Never before has the world awaited a new medicine with such bated breath. A vaccine for Covid-19 has the potential to unlock society and save millions of people from death and serious disease, and the hero of the hour is an industry that is often regarded with disdain.
“Traditionally and historically, public trust in pharma has been comparable to the trust they put in their broadband provider,” said Alex Davies, a healthcare PR expert at Hanover Communications, which counts many drug companies as clients.
Yet Covid-19 has provided these firms with an opportunity to save the world. AstraZeneca has even pledged to make its vaccine available to low- and middle-income countries on a non-profit basis in perpetuity, and to wealthier ones for the course of the pandemic. Which begs the question: could 2020 mark a reputational turning point for big pharma?
Those working in the industry have long been frustrated by its public image. Many are former doctors or scientists motivated by a desire to improve people’s lives through medical innovations. “They have resented the fact that whereas brands like Netflix are beloved for making TV shows, pharma companies make life-saving medicines and no one likes them,” said Davies.
Already there are signs of a shift in public attitudes. A recent survey put the industry’s “trust and like score” globally at 68.2%, up from 64.9% in 2018. Separately, when 2,072 British adults were polled on their willingness to share personal health data with the pharmaceutical industry in June, 72% said they felt either comfortable or indifferent about it. One in four said they felt more comfortable since the outbreak of Covid-19.
“Our hypothesis is that the public is waking up to the fact that the pharmaceutical industry is playing an important part in tackling the pandemic,” said Rachel Rowson, the head of innovation at MHP Health, which carried out the survey.
Dr Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said: “I think the coronavirus story over the past few months is an incredibly proud moment for everybody working in the industry, because pretty much every company has downed tools to throw its weight behind finding solutions to the pandemic.”
Even the author and academic Ben Goldacre, whose book Bad Pharma shone a light on disreputable behaviour in the industry, is impressed by its response to the pandemic so far. “Right now, everyone is hugely motivated to pull in the same direction – and fast. It’s amazing to see. More broadly, our research from the DataLab at Oxford has produced strong evidence that pharma is cleaning up its act much faster than academia, at least in some key areas, in recent years.”
For instance, a recent analysis suggested drug companies were now far better than academics at complying with a requirement to share the results of all clinical trials within 12 months of completion. “More than anything, it shows once again that problems in science are about bad systems and incentives rather than bad people or bad organisations,” Goldacre said.
AstraZeneca’s commitment to provide the vaccine it developed with the University of Oxford may seem like a further example of the industry doing the right thing. But are its motives purely altruistic, or are there other considerations as well?
“What AstraZeneca have done is remarkable, and it’s also remarkable they’ve been able to do it in such a short space of time,” said Davies. “But nothing will have a reputational benefit like delivering a vaccine at cost to the whole world. I think it will benefit the business for decades to come.”
Increasingly, drug companies are streamlining their own research and development, relying on collaborations with researchers in academic institutions instead. “The future of pharma is partnerships, and the currency is reputation,” Davies said. “There are a finite number of world-class academic institutions and there are a lot of pharma companies. If you have had a significant success like the Oxford vaccine, and done something with such societal good, I suspect you’ll find the door far more open to you.”
Even the financial hit of selling a Covid-19 vaccine at cost may not be as big as it initially sounds. “[AstraZeneca] so far refuse any transparency on the actual costs of development and manufacturing, including all the public funding they and the University of Oxford have received for that,” said Els Torelee, a researcher and advocate for social justice and health rights and visiting fellow at the Institute for Innovation and Public Purpose at University College London.
“Also, they may have an opportunity to make money once the pandemic is over, because vaccines could well be needed longer-term. We still don’t know how long the immunity conferred by any of the vaccines lasts, and if regular booster doses will be required.
Whereas the AstraZeneca/Oxford vaccine is expected to cost £2.23 per dose, the Pfizer/ BioNTech one is anticipated to cost closer to £15. Torbett said this didn’t necessarily mean it would reap vast profits from it.
“Early on, there was a global commitment by all companies that the vaccines and therapeutics developed are made available in an affordable and equitable way, as far as we possibly can,” he said. “Different companies have translated that in different ways, but my belief is that all [the vaccines] that are coming out are fundamentally very affordable, and are a drop in the ocean compared to some other aspects of the coronavirus response that we are having to spend money on.”
Pfizer/BioNTech may also have a relatively limited period in which to recoup the enormous investment they have made in developing a vaccine. Torelee said: “Their strategy may be to maximise returns ASAP, which means getting first to market and charging high prices, probably knowing that the inherent instability of mRNA vaccines means they will quickly be overtaken by other vaccines that are easier to use and with longer shelf lives.”
This doesn’t necessarily make them villains. The world needs vaccines – lots of them, and ideally as quickly as possible. Drug companies are businesses, after all. “The crucial thing is that they take this opportunity to showcase that what they do matters, and don’t mess it up,” Davies said.