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Let them eat cake.

This is effectively what Health and Human Services Secretary Alex Azar told Americans when asked about whether a treatment for the fast-moving coronavirus will be affordable.

“We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” he told a congressional committee on Wednesday in response to a question about affordability. “The priority is to get vaccines and therapeutics. Price controls won’t get us there.”


Talk about a Darwinian view of health care. Such a remark can only come from someone who should be diagnosed with Tin Ear Syndrome.

Predictably, his attempt to soothe anxious Americans — who fear the virus will erupt at any moment and are already fed up with the rising cost of medicines — sparked a backlash. Twitter was alight with criticism. Seizing on an opportunity to eviscerate the Trump administration, presidential candidate Sen. Bernie Sanders called his comments “outrageous.”


Indeed, his comments are outrageous, especially because the White House has claimed to work so hard to lower prescription drug costs. Just last May, Azar boasted “President Trump has done more than any president in history to tackle drug prices.”

Really? Too bad none of those efforts have so far amounted to anything.

The coronavirus, however, represents an opportunity to make a difference.

Rather than simply do the basic R&D work for a treatment and then offer an exclusive license to a drug maker to develop and market a product, the federal government ought to reach a deal that does ensure affordability.

After all, taxpayer funds are being used and taxpayers should be able to have access to any treatment. This is not a new concept. The notion has been broached several times over the past few years as companies have marketed high-priced medicines that somehow began with federally funded research.

Just last week, nearly four dozen lawmakers asked the White House to issue limited licenses requiring companies to make any coronavirus treatment available at a reasonable price. Instead, Azar made clear that an untold number of Americans will be out of luck.

I understand that a company devoting resources to develop a treatment deserves a return on its investment. This is also not a new concept. And no one said profits are verboten. But should we let some Americans who may contract the coronavirus die because the price is out of reach?

Americans are funding potential treatments. They should not have to pay twice, especially not with their lives.

Unfortunately, the federal government has been reluctant to push the pharmaceutical industry.

Why? Drug makers have resisted commitments to pricing terms while such projects are in the early stages of development. For this reason, the National Institutes of Health in 1995 removed what were called “reasonable pricing” clauses from cooperative R&D agreements. At the time, former NIH director Harold Varmus described such clauses as a “restraint” on new product development.

No doubt, Azar is familiar with this argument. He was, you may recall, head of U.S. operations for Eli Lilly, one of the world’s largest drug makers, before joining the Trump administration.

Funny, though, how a public flogging can change one’s mind.

By Thursday, Azar seemed more sensitive to concerns that a coronavirus treatment should be affordable to everyone.

At yet another congressional hearing, he made a point of saying “I have directed my teams that, if we do any joint venture with a private enterprise that we’re co-funding the research and development program, that we would ensure there’s access to the fruit of that, whether vaccines or therapeutics.”

Of course, any deal the administration might reach with one or more drug makers should be fully disclosed, so the American public can see the details. Freedom of Information Act requests should not be required. And released documents should not be redacted.

Meanwhile, if one day the federal government licenses a pricey treatment for Tin Ear syndrome, Azar should get the first prescription.

And most likely, he will be able to afford it. Hopefully, others will, too.

  • Think of this situation as a world war, with COVID-19 as an enemy with the capability to kill tens of thousands in this country alone if no defense is mounted against it; maybe the government could take some of the billions in tax dollars spent each year on munitions, military equipment, and *that* wall, and use them to contract out the development and production of an effective vaccine to fight this enemy to a consortium of 2 or 3 pharmaceutical companies – the government could then mandate that the charge for inoculation against COVID-19 could be no more than the charge for inoculation against influenza.

  • Hi Ginet,

    Thanks for the thoughtful reply. But…

    I’m not trying to politicize his remarks. I’m trying to point out that, despite the difficulties inherent in this situation, the administration should not cast any doubt or raise any concerns that affordability – and therefore, accessibility – will be an issue.

    Unfortunately, his remarks fell short, irrespective of the practical concern about getting products out the door. And I believe it’s a valid and important issue that needs to be addressed now, not later.

    As for subsidies, as you suggest, it’s not clear if that might happen or how that might work. That might do the trick. But we don’t know what a plan looks like or if one exists. So this only underscores a need, in my view, to press the issue now.

    My purpose in writing this column was not to be negative, but to highlight an issue that warrants discussion in real time. And since you’re giving Azar credit for understanding the situation, I find it disappointing that he didn’t know better than to raise doubts about affordability under these circumstances.

    But neither of us are mind readers. Hence a need to air concerns and, if need be, have a debate, or discussion, if you will.

    I appreciate the give and take. This is a serious matter and there are no easy answers. Any politics aside, I’m rooting for the administration to make the right moves. But that doesn’t mean Azar or any of the others on the Pence team should not hear concerns or objections.

    All best,
    ed at pharmalot

  • Ed, I agree we both want the same thing…where we disagree is in the politicization of this matter. Yes, in his initial remarks he didn’t guarantee affordability. However, he indicated the government would work to make it affordable. The quote from your article: “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest.” The second part of the sentence simply recognizes the reality that we need private investment to speed up solutions and we don’t have the luxury of time on this matter to start a lengthy and contentious discussions on price controls. Azar fully understands that the success of any solution will depend on broad access, and that if the price is not affordable to all the Government or the pharma companies (or both) will need to subsidize patients who can’t afford it. We need to work together on finding solutions (and making sure they are affordable). We don’t need to pick apart each others words to find the most negative reading.

  • A vaccine is most effective when it is widely used (so-called “herd immunity”). For highly contagious viruses, protection to the individual can be imperfect; the main benefit is from preventing spread. For example, measles vaccine prevents outbreaks when the vaccination rate is maintained above approximately 90%. Similarly, a corona virus vaccine priced so that many people can’t afford it would be ineffective as a public health tool. Azar, along with the rest of Trump’s response team (esp Pence) is incompetent.

  • Ed, very unfair comments on Alex Azar. Coronavirus is a global emergency. The priority must be to find treatments and vaccines. It should not be a test case for price controls. We need to go all out to find solutions. Azar is correct in saying the goal is to make it affordable, but its not the primary objective (which is, to find solutions). Regardless of the eventual price, the Government will need to ensure patients have access and utilize the treatments. If patients don’t have access, the disease will spread and the costs to society will be much higher. So the Government will need to ensure utilization. Now is not a time to play politics. Azar is doing a good job on Coronavirus and he needs all our support.

    • Hi Ginet,

      Thanks for the note.

      I agree with you about the overarching goal to find a solution, of course, but if you re-read his initial remarks, he did not say the government could ensure affordability. So does this suggest a scenario in which there are two choices? Either price controls or the sky is the limit? How does the government ensure utilization if affordability is an issue?

      I think we want the same things – a useful treatment that can be readily accessed. But his initial remarks suggested some people would have been denied. How is that acceptable?

      ed at pharmalot

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