COVID-19 and the High Cost of Dying

Illustration by Becky Grant

Put down the Clorox. Remdesivir may not be the effective coronavirus treatment the world desperately needs, but it has to be better than President Donald Trump’s idea about ingesting disinfectants. One strong point in remdesivir’s favor: the MAGA crowd hates it.

Remdesivir, which is administered intravenously, is an antiviral drug developed by Gilead Sciences, Inc. which patented it in 2017. It has just been approved by the Food and Drug Administration for emergency use in treating cases of Covid-19.

Remdesivir had previously been tested on the Ebola virus with lackluster results. Will it be effective in treating Covid-19? We don’t know yet, but initial trials look promising. In clinical trials conducted by the National Institute of Allergy and Infectious Diseases (the agency headed by Dr. Anthony Fauci), remdesivir lowered the median time for recovery by 31% to 11 days, as opposed to 15 days for patients given a placebo. The death rate for subjects receiving remdesivir was 8.0% as opposed to 11.6% in the placebo group. Dr. Fauci has expressed cautious optimism about remdesivir, saying it sets a new “standard of care.” Remdesivir has become the drug to beat.

Remdesivir was last in the news a month ago. On March 23, Trump’s FDA designated remdesivir as an “orphan drug.” The Orphan Drug Act grants manufacturers a seven-year monopoly as incentive to develop drugs for rare diseases, defined as diseases which affect fewer than 200,000 persons in the US.

Tragically, Covid-19 is anything but rare. As of May 2, 240,000 people worldwide have died from Covid-19, 67,000 of them in the US. That’s more than the number of Americans killed during the Vietnam War (but still fewer than the 2 million Vietnamese killed).

Gilead, however, made its application under a provision of the Orphan Drug Act which permits orphan drug status for drugs targeted at more common diseases if “there is no reasonable expectation that the cost of developing and making available a drug for such disease will be recovered from sales in the US.”

There was a huge public outcry led by more than 50 consumer groups who feared that a seven-year monopoly would make remdesivir unaffordable. Remdesivir was developed with a $37.5 million grant from the National Institutes of Health (NIH)—taxpayer money—with another $30 million earmarked for trials. You and I paid for remdesivir. We shouldn’t have to pay again.

The public pressure worked. The FDA designated remdesivir as an orphan drug on March 23. Two days later, on March 25, Gilead asked the FDA to rescind orphan drug status for remdesivir. A victory for consumers, right? Actually, no. Gilead sought orphan drug status solely in order to receive a tax break. Gilead doesn’t need a seven-year monopoly. It already has something much better: a patent on remdesivir that does not expire until 2037. If the FDA approves remdesivir for treating Covid-19, which is by no means guaranteed, Gilead will be able to charge what it likes until 2037. Until then, you can forget about a cheap generic version of the drug.

Something similar had already happened with vaccines. Testifying before Congress on February 26, Health and Human Services Secretary Alex Azar was asked about a coronavirus vaccine, generally thought to be at least one year away. Like Peter denying Christ, Azar refused three times to say that every American would be able to afford a coronavirus vaccine.

Earlier that week, the White House had asked Congress for $2.5 billion to fight COVID-19, with one billion dollars to go toward developing a vaccine. Azar was telling Americans that they might not be able to afford a vaccine they themselves had paid for

By the next day, the Administration had backpedaled. Azar guaranteed “affordable access” to whatever came out of any joint venture between government and private industry. Don’t believe him. Azar is not the person to look to for affordable pharmaceuticals. When Azar was president of drug manufacturer Eli Lilly’s US division from 2012 to 2017, the price of insulin doubled.

Don’t look to Congress either. Early drafts of the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, the coronavirus stimulus which became law on March 27, required vaccines, drugs, and tests developed with taxpayer money to be affordable. However, as noted by NPR, “the final bill included additional language that undercut that requirement.” (Sydney Lupkin, Gilead Lobbying Rose As Interest in COVID-19 Treatment Climbed,, May 2, 2020.)[1]

The FDA can allow other companies to manufacture remdesivir if the Secretary of Health and Human Services determines that Gilead can’t make sufficient quantities to meet demand. Let’s not kid ourselves, though. We’re talking about the Trump Administration.

In the meantime, Gilead has announced that it will ship 1.5 million doses of remdesivir to hospitals which the federal government determines need it the most. The 1.5 million doses will be distributed for free. After that, who knows? Gilead won’t say how much it will charge for remdesivir if it gets FDA approval.

The Affordable Care Act (“ACA” or “Obamacare”) could ensure that remdesivir is affordable. Under the ACA, health insurance plans, including employer-provided plans, cannot charge co-pays, deductibles, or co-insurance for vaccinations recommended by the Centers for Disease Control. “Obamacare basically makes many vaccinations free,” declares Business Insider. Medicare and Medicaid likewise prohibit cost-sharing.

All this is good, but it’s not enough. Even before the coronavirus pandemic, 87 million Americans were uninsured or underinsured. The pandemic has caused 30 million Americans to lose their jobs, a level of unemployment not seen since the Great Depression. Since about half of Americans get their health coverage through their jobs, this means millions of additional uninsured.

The newly-unemployed can sign up for an ACA plan for 60 days after they lose their jobs. HHS Secretary Azar urges them to do so, glossing over the fact that Republicans have been trying to kill the Affordable Care Act since it was enacted in 2010. They’re still trying to, even during the coronavirus pandemic. This is just one more proof of the utter inadequacy of the US for-profit health care “system.”

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I mentioned at the outset that Trump’s Make America Great Again followers hate remdesivir. Trumpers, prominently among them, Fox News’ Laura Ingraham, are still trumpeting the supposed merits of the antimalarial drug hydroxychloroquine while the president, formerly a big fan, talks less about it. The MAGAsphere likes hydroxychloroquine because it is relatively cheap and is available in generic form. Dr. Fauci’s measured judgment in favor of remdesivir is a black mark in their eyes because they believe Fauci undermines the president. Trump’s supporters also prefer hydroxychloroquine because it bubbled up from the paranoid wellsprings of the right-wing Internet. Remdesivir, on the other hand, is touted by scientists and the government. Distrust of large corporations also figures into the mix. Suspicion of corporations is ordinarily a good thing, but not when it provides aid and comfort to crackpots.


1. Joe Grogan, a former lobbyist for Gilead, who has announced that he will be leaving the administration on May 24, serves on President Trump’s Coronavirus task force. The Huffington Post comments that Grogan “has played a significant role in crafting major health policies, including drug pricing, for the Trump Administration.”


Charles Pierson is a lawyer and a member of the Pittsburgh Anti-Drone Warfare Coalition. E-mail him at