The coronavirus of 2019 has infected more than 155,000 people and claimed more than 5,000 lives. Some countries have closed their borders and discriminatory practices of xenophobia have swarmed their way into classrooms, the workplace, media and other institutions.
Hysteria, fear and anxiety have become the hallmarks of this growing epidemic since the first cases were reported in Wuhan, China. Exact incubation periods, profile of symptomatology and whether or not this is truly the first time coronavirus has been around are still in question. The anxiety surrounding this disease is even hampering the vitality of domestic and global economies. Last week, stocks tumbled for 7 consecutive days, with one of the sharpest declines occurring after President Trump gave a news conference earlier last week.
However, this writing won’t be a political debate. It won’t determine the fitness of Vice President Mike Pence to lead this national health emergency—but rather, will give needed attention to a public health and ethical concern.
Americans and other people around the world have been following the growing list of CDC guidelines. We’ve been washing our hands for 20 seconds (approximate length of the Happy Birthday song sung twice), obeying travel restrictions, self-quarantining at the start of flu-like symptoms. Although these measures have potentially slowed the spread of the virus, an instrument to cease its transmission is needed. A vaccine would be the answer. Problem solved? Not quite.
On one hand, it’s estimated that a coronavirus vaccine may not be market-ready for approximately 1-2 years. On the other hand, according to U.S. Health and Human Services Secretary Alex Azar, the Trump administration can’t promise that a vaccine will be affordable to all. Panicked and vulnerable Americans may not be able to get a preventative treatment to ensure their protection. A promising formula hasn’t even made its way into a syringe yet, but somehow, has already been assigned an expensive price tag. Why so prematurely?
Market exclusivity appears to be a main culprit behind high drug prices in the U.S. As the coronavirus vaccine is in development, the first drug company to reach success in developing a vaccine will be granted a patent by the Food and Drug Administration (FDA), essentially ensuring several years of protected monopoly status and profit‚ given it meets FDA qualifications. The presence of generic vaccines won’t be a reality for several years, which is one of the most useful tactics in driving prices down.
Newsflash.…America has seen this before. We have seen our best minds, resources and capital funneled towards public health crises. However, when the prized breakthrough is achieved, the less fortunate are the last in line to reap its benefits. For example, in 2013, the more effective drugs Solvaldi and Olysio were added to the market for treatment and cure of Hepatitis C, a viral infection that can cause liver damage and cancer.
A study in the Journal of Health & Biomedical Law highlighted the challenges patients face in getting these promising drugs within our complex healthcare system. Specifically, just one pill of Sovaldi costs approximately $1,000, which brings the total cost of the 12-week treatment to $84,000, according to the study. While patients with private insurance showed higher rates of denied authorization, even patients with Medicare and Medicaid faced strict restrictions when trying to access these drugs. Some need access to a primary care doctor, a hepatologist or to show proof that they do not use alcohol. This is a difficult laundry list for people to accomplish, particularly those who are a part of the lower economic class, with limited access to routine care or specialists who accept Medicaid.
What should be established as a low hanging and accessible fruit has been selfishly turned into a high-hanging potential source of disparity. I would argue that a medical practice or development fueled by a profitable end falls short of providing equitable access to healthcare. The practice of medicine exists for the expedient and efficient treatment of all, not the few with hefty pockets.
Although the warnings of HHS Secretary Azar and health care leaders may appear to simply be rhetoric at the moment, health disparities are not. Marginalized members of society will predictably carry the heaviest burden of this disease. Notably, Duke Health has been reported as the largest employer in Durham county, employing over 19,000 within its healthcare system. It can therefore be deduced that it is one of the largest contributors to not only the economy of Durham county, but the health of its residents. In light of its mission to deliver a healthier tomorrow, DukeHealth should not only investigate the epidemiology of this disease, but the access (or lack thereof) that residents may have to upcoming technologies and medical advances.
Whether private investors are called upon to make this vaccine a reality, which significantly drives up the cost, or not, the federal government should have the health and pockets of all in mind. To our public leaders and advisors, such as those with the federal Centers for Disease Control who are working on the front lines of this emerging pandemic: We, the people, are doing our part with adherence to guidelines that have been established to prevent transmission of COVID-19. We are hopeful that a vaccine would be economically accessible to everyone at risk. In the meantime, the subsidizing of coronavirus diagnostic tests and related treatment for non or underinsured people remains a reasonable public health response. Should the latter become a reality, our government can begin to match what has been its potential for centuries. Enabling the latter will begin to lessen the burdens of human finitude and show us what equitable human flourishing truly looks like.
Kirsten Simmons is a third-year medical student at Duke University School of Medicine. She is also completing a Master’s of Health Science in Clinical Research and a Master’s of Theological Studies at Duke University Divinity School as a Theology Medicine and Culture Fellow.
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