Taxpayers Funded Moderna Vaccine

 Pharmaceutical giant Moderna is threatening to more than quadruple the price of its COVID-19 vaccine. (Pfizer has already made similar noise.) 

A few facts: 

• Development of the vaccine marketed by Moderna was actually done in partnership with the federal government — specifically scientists at the National Institutes of Health (NIH) — and almost entirely funded by American taxpayers, to the tune of some $1.7 billion.

• On top of that, the U.S. government has been paying the company an additional $26.36 per dose — for millions and millions of doses — for almost three years now.

• As a result, Moderna — a company with just three employees as recently as 2013 — made more than $19 billion in *profits* over just the past two years.

• By the way, it costs the company less than $3 per dose to manufacture the vaccine. And — again — research and development was paid for by the American people, not the company.

• Yet Moderna’s CEO — a French man named Stéphane Bancel whose personal net worth is estimated at $6.3 billion — wants to jack the price up to as much as $130 per dose.

Here’s some of what Sen. Bernie Sanders said in a recent letter to Moderna’s CEO: 

“The purpose of the recent taxpayer investment in Moderna was to protect the health and lives of the American people, not to turn a handful of corporate executives and investors into multi-billionaires. ... Now is not the time for unacceptable corporate greed.” 

In reality, the so-called Moderna vaccine belongs to We the People. It is beyond outrageous for the company to even consider jacking up the price. 

A message for Moderna CEO Stéphane Bancel: 

You have already become unimaginably wealthy as a result of the COVID-19 vaccine marketed by your company. As you know full well, the development of that vaccine was funded almost entirely by the American people. Yet you are now planning to more than quadruple the price, which will — not might, will — result in preventable deaths of people who cannot afford your outrageous and immoral price gouging. Dr. Jonas Salk, inventor of the polio vaccine, refused to patent that medication — a choice estimated to have cost him $7 billion. Let that be your guidepost. How much more money could you possibly need, anyway? 

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Vaccine Rollout in California

 

	By Jill Cowan

Good morning.

As virus cases and hospitalizations drop and increasing attention turns to the state’s vaccine rollout, California officials are attempting a fine balancing act between speeding up the process and ensuring that vulnerable populations aren’t shut out.

On Tuesday, Dr. Mark Ghaly, the state’s secretary of health and human services, said in a news conference that the two goals were not mutually exclusive.

“This notion that we have to make a choice between speed and equity — it’s a false choice,” he said. “We can do both.”

But in a state where officials have repeatedly said that equity was a top priority, and that transparency would be built into the effort, information about who’s getting vaccinated and in what order has been difficult to come by.

So far, more than 3.5 million doses of vaccine have been administered in California, Dr. Ghaly said. The rate of vaccinations statewide, he said, has been building day by day, since a surge in hospitalizations over the holidays. According to a New York Times tracker, about 7.4 percent of the state’s population has gotten at least one shot. That number is 8 percent for the nation overall.

However, the state has not released demographic statistics about who received the vaccines, so it’s unclear whether Latinos or other Californians of color who have been at disproportionate risk have been vaccinated at commensurate rates.

Dr. Ghaly suggested state officials were weighing several methods of incentivizing vaccine providers to specifically target vulnerable communities, including with payments for performance.

Gov. Gavin Newsom last week announced that the state would revamp its vaccine distribution approach after widespread criticism that the rollout had been confusing and piecemeal.

Part of that restructuring involved enlisting two of the state’s biggest health insurers, Blue Shield of California and Kaiser Permanente, to help with a statewide distribution system that would prioritize equity and streamline a patchwork system.

And the state created a website and data portal that officials have said will not only notify Californians when they are eligible for a vaccine and help them make appointments, but also would help collect and share data with federal agencies or others who may be working to allocate vaccines.

[Visit the site, myturn.ca.gov, to sign up for notifications.]

On Tuesday, Dr. Ghaly declined to share details of the partnerships, but said any transitions to new systems would not disrupt existing appointments.

Experts have said that enlisting bigger, more experienced health care providers could help accelerate a vaccine rollout that has been hampered by its being implemented by already overwhelmed local public health departments.

