There has been much comment on the role of big pharmaceutical companies in developing a vaccine against Covid-19. Opinions generally fall into one of two camps: either that it is wrong to profit from a global catastrophe or that solutions would not be in sight were it not for the profit motive. Most of the inhabitants of these two camps are deeply entrenched and held strong views on the health and profits long before the Covid-19 pandemic.

This is an old debate and not a particularly useful one in the context of a pandemic. An examination of the way states and markets have worked (together) shows that both have made critical contributions. Not only have several effective vaccines been developed (in record time) but it also seems that a sufficient volume could be manufactured by the end of 2021 to provide global herd immunity. Allocation and distribution are of course far more worrying issues.

In March, British Prime Minister Boris Johnson was reported to have told a private meeting of Tory backbench MP’s that ‘the reason we have the vaccine success is because of capitalism, because of greed, my friends’. A few, like historian Andrew Roberts, defended Johnson’s statement while others of a similar inclination took delight in pointing out that it was the profit-driven pharmaceutical industry which developed the vaccines.

Strictly speaking, these enthusiasts for greed are wrong. With the exception of Pfizer (which did not accept US government assistance), the first wave of vaccines (produced also by Moderna, AstraZenca and Johnson & Johnson) were made possible by public funding, especially the US government’s USS18 billion Operation Warp Speed. The technology partners (Oxford University in the case of Astra Zeneca and BioNTech in the case of Pfizer) also received millions of dollars in public funding. BioNTech, which was part-bought by Pfizer in 2020, received USD445 million from the General government in the same year.

The fact is that the vaccines from profit-motivated Western corporates were products of public-private partnerships. Such arrangements are most viable where a complex health and science ecosystem already exists. It is difficult to imagine the creation of viable vaccines without big pharma but also without more nimble biotech companies, public and private researchers, philanthropists, government funding and all the linkages that bring these together.

Big Pharma has a critical role to play in the most resource-intensive part of vaccine development – three phase clinical trials – which can involve tens of thousands of people and are necessary for regulatory approval. But the stand-out players in the quest to find a Covid-19 vaccine were the two biotech firms, Moderna and BioNTech, who pioneered messenger RNA (MRNA) technology. mRNA does not require the traditional vaccine making methods of isolating a virus, growing it in a lab, learning how to inactivate it and then purifying the product, which can take years. To make an mRNA genetic strand, researchers only need the genetic sequence of the virus and this was available from Chinese researchers within weeks of the outbreak. Once that was available, it is claimed that Moderna took only two days to design the actual vaccine.

Biotech firms are an investors nightmare. Most run at a loss for years and the vast majority end in bankruptcy. But they exist to push the frontiers of medicine and when they make a breakthrough, the path to commercialisation usually hinges on attracting the interest of one of the big pharmaceutical companies. Moderna’s decision to develop its own production facilities is unusual and probably wouldn’t have happened without US government support.

Against the likes of Boris Johnson are those who have long criticised the profit motive in healthcare. Arguments range from scholars who suggest that market outcomes in health are less optimal than managed ones to activists who argue that ‘vaccine profits’ are unashamed profiteering. Referring to Pfizer, the New York Times remarked disapprovingly that ‘profits have trumped other concerns’. World Health Organisation general secretary, Tedros Adhanom Ghebreyesus joined the critics in mid-July when he argued that initiatives (by Pfizer) to develop a (third shot) booster vaccine were simply ‘greed’.

But this is conflating two unrelated issues. No-one knows whether a booster vaccine will be needed as and if the efficacy of current vaccines declines over time or as-yet-undetected but dangerous new variants of Covid-19 emerge. But no harm is done by efforts to develop one. There can be no doubt that greater efforts need to made to get vaccines into arms in especially poorer countries – the WHO’s primary concern – but it is also difficult to see how booster development sets back these processes.

The fact is that vaccines are not a major source of profit line for most pharmaceutical companies. Pfizer’s Prevnar pneumoccal vaccine is an exception but its sales rank some way behind drugs for arthritis, cancer and blood clotting offered by its rivals. Nor are epidemics good for business for the simple reason that they tend to require once-off vaccines and are thus not a source of on-going business. Efforts by big pharma to develop vaccines against SARS, MERS and Ebola were all loss-makers.

One of the more remarkable features of the race to develop a vaccine against the Covid-19 virus has been the absence of most of the giant pharmaceutical companies. Only one of the top ten pharma companies (by revenue), Pfizer, was among the initial developers of an effective vaccine. Johnson & Johnson followed two months later. The prominent British-Swedish firm AstraZeneca was a second-tier company (in terms of revenue) and was appreciably smaller than its UK rival, GlaxoSmith Klein (GSK). Moderna was a relatively small biotech firm.

The list of those missing in action is a rollcall of global big pharma. It includes GSK, US giant Merck and the major French firm, Sanofi, as well as AbbVie (maker of the world’s top selling drug in 2019, the anti-inflammatory Humira), the world’s top anti-cancer drug maker, Bristol Myers Squibb and another major company with best-selling cancer patents, the Swiss-based Roche.

These firms seem to have either lagged as mRNA vaccines were developed or failed in their own processes. Merck used a platform it had developed for an Ebola vaccine, with disappointing results. Sanofli fell behind when it experimented with an inadequately concentrated dosage (which showed a weak immune response) and GSK missed the bus altogether when it chose to develop an adjunct (which is added to vaccines) rather than a new vaccine. Drug-making is a competitive market and competition produces winners and losers. GSK’s share price fell 35.5 percent between January 2020 and February 2021.

The role of profits in health may seem rather Darwinian. But, as with evolution, a vibrant private health sector contains within it the seeds of future development. The story is more complex than greed versus altruism, the successful development of Covid-19 vaccines demonstrates that profits have a place in the health science ecosystem.