people with severe allergies, or those with compromised immune systems. To a much greater extent than other kinds of health care, then, vaccines have public health benefits in a way that does not require contrivance by moral argument.

It is worth noting that the United States already has a national vaccine program—and that it has been quite successful. In 1994, the CDC established the Vaccines For Children program (VFC), which pays to vaccinate children who meet certain criteria. Currently, the program provides vaccines for about half of all Americans under 18. For the cohort born between 1994 and 2013, the CDC has estimated routine childhood immunization will prevent 322 million illnesses and 21 million hospitalizations over the course of their lifetimes, and avert 732,000 premature deaths.

In financial terms, the returns on the program have been equally impressive. Again, from the CDC: “Vaccination will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented in these birth cohorts. After accounting for $107 billion and $121 billion in direct and societal costs of routine childhood immunization, respectively, the net present values (net savings) of routine childhood immunization from the payers’ and societal perspectives were $295 billion and $1.38 trillion, respectively.”

With the Democrats officially leaving “Medicare for All” off of their 2020 platform, the debate over systemic health care reform may rage on for some time. In the meantime, perhaps given their impressive track record, free-to-consumer vaccines are something we can all get behind.

Eddie Ferrara writes about policy from a data-driven perspective. He studied sociology at the University of Massachusetts Amherst. He blogs at eddiethoughts.com. Follow him on Twitter @EdwardFerrara_

Eddie Ferrara writes about policy from a data-driven perspective. He studied sociology at the University of Massachusetts Amherst. He blogs at eddiethoughts.com.

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