In at least one place, though, simply having a smaller, more nimble agency in charge has made a significant difference, officials there have said.

A Look at Long Beach

Mayor Robert Garcia of Long Beach told me that the fact that the city has its own health department, separate from Los Angeles County’s, had helped make its vaccine rollout a model within the state, hailed by Mr. Newsom.

“We can move fast and make decisions quickly,” Mr. Garcia said. “It’s been very beneficial.”

The city of about 467,000 people — Los Angeles County’s second largest — was the first jurisdiction to move from vaccinating health care workers and nursing home staff and residents to inoculating grocery store workers and critical public schoolteachers and staff. Anyone 65 and older has also been eligible, as directed by the state.

And it is also set to begin vaccinating crucial workers at California State University, Long Beach.

[See how the vaccine rollout is going in California and other states.]

As of Tuesday, some 48,000 doses had been administered, according to data provided by Jennifer Rice Epstein, a city spokeswoman. The city has also been inoculating nonresidents who work in Long Beach, but if the doses had all gone to residents, that would represent more than 10 percent of the population.

That includes shots for 16,000 health care workers, almost 7,000 long-term care facility residents and staff, and 2,500 grocery store workers.

Mr. Garcia said the city’s health department was able to build on significant work bringing testing to harder-hit neighborhoods, where many lower-wage, often undocumented workers live.

“We had one of the best testing operations of anywhere in the state,” he said. “A lot of our testing sites just became vaccine sites.”

Those efforts have been coupled with a robust notification system that frequently updates users, even if they are not yet eligible for a vaccine, he said.

The city data showed that about 49 percent of the people who have been vaccinated in Long Beach are white — a reflection of most of the vaccines having gone to residents 65 and older, a population that is mostly white, Ms. Epstein wrote in an email. Roughly 21 percent were Hispanic or Latino, about 20 percent Asian and 7.6 percent Black or African-American.

The city’s population is nearly 45 percent Hispanic or Latino, and roughly 28 percent white, 12 percent Asian and 11 percent Black, according to data from the U.S. Census Bureau.

Still, it’s tough to get a sense of how this compares with other jurisdictions or the state more broadly in the absence of more detailed data. But the numbers suggest that it will be challenging to fast-track vaccinations to specific at-risk groups.

In any case, Mr. Garcia said he believed that the statewide partnerships with insurers could help streamline vaccine distribution even more, in particular the allocation of doses to providers — whether they are public health departments or clinics.

“There needs to be a change,” he said. “I’m very hopeful this new system will fix some of the issues.” NYTimes, California Report

 

Checks and Shots

 

The Chief David Dayen, American Prospect

The first bill that President Biden introduced, even before taking office, was a $1.9 trillion American Rescue Plan, which really picks up most of the leftover elements on pandemic relief that Democrats were unable to advance in the CARES Act and the December COVID relief bill. Two things stood out in the bill: the topping up of $600 checks in December to $2,000 and funding to get the vaccine produced and distributed. Those two pieces both probably have enough bipartisan support to pass, even in the Senate with 60 votes. The checks are incredibly popular and Republicans would be playing with fire to hold them up, especially if they know they can be dumped into a majority-vote budget reconciliation bill anyway (in other words, they’d have taken a bad vote for nothing). And there’s literally no amount of vaccine money that would not pay itself back and then some, by leading to reopening the country in full faster. So there’s an argument being made, within the House especially, to just pass those two elements—what I’m calling "checks and shots"—under regular order, and deal with the rest of the American Rescue Plan later. This has a couple different benefits. First, Biden would get an early, bipartisan legislative win, creating momentum for his presidency. That’s probably the most minor benefit, since "momentum" really isn’t a thing.

