THE PROGNOSIS

This sounds like great news: Drugmakers are starting to develop a coronavirus vaccine.

The downside: That’s because they believe the virus is so deadly that developing a vaccine is worth risking a lot of money.

Drugmaker Johnson & Johnson has announced its Janssen unit will partner with the Department of Health and Human Services to work on a vaccine for the rapidly spreading coronavirus, which has infected 74,185 people and killed 2,004 around the world, according to numbers reported through the end of Tuesday.

On Monday, a second drug company — Sanofi Pasteur — said it’s also partnering with HHS to work on creating a vaccine using the company’s recombinant DNA platform. Both drugmakers will work with HHS’s Biomedical Advanced Research and Development Authority, otherwise known as BARDA.

“I think companies are looking at it in a way they hadn’t looked at it before because I think the disease itself is convincing people this has a potential to be around for a while,” Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told me.

“People are now realizing we could possibly have a true global pandemic of this coronavirus,” Osterholm added.

Janssen and Sanofi’s announcements are welcome news to government health officials, who have worried publicly that the pharmaceutical industry wouldn’t wade into vaccine development because they might never recoup enormous upfront costs — potentially $750 million to $1 billion — for a vaccine that won’t be ready until the epidemic has significantly slowed or even ended. 

Experts are giving mixed predictions about the spread of the virus. As some Chinese health experts predict a peak in infections by month's end, “Chinese leader Xi Jinping is striking an increasingly confident note that the country can control the outbreak and manage the economic and social fallout,” The Post's Gerry Shih reports. 

Yet international experts – including U.S. National Institute of Allergy and Infectious Diseases director Anthony Fauci – say they're wary of declaring the pace of infections is slowing.

There are 15 known cases in the U.S.:

The National Institutes of Health was already working with the biotech company Moderna Therapeutics to develop a vaccine. But NIH ultimately needs large manufacturing facilities to produce a vaccine in bulk. 

The process is “very difficult and very frustrating,” Fauci said at an Aspen Institute event earlier this month.

“You invest hundreds and hundreds and hundreds of millions of dollars to scale up on something that you hope might work. That's the real glitch there,” said Fauci, who noted “it is going to be a challenge to get a major company to do that." 

There’s a plethora of reasons other major drugmakers might not want to get involved in developing a coronavirus vaccine. 

For one thing, that investment would leave them fewer resources to invest in the blockbuster biologic drugs that really bring in the cash. Revenue from the largest biologic drug is more than two to three times that from the largest vaccine, according to a McKinsey analysis.

It’s also harder to get vaccines federally approved; because they’re used to prevent illnesses, they face a higher quality and safety standard. Before they can be sold, they must be tested on thousands of people. 

And as with the Ebola outbreak in 2014, the population in need of the vaccine can be relatively small (even if the disease is deadly) and epidemics typically subside before the vaccine is ready. So a drugmaker could spend millions of dollars developing the vaccine, only to find an insufficient market for it. 

“They don’t want a niche product that might not ever sell,” Osterholm said. 

In multiple cases over the past few decades, drugmakers have struggled to bring vaccines to market. 

GlaxoSmithKline saw its swine flu vaccine withdrawn from sale after it was discovered to cause narcolepsy in some people. Sanofi quietly ended its work in 2017 to develop a Zika vaccine. Merck developed a vaccine for Ebola but didn’t get regulatory approval in the United States until last year. Now the company says it won’t try to develop a vaccine protecting against other strains of Ebola.

So the fact that some drugmakers are now venturing into the coronavirus space means they’ve determined there will be a sustained and substantial demand for a vaccine, even though it will probably take at least a year to develop. 

There are three other major vaccine developers — Pfizer, Merck and GlaxoSmithKline. If they jump in, it bodes well for vaccine development — but provides another data point that bodes poorly for the efforts of health officials to stem the virus’s spread.

A few more coronavirus developments:

— A respected neurologist who was director of Wuchang Hospital in Wuhan died Tuesday after contracting the virus, our Washington Post colleagues report.

“Liu Zhiming, 51, became the most prominent victim of the outbreak since another doctor, whistleblower Li Wenliang, died Feb. 7, sparking an outpouring of public anger and grief. Liu’s death follows that last week of a nurse, Liu Fan, from the same hospital,” they write. “A total of eight front-line health workers have died, while as many as 3,000 have been infected with the coronavirus.”

