The rush to produce a COVID-19 vaccine is progressing at breakneck speed, with various media saying that something may be available before the end of the year. The greatest concern is that shortcuts in the normal development process will result in safety issues. This concern, however, tends to be overwhelmed by sheer demand that is promoted, at least partly, by politics. U.S. President Donald Trump desperately wants something before the November election, and, in Japan, those invested in the postponed 2020 Tokyo Olympics and Paralympics say they need a vaccine by early next year.
Money also has something to do with it. Obviously, the first pharmaceutical company that comes up with a vaccine is going to hit the jackpot because governments all over the world are counting on one to restart their economies. They will pay almost any amount, even if the vaccine’s initial effectiveness is less than what would normally be acceptable. Most companies are shooting for at least 50 percent efficacy. At that rate, hoping to acquire immunity from a COVID-19 shot would be akin to flipping a coin. And, of course, there’s the added possibility you might be made sick from it.
This is not to suggest that a vaccine shouldn’t be pursued as aggressively as possible, but rather that there is a history of vaccines and related medical treatments that have proven to be problematic due to the confluence of acute public anxiety surrounding a medical emergency, public sector involvement in solving the emergency, and money. Japan, in fact, offers at least one salient example.
During a discussion of the matter on the Aug. 14 edition of the web talk show Democracy Times, several freelance journalists recalled the Tamiflu controversy. Tamiflu was a prescription drug developed in the United States that was said to be effective in treating influenza, and Japan imported millions of doses of the drug after waiving domestic testing requirements. When a number of young people died supposedly as a result of taking Tamiflu, its distribution was restricted so that more studies could be conducted as to its side effects. In the end, even its efficacy was questioned. Then, in 2009, as reported in a recent Mainichi Shimbun article, Japan imported 67 million vaccine doses from two foreign companies to treat a new seasonal flu, again using an exceptional fast-track approval method, but an epidemic never materialized and almost none of the doses were used.
In a recent interview in Harbor Business Online, Junichiro Yamaoka, who has written extensively about the pharmaceutical industry, elaborated on the Tamiflu affair, saying that Japan turned to the drug in 2003 when the avian influenza was spreading throughout Asia, and the following year the administration of Prime Minister Junichiro Koizumi decided to stockpile enough Tamiflu for 10 million people. By 2005, Japan accounted for 75 percent of the world’s supply of the drug.
Tamiflu’s license was held by the U.S. pharmaceutical company Gilead Sciences, Inc., whose chairman from 1997 to 2001 was Donald Rumsfeld, who left that position to become the U.S. secretary of defense. At the time, the U.S. was pressuring Japan to reform its health sector by speeding up approval of foreign-made drugs. In 2001, Japan approved Tamiflu to be prescribed through the national insurance system. According to Yamaoka, Gilead’s policy under Rumsfeld was to sell its drugs worldwide at premium prices.
Gilead also developed Remdesivir, the first drug in Japan to be approved, in May, for treating COVID-19. As with the potential COVID-19 vaccine, Remdesivir’s authorization was fast-tracked. Yamaoka explains that Remdesivir was originally developed to treat Ebola, and that even in the United States, where COVID-19 has killed about 200,000 people so far, it isn’t widely used to treat COVID-19, perhaps because of possible dangerous side effects, including multiple organ failure.
Yamaoka’s point is that large pharmaceutical companies can exploit nationalized health services, especially during a pandemic. This isn’t to say that national health services are inherently wasteful or nearsighted — one of America’s main problems with the current pandemic is its lack of universal health coverage — but rather that politics invariably enters the picture. The government has even promised to protect these pharmaceutical companies from litigation if anything goes wrong, a major consideration given that Japan could have more than 500 million doses of vaccines by six different manufacturers some time next year.
It is the media’s job to interrogate such actions, and, in Japan, the pharmaceutical industry spends a lot on advertising. As with electric power industry advertising, this money is leveraged to sway media companies rather than cultivate customers, since there’s no concrete proof that drug ads increase overall sales, so the mainstream press is often cautious about covering drug-related matters in a critical way. The foreign press has less compunction about focusing on uncomfortable truths. Reuters reported that Japan is panic betting on future vaccines expressly because of the Olympics. Moreover, connections between the government and the drug industry have always been strong owing to the well-known — and ostensibly forbidden — practice of health ministry bureaucrats retiring to comfortable jobs in pharmaceutical companies.
In any case, it doesn’t look as if a domestically developed vaccine will be ready before next summer at the earliest, so the government is playing it safe by looking abroad. It will also join a WHO program to secure vaccines en masse with other member countries. At present, a foreign-developed vaccine will not likely be ready this year, either, but the Japanese public is wary about vaccines anyway, so increased media scrutiny of rushed testing and possible side effects could simply undermine the government’s intention to get everyone vaccinated, regardless of when a vaccine is available. At this point, there are just too many variables to make a prediction.