More important, a bill under regular order would get checks and shots out quick. Reconciliation takes time, and apparently the House is staying out of session next week. A full bill through reconciliation will run up against the extended unemployment deadline in March. By contrast you could put a checks and shots bill on the floor almost immediately.  Checks will circulate through the economy: the current $600 iteration is already boosting restaurants. With unemployment still high, any amount that can help people needs to get there right away. And vaccine money is vital. I know the private sector—God help us—wants to take over the rollout, but keep in mind that the most failed part of distribution right now is the Walgreens/CVS effort to vaccinate nursing homes. Who distributes the vaccine is less important than if they are funded for the effort in a coordinated way, with a Public Health Jobs Corps of 100,000 strong and a central government standing up mobile clinics and all the rest. And since we’re in a race with the more transmissible variant, time is of the essence. Third, as I’ve stressed, this is a trust-building exercise. Democrats ran and won in Georgia on checks. The Biden presidency is going to rise or fall on the vaccine rollout. Getting those priorities covered will show the public that promises can be kept. I know there’s a lot of Twitter grousing about $2,000 checks versus $1,400. I think Congress is likely to go with $1,400 but a standalone bill that isn’t risking the rest of the package is also more fertile ground to advocate for bigger checks.

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Punchbowl, which has reported a little on this, describes this as a "nibble" or a "big bite." But checks and shots are actually a significant portion of the American Rescue Plan. The estimate for $1,400 checks, especially ones that include adult dependents as the Biden bill does, is anywhere between $435 and $465 billion. Add $600 to that and it’s another $200 billion. And "shots," defined as a national vaccination program, is $160 billion. If you include the Public Health Jobs Corps and scaled-up testing to open schools and investing in COVID treatments, you’re scraping $400 billion, which is what the Biden fact sheet puts toward "critical measures for addressing COVID-19." So this "skinny" bill is anywhere between $595 billion and $1.07 trillion. Not very skinny! You could see it becoming comparable to the $900 billion relief bill passed a month ago.

Trump Vaccine Role Out is a Mess

 David Dayen, The American Prospect

There are two parts to Joe Biden’s COVID response plans. The first, the American Rescue Plan, is a legislative action for economic relief and funding support. The second involves taking over what has been an uneven vaccine rollout. While this also requires funding—Biden has asked for well over $150 billion in the ARP—there’s also plenty of executive prerogative to shape the rollout and maximize distribution. In the past couple days the Biden team has been explaining their plans. The urgency here has never been greater, for two reasons. First, the Trump administration really didn’t create a national vaccination strategy and apparently lied about what little role they did play. Second and far more important, the timeline for getting shots into arms has rapidly narrowed, due to the more transmissible variant B.1.1.7, which will become the predominant strain in the country by March, according to the CDC. Despite all the bumps in the road, the U.S. has hit a seven-day rolling average of just under 900,000 daily doses, not far off of Biden’s stated 1 million per day pace. But with B.1.1.7 looming along with a certain surge of cases, we probably need something more like 2 million per day to really make a dent in the crisis.

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There’s going to be a false dawn over the next month. Cases and hospitalizations have peaked and are coming down, while deaths have hit a plateau. But that will only last as long as B.1.1.7 is in the background. As soon as that becomes more of the primary way the virus is transmitted, those numbers will shoot back up. The only escape from that terrifying reality is either something like a lockdown, everyone being requisitioned N95 masks (which they use), or a mass mobilization of vaccines.  So what is Biden planning to do? He has outlined a plan that includes opening up mobile clinics in undeserved communities and increasing availability of vaccines at local pharmacies, the combination of which would put access within geographical reach of almost everyone. He would deploy FEMA and the National Guard to help put this distribution network together. The National Association of Chain Drug Stores claims that they could administer 100 million shots in a month, blowing away Biden’s benchmark of 100 million in 100 days. I was on a call with the NACDS the other day, where officials stressed their “deep experience with vaccinating America.” But looking at the one program that has been entrusted to chain drug stores so far, an effort with CVS and Walgreens to vaccinate nursing homes, I have to be skeptical in their abilities to rapidly turn their for-profit stores into free vaccination clinics. The CVS/Walgreens plan stalled out of the gate, yet NACDS senior vice president Kathleen Yeager had the gall to say that they were doing a “phenomenal job” at nursing homes.