— Hundreds of millions of people across China — about 10 percent of the world's population — are on lockdown. While the Chinese government says the restrictions are needed to prevent the further spread of the coronavirus, some public health experts say China in some cases hasn't met the criteria for imposing quarantines.

New York Times reporter Paul Mozur:

—Chinese national health authorities have released stricter guidelines for how coronavirus cases are diagnosed. That could decrease the rate of new cases in the outbreak’s epicenter.

It works like this: The National Health Commission eliminated the distinction between how cases would be classified between Hubei province and other regions. Cases will now be reported under two categories: “suspected cases” and “confirmed cases." But cases can only be described as “confirmed” if they stem from a positive result in a nucleic acid test.

— Japan's health minister said the Diamond Princess quarantine will end as scheduled on Wednesday. Eighty-eight more cases were discovered, bringing the total linked to the ship to 542.

While more than 300 Americans were evacuated from the cruise ship earlier this week, more than 100 U.S. citizens still on board or in hospitals in Japan have been placed under travel restrictions. These Americans are prevented from returning to the United States for at least 14 days after they have left the ship.

— Starting tomorrow, Russia will temporarily suspend entry of Chinese citizens because of the outbreak, banning them from traveling to Russia for employment, tourism and education.

AHH, OOF and OUCH

AHH: All the elements seemed to be in place for Congress passing a Senate bill lowering the prices of prescription drugs – bipartisan backing, President Trump’s endorsement and broad public support.

Not so.

The bill from the Senate Finance Committee "reveals the perils of tackling one of the nation’s most hot-button topics just months before a presidential election. And even though Trump has said he supports the measure, he has stopped far short of trying to ensure its passage,” our Post colleagues Yasmeen Abutaleb and Erica Werner report. 

The legislation has not gained the support of the top Senate Republican and Democrat, nor is Trump tring to ensure it passes.

Those close to Senate Majority Leader Mitch McConnell say he's personally opposed to the bill because of the price caps it imposes on drug companies and because the legislation splits his party. And Senate Minority Leader Chuck Schumer has not said whether he backs it, instead throwing his support behind a House-passed bill with almost no Republican support.

Trump has publicly supported the bill through tweets and in his State of the Union address this month, but he has not lobbied individual senators to support the measure or personally pressured McConnell for action, our colleagues write.

It's deeply frustrating to Sen. Chuck Grassley, the bill's Republican co-sponsor. “Throughout the fall, Grassley said that he asked White House advisers to get Trump involved in winning support for the legislation and speaking publicly about it, but that they were reluctant to involve Trump to that degree,” Yasmeen and Erica write. “Grassley said he ‘never got a good reason’ as to why advisers did not want to involve the president.”

— Rev. Al Sharpton is urging members of the Congressional Black Caucus to oppose bipartisan surprise medical billing legislation offered by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the leaders of the Senate health committee.

In a letter obtained by The Health 202, Sharpton wrote that he heard deep concerns from black Americans about medical bills during an event in Charleston housted by his group, National Action Network, ahead of the state's presidential primary. Sharpton charged that the Alexander/Murray bill – and a similar bill from the House Energy and Commerce Committee – protects insurance companies at the expense of patients.

“Why are both parties in Washington, DC lining up behind legislation that would allow insurance companies to protect their billions in profits while low income Americans are left holding the bag?” Sharpton wrote.

“I urge you, and all Members of the CBC, to tackle these issues in a way that prioritizes those who need your help the most,” Sharpton wrote. "No more Republican assaults on affordable healthcare. No more bipartisan bows to Big Insurance."

OOF: Pharmacies in Hong Kong are dealing with nervous customers amid the coronavirus outbreak. Some people wait in line for hours to buy products like face masks and disinfectants, and some customers are starting to hoard products, the New York Times’s Isabella Kwai reports

May Tang, who works at a small family-owned pharmacy in Hong Kong, told the Times: “You could say we’re tired … Not many people can experience so many things at once. It will be written down in history.”

“Before the New Year, a box of 50 masks was 50 Hong Kong dollars, about $6.50. Now the price has doubled — if you can find masks at all,” Isabella writes. “When Ms. Tang first noticed the growing demand, she said she tried to order high-quality masks from German and British suppliers. But with months to go before a potential shipment would arrive, the pharmacy has been forced to rely on whatever is available.”

