Health and Human Services Secretary Alex Azar sparked outrage last week when he said that the federal government could not guarantee that a potential vaccine for COVID-19, the coronavirus currently sweeping across the world, would be affordable. The government “can’t control” vaccine prices “because we need the private sector to invest,” Azar told lawmakers. But Azar’s economics are wrong: the federal government can ensure that a vaccine would be cheap—or even free—while giving the private sector powerful incentives to pour resources into vaccine research.
The solution? A large cash prize for any firm that develops a successful coronavirus vaccine. The prize would be payable only on the condition that the firm makes the vaccine available to patients at low or zero cost. If designed well, such a prize will assure private-sector enterprises that they will be financially rewarded for a coronavirus vaccine while also ensuring that individuals at all income levels will be able to afford immunization.
Bringing a COVID-19 vaccine to market will likely require the help of a private-sector pharmaceutical company with the capacity and experience to conduct costly clinical trials and then to manufacture millions of doses. Generating sufficient private-sector interest in vaccines for viral pandemics has proven difficult in the past. One concern facing pharmaceutical companies is that if they develop a vaccine, they will face overwhelming political pressure to make it available on the cheap.
Fortunately, the choice between incentives for innovation and affordability for patients is not either/or. Prizes can resolve the tension between innovation and affordability by accomplishing both. Committing to a substantial cash prize for a successful coronavirus vaccine will boost confidence among firms that their research efforts will be remunerated. And attaching the condition that the prizewinner must make its vaccine available to all at little or no cost will ensure that price is no barrier to immunity.
So-called “challenge prizes” have a long and storied history. Starting in the 1560s, various European countries—first Spain, then the Netherlands, then England—offered prizes to any inventor who could develop an accurate tool for measuring longitude. (English clockmaker John Harrison ultimately claimed his country’s longitude prize in the mid-18th century.) Napoleon Bonaparte awarded a 12,000-franc prize in 1810 to the French chef who came up with canning as a method of food preservation.
More recently, in 2010, the U.S. Congress passed a law establishing a framework for federal agencies to run prize competitions. Since then, more than 100 federal agencies have administered nearly 1,000 prize competitions involving over $300 million.
Perhaps the most successful modern-day prize effort is a partnership between the Bill & Melinda Gates Foundation and several national governments around the world to incentivize the development and dissemination of a vaccine against pneumococcal disease. That alliance has resulted in the immunization of more than 183 million children across 59 countries, likely saving hundreds of thousands of lives.
The next natural target for a challenge prize is a safe vaccine that is effective in preventing COVID-19. Some of the specifics still need to be worked out—how safe is “safe,” how effective is “effective”—but those are the sorts of specifics that a prize committee can adjudicate. Implementing a coronavirus vaccine prize will also require a number of design choices. For example, o encourage dissemination, we suggest that payments be tied to the number of patients vaccinated—an approach that has succeeded in the case of the pneumococcal vaccine. Bonus payments could be offered for improved vaccines with greater efficacy or less frequent or severe side-effects.
The most challenging design question may be: How much money? Public health experts predict that a pandemic could infect 40% of the global population or more. The fatality rate outside of China’s Hubei province appears to be around 0.7%. Federal agencies assign a value of around $10 million to the saving of a life. Given all that, a fully effective vaccine would be worth $28,000 per person.
That’s high—though it helps to illustrate just how hugely valuable a coronavirus vaccine could be. We suggest a prize of $500 per vaccinated person, which would be more than double the price of any other major vaccine on the market today. If everyone in the U.S. took the vaccine, the total cost to the federal government would be about $165 billion, less than 3.5% of the federal budget.
If the U.S. federal government won’t step up to the plate, perhaps states and cities, other countries, philanthropists, or Corporate America will. Coronavirus fears have wiped more than $3 trillion in value from U.S. stock markets. The largest U.S. companies would be doing their shareholders a favor by funding a generous coronavirus vaccine prize.
If the effort to establish a coronavirus vaccine prize brings the pandemic to a quicker and less deadly end, then it will be a banner success. But it could do even more. It could demonstrate—dramatically—the potential role for prizes in and beyond the pharmaceutical sector. It could bring us closer to a model in which private-sector innovation and public access to essential medicines are not antonyms. To be sure, containing COVID-19 and saving lives are the most immediate objectives, but they are not the only goals. An outbreak, one might say, is a terrible thing to waste.