Distribution is clearly something Biden’s team has thought a lot about, and that’s been the main bottleneck to this point, though it’s in the process of untangling. But we’re about to hit a bigger bottleneck with supply. As of a little over a week ago, states had only used about 29 percent of their supply. That number is now up to 46 percent, and with more efficient delivery networks coming on line, we’re going to hit a supply squeeze without some new stockpile of doses on the way. Hopes were dashed on this a couple times over the past few days. It became clear that there was no federal reserve of vaccines like the Trump administration had been intimating, letting down states that were relying on a big release of doses. I’ve heard from people who’ve received their first shot and been told that they cannot schedule the second because of uncertainty with supply. A much bigger issue is the apparent slowdown at Moderna. In the new year, production has dropped 36 percent. If Moderna were to hit its promised allocation for the U.S. of 100 million doses by the end of March, it would need to be making 1.1 million doses per day. It’s making about 303,000 in January. There appear to be supply chain issues with some of the materials that go into the vaccine. Incoming CDC director Rochelle Walensky expressed confidence that there would be enough supply to meet the 100 million in 100 days goal. But again, that’s not going to be enough to prevent a severely dangerous and economically ruinous situation in the spring, thanks to B.1.1.7. We need twice that, and supplies are short.

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The Biden administration will be using the Defense Production Act to try to alleviate some supply problems, though that will take time to ramp up. One possible ray of hope on the supply side is the ability to squeeze an extra dose out of Pfizer’s shipment of vaccine vials. But that only works if you use “low dead-space” syringes that don’t waste medicine, and the government’s shipments of syringes are often “high dead-space.” It’s unclear which company is supplying high dead-space syringes; the government has contracted with several supply firms, like Smiths Medicaland Retractable. But this leads to two problems. First, getting the high dead-space syringes out of production so that every Pfizer vial can yield six doses instead of five, instantly increasing supply by 20 percent; second, making sure all distributors have enough low dead-space syringes, since the government has only been giving out five syringes per vial. This is one place the Defense Production Act can come in, to make syringes. So it’s a scramble. We knew that the Trump administration would leave a mess; that was built in. The B.1.1.7 variant added a severe degree of urgency to the Biden team to really get this completely fixed, streamlined, and moving at double speed, in a matter of weeks.

Vaccine Rollout- incompetent

 David Dayen, American Prospect. 

First Response, David Dayen, American Prospect

As of Sunday, 4.33 million Americans have received a dose of one of the two coronavirus vaccines made available for emergency use. Trump administration officials with Operation Warp Speed initially promised 20 million people vaccinated by the end of the year, meaning 40 million shots. We didn’t get within 10 percent of that goal. Only one state, South Dakota, has administered doses for as much as 3 percent of the population, and in deep South states stretching from North Carolina to Mississippi, the number’s closer like 0.75 percent. Georgia and Kansas have only used 17 percent of their allotment; the average usage rate is around 30 percent. This is an abjectly terrible, inexcusable performance. If we need 85 percent immunization for true herd immunity, after three weeks of vaccinations we’re barely above 1 percent. That puts us in good shape for herd immunity by June 2025.  It’s made worse by the fact that a more transmissible variant of the virus has established itself in the country. If this was a race between immunization and mutation, the mutation would be Secretariat and immunization would be the rest of the field. With more transmissibility, hundreds of thousands of people could die before we start to reach enough at-risk communities to get those numbers down. Moreover, the more botched the rollout looks at the early stages, the more fuel given to anti-vaxxers to demonize the value of the effort.

We knew this vaccine effort was coming really since the first declaration of a pandemic. We’ve had months to strategize and plan and work out the logistics. We deliver hundreds of millions of flu shots every year; while this was a heavier lift, it’s not that much heavier. In that context, the lack of preparedness is unbelievable and yet also perfectly predictable and a fitting coda to a year of deep exposure to the realities of our frayed social structure.  When you have such a full-spectrum disaster, there are a thousand reasons why. Let’s go over some of them, in an effort to figure out if we can rebound from the failures: A Complete Lack of Leadership: This is really the big one. The president is too busy leaning on Secretaries of State like the world’s worst mob capo to care about vaccinations. If the vaccines aren’t golf balls he doesn’t know about them. The one time he’s bothered to make any excuses, it was to correctly, and horrifyingly, explain the mass immunization process: the federal government supplies an allocation to each state, and it’s up to themto figure out how to get it into people’s arms. Sometimes they’re only given a couple days notice to the states before that allocation goes out. Then the states have to manage keeping doses ultra-cold in storage, shipping to every part of the state, finding the trained professionals to give the shot, working up priority lists, educating people on the importance of the vaccine, keeping track of recipients who need to come back for a second dose, etc., etc.