OUCH: During a CNN town hall last night, Sen. Bernie Sanders (I-Vt.) was asked about Rep. Alexandria Ocasio-Cortez (D-N.Y.) comments to HuffPost that a “worse-case scenario” might be that Congress passes a public option instead of Medicare-for-all – and that might not be so bad.

Sanders distanced himself from Ocasio-Cortez’s remarks, saying his Medicare-for-all policy proposal is compromise enough, as our Post colleague Sean Sullivan writes. 

“I love Representative Alexandria Ocasio-Cortez. She has done more in her first year in Congress to transform politics, to get young people involved, than any freshman member of Congress that I can remember,” Sanders told CNN’s Anderson Cooper. “But my view is that Medicare-for-all, the bill that we wrote, is in a sense already a compromise. It is a four-year transition period.”

In the interview with HuffPost, Ocasio-Cortez suggested there was some flexibility on Sanders’ Medicare-for-all proposal, saying a “president can’t wave a magic wand and pass any legislation they want.” 

“The worst-case scenario? We compromise deeply and we end up getting a public option. Is that a nightmare? I don’t think so,” Ocasio-Cortez said. 

HEALTH ON THE HILL

— The debate over single-payer health-care programs continues to be a topic of concern fracturing organized labor, and it’s especially true in union-heavy states such as California, New York and Michigan, Politico’s Ian Kullgren and Alice Miranda Ollstein report. 

“It’s a discussion at every single bargaining table, in every single union shop, every single time it’s open enrollment and people see their costs going up,” Sara Nelson, president of the Association of Flight Attendants, told Politico. 

The Health 202 wrote last week about labor unions’ skepticism about Medicare-for-all, and what that means for some presidential candidates, including Sanders and former South Bend, Ind., mayor Pete Buttigieg.

The issue emerged when a Nevada’s 60,000-member Culinary Workers Union, the state’s most influential labor union, was critical of Sanders’s health plan and later said it would not endorse any Democrat in the upcoming Nevada caucuses.

“On one side of the divide are more liberal unions like the American Federation of Teachers and the Service Employees International Union, which argue that leaving health benefits to the government could free unions to refocus collective bargaining on wages and working conditions,” Ian and Alice write. “On the other side are more conservative unions like the International Association of Fire Fighters and New York’s Building & Construction Trades Council, which don’t trust the government to create a health plan as good as what their members enjoy now.”

— And here are a few more good reads:

In a party that’s shifted leftward on abortion rights, Democratic presidential hopefuls are offering different approaches to a central challenge: how to talk to voters without a clear home in the polarizing debate over the government’s role in the decision to end a pregnancy.
Associated Press

INDUSTRY RX

More evidence of the holes in the coronavirus quarantine on board the Diamond Princess cruise ship came Tuesday when Japan said the number of infected passengers and crew passed 500.
Wall Street Journal
By The Way
Cruise lines have found themselves at the center of the coronavirus outbreak. How big a hit will the industry take?
Hannah Sampson

MEDICAL MISSIVES

The crisis for America’s rural hospitals is getting a lot worse.
Vox
Inspired Life
Emergency room nurse Martha Phillips watched a rape survivor walk out of the hospital in oversize scrubs last December, her arms clutched tightly around her chest in embarrassment because her bra had been taken as evidence. Phillips was outraged on her behalf.
Cathy Free
Among nonprofit hospitals, those with the highest net incomes tend to devote the smallest proportion of their earnings to providing free care to uninsured patients and low-income people who struggle to pay their bills, a U.S. study suggests.
Reuters
Health
Experts say there are fewer incentives for agencies to deal with those who need extensive physical, occupational and speech therapy — and some are losing services.
Judith Graham

STATE SCAN

Virginia Politics
Del. Mark Levine (D) said the intent was to threaten him over a measure later killed in committee.
Gregory S. Schneider

DAYBOOK

Coming Up

  • The Washington Post will host a live talk on Feb. 26 on the plight of working families and low-income workers in the United States. Discussions will include topics such as the rising cost of health care.
  • The House Transportation Subcommittee on Water Resources and Environment will hold a hearing on proposals for a Water Resources Development Act of 2020 on Feb. 27.

SUGAR RUSH