A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. 

That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21.

The study is based upon an extensive analysis of US  government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. 

The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense.  

Most funds invested in vaccine procurement

While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. 

That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology.

Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development.  

“The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study.

Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines.  

An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus.

After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. 

“[This is] the largest public investment for a disease ever,” Lalani said.

Risks were socialized while financial rewards were privatized 

The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. 

“In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. 

“However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.”

Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose.

Research or share buy-backs? 

A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development.

Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. 

“Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines.

“As this research shows, that claim is a total myth,” she said. 

What’s the counter?

The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. 

Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed.

And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. 

The medical upside of mRNA

The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary.

“Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.”

The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients.

“Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.”

Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.”

Image Credits: Ajay Suresh, NIH, Nature Biotechnology.