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No Money: Before the COVID relief bill was finally signed December 27, states had received only around $340 million to pull this off. For the whole country. There’s another $8 billion on the way with the relief bill but even that’s an undercount. For those who say this is a miniscule part of state budgets, reallocation amid severe revenue shortfalls, especially when the feds were promising distribution support, isn’t realistic. Donald Trump walking away from his responsibilities is the biggest factor in the disastrous rollout.  Bad Process: Public health departments, which have been doing testing and tracing and recommendations for distancing, and are already pretty stressed, have to handle all this. Some states have shifted to hospitals to take the lead in distributing the vaccine, rather than public health departments. Hospitals, you might recall, are busy with trying to save people from dying from the virus; they don’t have the capacity to take on this project. In states with severe outbreaks like California, too many health workers are attending to patients to pull some off to give the vaccines. That’s why a Public Health Jobs Corps should have been stood up months ago. Other hospital networks just don’t have the facility with mass immunization; that situation in West Virginia, where patients got monoclonal antibodies instead of the vaccine, is an example of what can happen when you throw responsibilities onto overwhelmed entities at the last minute. The chaos of long lines and unclear delivery timing is another example. Hostile Takeover: The overcorrection to Donald Trump’s complete absence has been something like what we’re seeing in New York, where Andrew Cuomo blustered into a process health officials had been preparing for years and took it over. He’s now building the plane while it’s in the air, when county officials had the plane already prepped for takeoff.

Holding Back: A large segment of doses have been deliberately held back, about half to give to nursing home facilities administering through a separate federal process with CVS and Walgreens that could take months. (So much for handing over immunization to chain pharmacies; they’re performing perhaps worst of all! The “private sector is always more efficient” religion is pernicious.) Other doses are being held back to ensure enough doses are available to give out the second shot. That seems like a significant mistake. Just today, the U.S. has floated cutting the Moderna dosage in half, instantly doubling the available amount. Between that and the extra doses found in Pfizer vials, I don’t see the necessity in holding back doses for the second shot, as more product continues to roll off assembly lines. The Vagaries of Prioritization: We have a sick society caught up too much with whether someone, somewhere is getting a better deal than us. This manifests itself in the endless discussions of priorities and “line jumping,” when every shot in every arm is marginally better news for everyone in the country. The aforementioned Cuomo is mandating criminal penalties for not following prioritization, which seems like a popular idea but is one that guarantees throwing lots of shots in the garbage when they expire. The least effective shots are the ones not distributed. Tying oneself up in knots to ensure the perfect rollout has corrupted the rollout. America doesn’t do such nuance well. Holiday Hours: Seriously, holiday hours! There wasn’t enough staff around to administer vaccines because of Christmas and New Year’s. That will self-correct of course but it’s really shocking, especially because we had a few months’ warning that the vaccine was likely to be active around that time. In Israel, they opened 24-hour pop-up clinics and got rabbinical dispensation to keep them open on Shabbat as a medical emergency. Well over ten percent of the population is vaccinated as a result.

The Resistance: There have been health care workers who have refused to take the vaccine. This is a minor issue that will be ameliorated as more become comfortable with its effectiveness, but the problem is that the system in place appears paralyzed over what to do in such a situation, and this could lead to spoilage rather than just getting the shots out to whoever wants one. This was always going to be a bumpy rollout, because we have historically underfunded the entities most responsible for distribution, and we have an executive branch that’s checked out. I wrote in September that “the last people you would trust to execute this well would be in a Trump administration consumed with clinging to power post-election.”  Can Biden turn it around? He’s committed to using the Defense Production Act to increase vaccine supply, but it’s the distribution plan that’s needed. Mitt Romney has a thumbnail of a plan that at least understands the urgency required. We are treating something that will save millions of lives and our economy with the nonchalance of a half-planned dinner date. This should be the only thing government is doing for the next 4-6 months.