How much will a Covid-19 vaccine cost?

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The coronavirus vaccine race has fueled a debate over the cost of injections and who will pay for them, as prices range from $ 3 to over $ 30 per dose and public health advocates including Bill Gates are calling for a price caps for poor countries.

Even as billions of dollars of public money have been invested in vaccine development, drug makers have been reluctant to discuss the price of a vaccine. They say this is the result of many factors, including efficiency, test results, development and manufacturing costs, competition, demand and the fact that the buyers are private groups – such as insurers. – or public bodies.

The urgency and global spread of the pandemic have added layers of complexity. In the rush to develop the right vaccine, companies are experimenting with different technologies. In an unprecedented move, some drugmakers then plan to allow other companies to manufacture their doses, further complicating cost calculations.

U.S. biotech company Moderna says it will charge a maximum of $ 37 per dose for its Covid-19 vaccine, among the highest prices disclosed to date © Chandan Khanna / AFP via Getty

The price of all vaccine contracts has been shrouded in secrecy, with companies and public institutions defending their right to confidentiality. But people familiar with talks between drugmakers and the European Commission say AstraZeneca has sold its jab for around $ 3-4 per dose under deals with the EU, while the vaccine Johnson & Johnson and the vaccine jointly developed by Sanofi and GSK came in at around $ 10 per dose.

In contrast, Moderna – a newer and still loss-making company – has sought to launch its vaccine for between $ 50 and $ 60 per course of two injections, after initially asking for almost double that amount. Other biotech companies, like CureVac, said they would look for an “ethical margin” on their prices.

Pressure from civil society and media reports have prompted some companies to disclose projected list prices, with Moderna doing so in August and posting a maximum price of $ 37 per dose.

One of the vaccine pioneers in China, Sinovac, this week started selling its vaccine in some cities for $ 60 for two injections as part of an emergency use program with hundreds of thousands of participants.

The prices of existing vaccines vary widely.  Chart showing the price differences per dose for different vaccines between the US public and private sector

At the heart of the discussion is both an ethical and a practical question: Should drug companies work with rich countries to ensure that poor countries’ fees are capped?

Mr Gates, for example, told the Financial Times that drug companies should support a system in which rich countries subsidize vaccines so that poor countries pay $ 3 or less per dose.

“The price needs three levels where rich countries reimburse a large part of the fixed costs, middle-income countries reimburse a part of the fixed costs and the poorest countries pay a true marginal cost,” Mr Gates, co-chair of the Bill & Melinda Gates Foundation said in an interview.

The billionaire software developer-turned-health-care philanthropist says any effective vaccine must be available wherever it’s needed at a non-prohibitive cost. “We actually had to explain to a few CEOs of pharmaceutical companies that, even in the nonprofit context, this prioritization is absolutely necessary to maximize human benefit.

Some manufacturers in countries like India, which has a large drug production industry, have criticized Western pharmaceutical companies for trying to support prices by failing to ramp up production to meet demand.

“They don’t want to give it to the rest of the world because they’ll have to compete with me at $ 3 [a dose]Said Adar Poonawalla, Managing Director of the Indian Serum Institute, the world’s largest vaccine manufacturer. “We’re making a little margin, but it’s just normal business,” he said. He added that the higher production costs in Europe did not justify the price difference between his company’s products and those of some Western vaccine producers.

Gavi, the UN-backed vaccine alliance and the Gates Foundation last month expanded an agreement with Mr Poonawalla’s institute for the delivery of up to 200 million doses of vaccine candidates authorized by AstraZeneca and Novavax to low and middle income countries to a maximum of $ 3 per year dose – with the possibility of increasing the order volume several times.

Other initiatives to support global access include the efforts of the Coalition for Epidemic Preparedness Innovations, which is co-funding nine vaccine candidates with a mix of partners, including large companies and academia.

But the Covax initiative, the World Health Organization’s flagship program to deliver 2 billion Covid-19 vaccines to the poorest countries by the end of next year, had to delay its full launch until ‘to this month after struggling to join rich countries.

Mr Gates said he hoped in the long run that competition would keep prices low. “By the end of this year, or certainly the first quarter of next year, it’s likely that out of the top six vaccines, two or three of them will probably show their effectiveness, and then we’ll go for them. races, ”he said.

But he also acknowledged that the prices of some vaccines would likely remain higher than others. For example, mRNA vaccines, such as those from Moderna and the Pfizer and BioNTech partnership, are more expensive to manufacture than vaccines based on an adenovirus vector such as the vaccine developed by AstraZeneca and the University of Oxford, a- he declared.

A fundamental challenge for effective planning and pricing is that everyone involved has had to cut the normal decade-long vaccine development cycle into a fraction of the time, a senior EU official said.

“We are now trying to reduce that to 12 to 18 months and not just produce a few vaccines, but produce them in the hundreds of millions, if not billions, in volume,” the official said. “This is risky business.”

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