DFA Leader Dr. Reshma Ramachandran Offers Testimony at COVID-19 Immunization Hearing

On February 26, 2021, Dr. Reshma Ramachandran, co-chair of Doctors for America’s Drug Affordability Action Committee, appeared before the Health Subcommittee of the U.S. House Ways and Means Committee during a hearing on COVID-19 immunizations. Dr. Ramachandran offered the following comments as part of her testimony; the comments have been updated to reflect changes in fact since the testimony was provided.

The record-breaking availability of multiple safe and effective COVID-19 vaccines is an incredible scientific achievement. This would not have been possible without financial support from taxpayers, whose dollars fueled government agency research and federal programs such as Operation Warp Speed. The Moderna vaccine, which is one of three currently available in the U.S., benefitted fully from this public support for its development and manufacturing. For several vaccine candidates, the American public has taken on the risk of creating these vaccines by not only paying up front for their development and production, but also for their purchase. 

Despite this, both manufacturers and the U.S. government have left the American people in the dark on how their taxpayer dollars are being spent and whether access to these vaccines will be guaranteed.

As a first step, it is imperative that Congress make transparent exactly how much the public is investing in the development, manufacturing, and purchasing of COVID-19 vaccines as well as the agreements that clarify the spending terms. Over the past year, Operation Warp Speed has repeatedly announced the allocation of billions of taxpayer dollars to individual vaccine manufacturers. Other government agencies including the National Institutes of Health have been granting funds and resources to these companies. These are worthwhile and necessary investments but no comprehensive database exists of these expenditures. Moreover, access to these spending agreements has been incredibly difficult with only heavily redacted records being made available after several requests and lawsuits., 

As a result, it is unclear who owns this publicly-funded vaccine technology and whether the American people have any recourse should the companies face production delays, as we have seen repeatedly over the past months, or if they set excessive prices. Additionally, modified versions of these vaccines are now being developed to prevent rapidly emerging variants, built on this publicly-funded research. Clarifying who owns the vaccine technology and data through transparency of these agreements would inform whether the U.S. government is able to help boost supply of future, adapted vaccines.

One solution to ensure full transparency of both taxpayer spending and the conditions for this financing has been outlined by Congressman Doggett in the Taxpayer Research and Coronavirus Knowledge or TRACK Act. This bill would create a user friendly, public database of any agreements as well as all federal funding across agencies for biomedical R&D related to COVID-19.

In addition to transparency of taxpayer funds and terms, Congress should require all agreements with companies to include protections for patients to ensure adequate supply and access. These should apply not only to current vaccine candidates, but also to modified versions meant to address variants built on taxpayer-funded technology. All licenses awarded by the U.S. government for publicly-funded COVID-19 technology must be made open and non-exclusive. In doing so, the U.S government would be able to license vital data and technology, especially during a pandemic, to multiple manufacturers to meet demand.

Moreover, Congress and the Biden administration could require companies to share the vaccine technology and data to further boost supply and ensure access. One comprehensive approach would be to couple Section 1498 and full use of the Defense Production Act as outlined by Senator Elizabeth Warren (D-MA) and Representative Katie Porter (D-CA) in their letter in January 2021 to the Biden Administration. Finally, as has been narrowly included in a few contracts, Congress could also require reasonable pricing in exchange for procurement of doses., 

Manufacturers have repeatedly said they have set a lower, “pandemic” price for these vaccines. Still, they are anticipating significant profit margins this year, and have confirmed that prices will be set higher in the future. While the federal government has been able to secure modest discounts, future pricing of COVID-19 vaccines will likely be problematic for patients as annual doses will be needed and pandemic pricing will no longer be available. Lest we not learn from other vaccine markets – my research found that both public and private sector prices for the influenza vaccine rose over the past two decades despite larger volumes distributed, multiple manufacturers, and several similar products being available. Such a pattern for COVID-19 vaccines of increasing prices would have significant implications on health spending, public health program budgets, and insurance premiums for those with private plans. 

My patients often ask me when they might receive the vaccine as our leaders have had to prioritize populations for the vaccine rollout due to limited supply. By safeguarding transparency and access, Congress would be ensuring a future our patients have already paid for – one of hope in being able to receive and afford this vaccine and no longer having to wait and be burdened by this devastating disease.