Links - 15th July 2020 (2) (Vaccines and the Market)

Goldman asks: 'Is curing patients a sustainable business model?' - "Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering “gene therapy” treatment: cures could be bad for business in the long run.“Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.”“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients Tuesday. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”"
Naturally, there're naive people (e.g. libertarians) who claim that the profit motive means that the private sector will be motivated to solve all problems

Big pharma failing to invest in new antibiotics, says WHO - "Big pharma continues to walk away from investment in new antibiotics and there are alarmingly few useful new drugs in the pipeline to deal with the worsening crisis of antibiotic resistance, according to the World Health Organization... There have been only eight new antibacterial agents approved since 1 July 2017, but overall, says the report, “they have limited clinical benefits”. There has been one important success story: pretomanid has been approved for patients with drug-resistant tuberculosis. But it was developed not by a pharmaceutical company but by the not-for-profit TB Alliance... The big pharmaceutical companies are not investing in antibiotic research because there is not a lucrative market for them. A novel drug needs to be kept for cases of dire necessity, not sold widely. Overuse will mean resistance to it inevitably develops and although the world badly needs the drugs, new classes of antibiotic are difficult to find."

Vaccines Are Profitable, So What? - The Atlantic - "While the main fixation of anti-vaccine groups is an old, discredited study linking vaccination to autism, another is a conspiracy theory circulated online that both doctors and pharmaceutical companies stand to profit financially from vaccination—which supposedly leads to perverse incentives in advocating for the public to vaccinate.But that argument is historically unfounded. Not only do pediatricians and doctors often lose money on vaccine administration, it wasn't too long ago that the vaccine industry was struggling with slim profit margins and shortages. The Economist wrote that "for decades vaccines were a neglected corner of the drugs business, with old technology, little investment and abysmal profit margins. Many firms sold their vaccine divisions to concentrate on more profitable drugs." In fact, vaccines were so unprofitable that some companies stopped making them altogether. In 1967, there were 26 vaccine manufactures. That number dropped to 17 by 1980. Ten years ago, the financial incentives to produce vaccines were so weak that there was growing concern that pharmaceutical companies were abandoning the vaccine business for selling more-profitable daily drug treatments. Compared with drugs that require daily doses, vaccines are only administered once a year or a lifetime. The pharmaceutical company Wyeth (which has since been acquired by Pfizer) reported that they stopped making the flu vaccine because the margins were so low. “Historically vaccines were produced at a relatively low price and sold with a low profit margin. They were add-ons to other products—mostly drugs—that pharmaceutical manufacturers were producing," explains Neal Halsey, professor of pediatric infectious diseases and international health at Johns Hopkins Bloomberg School of Public Health. "The people working in vaccines described themselves as the stepchild of others, and they had to fight hard for the resources to develop new vaccines.”... profit margins are hard to know, as R&D (which can take up to 15 years), manufacturing, trials to test efficacy, and distribution costs for specific vaccines and drug products are not public... Pharmaceutical companies need incentives to keep producing vaccines, because regardless of profits the economic and social benefits of vaccination are huge—in lives and the billions of dollars saved."
Conflicts of interest apparently aren't a problem in certain scenarios

Why can’t we cure the common cold? - "researchers at the University of Wisconsin-Madison decided to investigate one of the best-known ways of catching a cold. They infected volunteers with a cold virus and instructed them to kiss healthy test subjects on the mouth for at least one minute. (The instruction for participants was to use whichever technique was “most natural”.) Sixteen healthy volunteers were kissed by people with colds. The result: just one confirmed infection. The most common beliefs about how to treat the disease have turned out to be false. Dubious efficacy has done little to deter humankind from formulating remedies... Today, “winter remedy” sales in the UK reach £300m each year, though most over-the-counter products have not actually been proven to work. Some contain paracetamol, an effective analgesic, but the dosage is often sub-optimal. Taking vitamin C in regular doses does little to ward off disease. Hot toddies, medicated tissues and immune system “boosts” of echinacea or ginger are ineffective. Antibiotics do nothing for colds. The only failsafe means of avoiding a cold is to live in complete isolation from the rest of humanity. Although modern science has changed the way medicine is practised in almost every field, it has so far failed to produce any radically new treatments for colds. The difficulty is that while all colds feel much the same, from a biological perspective the only common feature of the various viruses that cause colds is that they have adapted to enter and damage the cells that line the respiratory tract. Otherwise, they belong to quite different categories of organisms, each with a distinct way of infecting our cells. This makes a catch-all treatment extremely tricky to formulate... An early experiment at the CCU involved a group of volunteers being made to take a bath and then to stand dripping wet and shivering in a corridor for 30 minutes. After they were allowed to get dressed, they had to wear wet socks for several hours. Despite a drop in body temperature, the group did not get any more colds than a control group of volunteers who had been kept cosy... viruses were behind 85% of asthma attacks in children; about half of those were rhinoviruses. Previously, most studies had detected viruses in fewer than 20% of asthma attacks. Johnston went on to find that rhinovirus also exacerbates symptoms in 95% of cases of smoker’s cough (formally known as chronic obstructive pulmonary disease, or COPD)... For doctors, vaccines are preferable to drugs because they shield the host from invasive organisms before they cause any damage. For pharmaceutical companies, vaccines are significantly less attractive. Not only do they take years and hundreds of millions of dollars to develop, even if that process is successful – which it often isn’t – it can still be hard to make much money. Vaccines are usually injections administered on a single occasion, while drugs are taken for prolonged periods. And people don’t want to pay much for vaccines. “Everybody wants vaccines for pennies rather than pounds because you get them when you’re healthy,” Almond said. “Nobody wants to pay anything when they’re healthy. It’s like car insurance, right? But when you’re sick you will empty your wallet, whatever it takes.”... At this point in time, perhaps the biggest barrier to us curing the common cold is commercial. Researchers at universities can only go so far; the most generous grants from bodies such as the UK Medical Research Council are around £2m. It falls to pharmaceutical companies to carry out development beyond the initial proof of concept. “You’re looking at 10-15 years’ work, minimum, with teams of people, and you’re going to spend $1bn (£760m) at least,” Almond told me.Successes have been rare, and there have been spectacular flops... After the $1bn or so spent on development, there are also manufacturing and distribution costs to consider. There needs to be a return on the initial investment. “You sure as hell can’t do it if there’s not a market at the end, you’re wasting the company’s money, and if you do that too often, you’ll bankrupt the company,” Almond says. “There isn’t a conspiracy out there that says, ‘Let’s not do vaccines so people can get ill and we charge them a lot’, nothing like that. It genuinely isn’t easy.”"