The Case of the Missing Lyme Vaccine

There was one, and it worked. The newest episode of The Politics of Everything tries to figure out where it went.

Here is the new episode of The New Republic's podcast, The Politics of Everything, which I host with literary editor Laura Marsh. This one is about the Lyme disease vaccine, which was approved in 1998 and then pulled from the market in 2002 by its manufacturer, SmithKline Beecham. Our guests are Rebecca Onion, who wrote about the vaccine for Slate, and Andrew Zaleski, who wrote about a promising new Lyme preventative treatment for Outside magazine.

As I mention briefly in the show, I contracted Lyme disease when I was young, and (as I don't mention), it got pretty bad. (I didn't receive proper treatment for it for months, in part because doctors didn't recognize or diagnose Lyme as often back then, and also because I assumed the physical misery I was constantly experiencing was actually just how existence was going to be now that I was 13 years old). (I'm better now.) Lyme has only gotten more widespread since then. The knowledge that there is an existing preventative treatment that you cannot get because the company that developed it simply chose to stop selling is incensing.

But it all happened according to the logic of our health and legal systems. The pharmaceutical company (by that point GlaxoSmithKline) that withdrew the drug faced class-action lawsuits about vaccine side effects, and widespread skepticism about the vaccine caused it to be much less profitable than projected.

The way it's supposed to work is that our for-profit pharmaceutical market incentivizes private corporations to develop necessary new drugs and treatments, with the expectation that doing so will prove profitable, and our adversarial legal system incentivizes those corporations not to do things like release dangerous vaccines. None of that worked out in this case. You can listen to this episode for our explanation of why that is. Our usual policy response to this failure has been to make it difficult or impossible to sue pharmaceutical companies for negligence or side effects. Fearing that lawsuits would cause vaccine manufacturers to stop producing the whooping cough vaccine in the 1980s, Congress passed a bill indemnifying manufacturers of many vaccines from lawsuits, sending most vaccine injury claims to special no-fault "vaccine courts."

One obvious flaw with the notion that shielding companies from legal liability will induce them to develop and provide novel treatments for medical ailments is that it does not make it profitable to continue producing those treatments if enough people simply come to believe that they may be harmful. The literature I've read on the Lyme vaccine has grappled with this problem and found no easy answers. But this nut is only hard to crack if you take for granted that the point of pharmaceutical research is for pharmaceutical companies to be profitable and not get sued to death. If the point were, instead, to eliminate diseases, potential and unproven adverse effects in miniscule populations would not be enough to prevent everyone else from accessing an effective, tested treatment.

If a company doesn't want to bear the risk of manufacturing and selling an FDA-approved treatment that the government has determined is mostly safe and mostly effective, then the government should simply assume that risk--and the patent.