My daughter is an animal lover in the truest sense. Our house is essentially a zoo of stuffed creatures—capybaras, axolotls, highland cows, you name it. When she discovered Squishmallows, my wallet felt it immediately. I gently pushed back and encouraged her to reconsider, and my gracious girl took heed. She pivoted—straight to Jellycats—which, if you aren't familiar, make Squishmallows look like a bargain bin find.
That anecdote likely resonates with parents navigating the latest toy du jour, but there's actually a larger lesson for us. As any parent of a collector knows, pushing back on one thing doesn't always produce the outcome you intended.
For years, one of the loudest arguments against vaccines, and against the public health professionals, scientists, and clinicians who recommend them, has been that they're a pharmaceutical cash grab. That drug companies are getting rich off your kids' shot schedules. That the whole enterprise is less about health than about profit.
I'm not going to pretend pharmaceutical companies aren't in it to make money. Of course they are, and nobody should expect otherwise. But if profit is what drives pharmaceutical investment, the industry's own behavior is the most honest answer to whether vaccines were ever actually where the smart money was.
If a goal of undermining vaccine policy was to limit pharmaceutical profit, how's that going? Let's follow the money.
How current vaccine policy affects companies
When Moderna CEO Stéphane Bancel was asked at the World Economic Forum in January whether the current vaccine policy environment would affect his company's ability to develop new vaccines, he didn't hesitate: “100%." The company has since signaled it will not invest in new phase 3 vaccine trials for infectious diseases for the foreseeable future, pivoting its pipeline toward oncology (specifically cancer treatment, not prevention). Meanwhile, the federal government canceled nearly $500 million in contracts funding mRNA vaccine development — the same technology that helped mitigate a pandemic and, as researchers at Johns Hopkins have noted, holds enormous promise for future infectious diseases, cancer, and autoimmune conditions.
Moderna isn't alone. Johnson & Johnson explicitly cut back spending on infectious disease vaccines, redirecting resources toward treatments for chronic conditions like cancer and autoimmune disease. Merck's vaccine sales cratered in 2025—Gardasil down 39%, Pneumovax down 37%—dragging on overall growth so visibly that analysts publicly questioned the company's trajectory. Pfizer is pivoting aggressively to obesity treatments.
Many of the world's largest pharmaceutical companies are moving in the same direction at the same time—away from vaccines and toward treatments, which have always generated significantly more revenue.
Many of the world's largest pharmaceutical companies are moving in the same direction at the same time—away from vaccines and toward treatments.
Vaccines were never the profit engine they've been made out to be, and economists have understood this for decades. The math follows a clear logic. For treatments, pharmaceutical companies negotiate with insurers and payers over a known, defined population with a demonstrated need and medical urgency. These conditions give manufacturers significant pricing leverage. For vaccines, the dynamic reverses. Government programs and insurers buying vaccines on behalf of a healthy population face far less urgency and have considerably more leverage to push prices down. Not everyone who receives a vaccine would have gotten the disease, which makes it structurally harder to justify high prices to payers than it is for a treatment with a sick patient behind it.
For these reasons, treatments generate substantially higher revenue than vaccines, and that gap can grow considerably larger, depending on the disease and population. (My Unbiased Science team and I are actively working on a deeper economic analysis of exactly this dynamic with some brilliant health economists—stay tuned.)
Prevention is a lousy business model
What about COVID-19 vaccines? For a brief, historically anomalous window, vaccine manufacturers did generate extraordinary profits. But those profits came from guaranteed government bulk purchases, emergency authorization pathways, and essentially zero market competition—conditions that have never existed for routine childhood vaccines and likely never will again. Using that exception to characterize vaccine economics broadly is a bit like concluding that construction is always a windfall because someone got a government contract to rebuild infrastructure after a disaster.
Prevention is also a lousy business model in another respect. A wildly successful vaccine reduces the number of sick people, which shrinks the future market for treatments. From a purely commercial standpoint, an effective vaccine is a company undermining its own long-term revenue stream. Treatments don't have that problem. Every person who remains sick is a continuing customer. And yet, despite these commercial headwinds, vaccines have persisted because they work. They are among the most rigorously tested and regulated products in the history of medicine, and they have saved more lives than perhaps any other intervention we have. The market never fully rewarded that, but the science delivered anyway.
Pharma is not the devil it's been made out to be. It has its issues, it has made its missteps (opioid crisis, anyone?), and nobody is mistaking it for a humanitarian organization. But it is also not some monolithic conspiracy against public health. It is a collection of for-profit companies responding rationally to market signals. And right now, the market is sending a very clear signal—one that the loudest critics of pharmaceutical influence helped create. The deep irony is that the very people who condemned vaccines as a Big Pharma profit scheme may be the ones most responsible for making pharma bigger.
Fewer vaccines mean more preventable illnesses. More preventable illnesses mean more people who need treatment. More treatment means more pharmaceutical revenue—recurring, long-term, high-margin revenue of exactly the kind that vaccines don't generate.
The deep irony is that the very people who condemned vaccines as a Big Pharma profit scheme may be the ones most responsible for making pharma bigger.
Consider two examples. Before the rotavirus vaccine was available, the virus caused 55,000 to 70,000 hospitalizations in the United States every single year. Those hospitalizations didn't disappear on their own—someone treated them, and someone profited from that treatment.
Hepatitis B makes the cost calculus even more explicit. The hepatitis B vaccine requires a series of doses to reach full effectiveness. But liver cancer that can be caused by chronic hepatitis B infection requires a course of treatment that can run into the tens to hundreds of thousands of dollars, depending on the stage and whether transplantation is an option, not to mention that it can claim lives. A recent economic analysis found that the downstream costs of hepatitis B complications, including cirrhosis, liver cancer, and transplantation, are staggering compared to the cost of prevention. As researchers have noted more broadly in JAMA Health Forum, prevention is rarely free—but the alternative almost always costs far more.
When Jellycats compound your Squishmallow problems
The people who spent years insisting vaccines were making pharmaceutical companies rich have, through their own policy choices, created conditions for pharmaceutical companies to become richer. Just not from vaccines. From everything that comes after.
My daughter still has her Squishmallows. She also now has her Jellycats. The original problem didn't go away—it just got more expensive. Sometimes the thing you push back on gets replaced by something costlier.
We were told to be suspicious of the vaccine market, so it’s being dismantled. In doing so, we are handing the industry a more lucrative one.
Be careful what you wish for.
Dr. Steier is a public health scientist and scientific communicator. She is the founder of Unbiased Science, an organization that uses data visualizations, real-world analogies, and human voice to communicate complex scientific concepts for public understanding via multiple media modalities.
The opinions voiced in CIDRAP Op-Ed pieces are the authors' own and do not necessarily represent the official position of CIDRAP.
