By RICHARD SKOLNIK
We continue to hear from a number of people, including in our own community, that “treatments should have been the focus from the beginning”.
Such comments reflect a lack of understanding about how vaccines work and their costs. They also reflect a lack of understanding of the costs and effectiveness of COVID treatments and who bears such costs.
With this in mind, I lay out some facts below about the relative costs and effectiveness of vaccines and some of the available and soon to be available COVID treatments. References are given at the end for all data used in the article.
As I have mentioned in earlier articles, vaccines against COVID, like many other vaccines, don’t confer lifelong immunity and need boosters. Yet, they still provide enormous benefits at low cost. The latest (Oct. 18) data for New Mexico shows that the unvaccinated have a 4.5 times greater risk of infection, a 6.0 times greater risk of hospitalization, and an 11.7 times greater risk of death than the vaccinated.
This is even in the face of waning immunity from vaccines. Moreover, this data does not take account of the likely effect of the boosters that are now being given. The Pfizer vaccine costs the US government about $20, or about $60 for a full dose plus a booster.
Below are some key data on the costs and effectiveness of COVID-related therapeutics:
- In clinical trials, Regeneron’s monoclonal antibody treatment reduced hospitalization by about 70 percent, shortened the duration of symptoms by 4 days, and reduced symptomatic infection among exposed individuals by 80 percent. Such treatment is authorized for post-exposure prevention in people over 12 years of age who have a high risk of progressing to severe disease and in people who test positive for the SARS-CoV-2 virus and have a high risk of progressing to severe disease. Regeneron’s monoclonal antibody costs about $1,250 and has been generally given in selected settings by infusion. However, a lower dose has also been approved for use by injection. Clinical trial results published in September 2021 concluded that Regeneron’s treatment when given by injection was over 60 percent effective in preventing infection in close contacts of infected cases. It also reduced the duration of symptoms and high viral load.
- Remdesevir costs about $3,120 for a typical patient. In clinical trials, those who received Remdesivir had a median recovery time of 10 days, compared with 15 days among those who received placebo. This drug is indicated for people over 12 years of age who are hospitalized and is given by injection in a hospital, generally over 5 to 10 days.
- Reports from clinical trials suggest that Merck’s new pill to treat COVID, molnupiravir, will reduce severe illness and hospitalization by about 50 percent, compared to a placebo, if used quickly after infection. It has been suggested that the cost of the 40-pill course of therapy could be around $700. The drug has not been tested on pregnant woman or children.
- The average cost of treating a patient for COVID in the hospital has been estimated at about $20,000.
- ECMO (extracorporeal membrane oxygenation) is a treatment for severely ill COVID patients. Various reports estimate the cost per day of ECMO to be between $20,000 and $40,000. The latest studies show the median length of stay on ECMO of COVID patients was about 20 days for those put on it after May 2020. The mortality rate of these patients was 48 percent.
Of course, when considering the value of vaccines and therapeutics, we also need to consider the full costs to individuals and to society of COVID illness. This must also include what we know – and what we don’t know – about long-COVID.
I am fully in support of developing treatments, as fast as possible. They are essential. In fact, had I been responsible for government policies, I would have been much more vigorous than the federal government was in using advanced market commitments and other tools to spur the development of therapeutics.
Nonetheless, the data above should make clear to all of us why vaccines, in conjunction with masking and social distancing, must remain for now the foundation of our approach to addressing COVID. Cost-effectiveness is a key principle of public health. We should address COVID at the least cost that is effective. This is especially important since an important share of COVID costs are borne by taxpayers, rather than by individuals.
Editor’s Note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health. Skolnik has written this article in his personal capacity.