There’s an old adage that states: “An ounce of prevention is worth a pound of cure.” That’s never sounded truer than now as we continue to struggle through the damage of COVID-19 — so far without vaccines. One of the many lessons we’re likely to take away from the pandemic will be the need for public health stakeholders to support more cost-effective and prevention-focused care, not just to prepare for future pandemics but also for the everyday long-term sustainability of their systems.
Vaccination is broadly recognized as one of the most cost-effective interventions that contributes to health care system efficiency. Vaccines are unmatched in their simplicity and cost-effectiveness. They save millions of lives and help to avoid the massive health care costs associated with hospitalizations that would otherwise occur across many infectious diseases.
We can already learn one thing from the current pandemic response: when all stakeholders in public health actively work together behind a single critical goal, we increase our chances of finding solutions to even the most difficult challenges.—
Prioritizing prevention in health care ecosystems before it’s too late
Despite these and other important benefits of vaccinations, health care systems are not generally set up to reward the prevention of disease and instead favor reimbursements for costly treatments. It’s harder for governments to justify broad vaccination to avoid thousands of cases of influenza — a disease known to trigger life-threatening pneumonia — than it is to reimburse the hospital stays for patients who don’t get vaccinated and end up in the hospital with severe cases of pneumonia.
This imbalance must be adjusted in order to keep skyrocketing costs of critical care under control. Across policymakers, procurement agents, regulators, health care professional associations, and vaccine manufacturers, we all must work together to rebalance the following trends:
1. Vaccine cost-containment policies prioritized
Read our COVID-19 and the Polls series
As the pandemic rages on, elections continue across the world. In this series, we explore how COVID-19 has affected people’s choices at the ballot, how health features on political agendas, and the wider repercussions of voter choices during the pandemic.
Vaccines are often purchased through government tenders that prioritize low prices as the main evaluation criterion. This policy ignores the broad benefits of new vaccines that can potentially save even more lives and money than existing standards of care. In other words, if the sole purchasing criterion is minimizing the upfront vaccine budget, buyers ignore the benefits of outcomes: hospitalization and long-term care avoidance. They may unintentionally be doing their populations a double disservice in both public spending and public health.
2. Procurement processes based on budget cycles only
Vaccine production is long and complex, requiring between six months to a few years to complete in total. In too many countries still, governments often set one-year tender processes simply based on their budget cycles rather than the long-view requirements for vaccine manufacturing.
3. Redundant regulatory complexities
Quality controls are essential in vaccines; if our products aren’t safe, they cannot be effective. Both manufacturers and country health authorities undertake stringent quality controls throughout the manufacturing process. In fact, quality controls amount to a large majority of the production process, but multiple layers and diversity of regulations can become prohibitively burdensome.
For example, before a European-manufactured pediatric vaccine can reach a baby in China, it is tested three different times for the same quality criteria — by the manufacturers’ own labs, the reference European national control lab, and by the Chinese authority’s control labs. These trends can cause supply delays and shortages in the short-term and vaccine supply sustainability challenges in the long-term.
Seeking the lowest price and fastest turnaround with redundant regulatory controls could drive more manufacturers out of the industry and even call into question its long-term sustainability. If vaccine innovators know that their future products will face such hurdles, it drastically bridles the incentives to invest in new or additional vaccines over time.
As a consequence, some of the world’s greatest vaccine innovators of the past, including Novartis and Baxter, have exited the vaccine market completely. Today, only four global vaccine manufacturers continue to invest in vaccine innovation to bring new vaccines to people to avoid and manage life-threatening diseases such as respiratory syncytial virus, human papillomavirus, and others.
4. Building healthier vaccine ecosystems for all
We can already learn one thing from the current pandemic response: when all stakeholders in public health actively work together behind a single critical goal, we increase our chances of finding solutions to even the most difficult challenges.
This same logic can also apply to the long-term sustainability of health care systems, supported by robust investment and resourcing behind innovative vaccines. We must work together on several fronts. This includes strong and ongoing public-private partnerships where business models that invest in research and development are recognized to the full extent of their disease-preventing products’ value. This allows not only for continuous innovation but also better preparedness at a global scale for the unpredictable changes in infectious disease epidemiology.
For example, with additional support and investment-sharing from the United States and other countries worldwide, Sanofi’s long-standing collaboration with the U.S. Biomedical Advanced Research and Development Authority in support of influenza pandemic preparedness, was well-positioned to pivot effectively into COVID-19 vaccine development. It’s worth noting too that the regulatory agencies in these and other national and regional governments are also adjusting their approach in real-time to data and procedural oversight to more rapidly review and potentially approve COVID-19 vaccines that demonstrate their efficacy and tolerability.
While we cannot and should not operate in pandemic mode over the long-term, the crisis is starting to show the potential of a more robustly prioritized vaccine ecosystem, one that can more effectively help prevent disease and avoid a much larger portion of current health care cost burdens in critical hospitalizations and long-term care. An ounce of prevention is indeed worth a pound of cure, particularly in infectious diseases, and I’m eager to continue working with all of our stakeholders in public health to help ensure we’re appropriately investing in a balance in both.