A New Era of Vaccines Leaves Old Questions About Prices Unanswered

Published

2 years ago

October 30, 2023

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The world is entering a new era of vaccines. Following the success of covid-19 mRNA shots, scientists have a far greater capacity to tailor shots to a viruss structure, putting a host of new vaccines on the horizon.

This story also ran on Time. It can be republished for free.

The most recent arrivals as anyone on the airwaves or social media knows are several new immunizations against respiratory syncytial virus, or RSV.

These shots are welcome since RSV can be dangerous, even deadly, in the very old and very young. But the shots are also expensive about $300 for those directed at adults, and up to $1,000 for one of the shots, a monoclonal antibody rather than a traditional vaccine, intended for babies. Many older vaccines cost pennies.

So their advent is forcing the United States to face anew questions it has long sidestepped: How much should an immunization that will possibly be given maybe yearly to millions of Americans cost to be truly valuable? Also, given the U.S. is one of two countries that permit direct advertising to consumers: How can we ensure the shots get into the arms of people who will truly benefit and not be given, at great expense, to those who will not?

Already, ads on televisions and social media show active retirees playing pickleball or going to art galleries whose lives are cut short by RSV. This explains the lines for the shot at my local pharmacy.

But indiscriminate use of expensive shots could strain both public and private insurers already tight budgets. Email Sign-Up

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Other developed countries have deliberate strategies for deciding which vulnerable groups need a particular vaccine and how much to pay for it. The U.S. does not, and as specialized vaccines proliferate, public programs and private insurers will need to grapple with how to use and finance shots that can be hugely beneficial for some but will waste precious health dollars if taken by all.

A seasonal viral illness, RSV can cause hospitalization or, in rare cases, death in babies and in people age 75 or older, as well as those with serious underlying medical conditions such as heart disease or cancer. For most people who get RSV, it plays out as a cold; youve likely had RSV without knowing it.

But RSV puts about 2% of babies under age 1 in the hospital and kills between 100 and 300 of those under 6 months, because their immune systems are immature and their airways too narrow to tolerate the inflammation. Merely having a bad case of RSV in young childhood increases the risk of long-term asthma.

Thats why Barney Graham, the scientist who spent decades at the governments National Institutes for Health perfecting the basic science that led to the current shots, said: The most obvious use is in infants, not adults.

Thats also why European countries trying to figure out how best to use these vaccines without breaking the bank focused first on babies and determining a sensible price. Though more of the very old may die of RSV, the years of life lost are much greater for the very young. (Babies can get the monoclonal antibody shot or gain protection through a traditional vaccine given to the mother near the end of pregnancy, conferring immunity through the womb.)

A consortium of European experts led by Philippe Beutels, a professor in health economics at the University of Antwerp in Belgium, calculated that the shots would only be worth it in terms of the lives saved and hospitalizations averted in infants if the price were under about $80, he said in a phone interview. Thats because almost all babies make it through RSV with supportive care.

The calculation will be used by countries such as Belgium, England, Denmark, Finland, and the Netherlands to negotiate a set price for the two infant shots, followed by decisions on which version should be offered, depending partly on which is more affordable.

They have not yet considered how to distribute the vaccines to adults considered less pressing because studies show that RSV rarely causes severe disease in adults who live outside of care settings, such as a nursing home.

Why did the United States and Europe approach the problem from opposite directions?

In the U.S., there was a financial incentive: Roughly 3.7 million babies are born each year, while there are about 75 million Americans age 60 and older the group for whom the two adult vaccines were approved. And about half of children get their vaccines through the Vaccines for Children program, which negotiates discounted prices.

Also, babies can get vaccinated only by their clinicians. Adults can walk into pharmacies for vaccinations, and pharmacies are only too happy to have the business.

But which older adults truly benefit from the shot? The two manufacturers of the adult vaccines, GSK and Pfizer, conducted their studies presented to the FDA for approval in a population of generally healthy people 60 and older, so thats the group to whom they may be marketed. And marketed they are, even though the studies didnt show the shots staved off hospitalization or death in people ages 60 to 75.

That led to what some have called a narrow endorsement from the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices for people 60 to 75: Patients in that age range could get the shot after shared clinical decision-making with a health provider.

It is likely that because of this fuzzy recommendation, some Americans 60 and over with commercial insurance are finding that their insurers wont cover it. Under Obamacare, insurers are generally required to cover at no cost vaccines that are recommended by the ACIP; however, if a provider recommends vaccination, then it must be covered by insurance.

(In late September, the ACIP recommended immunization of all babies with either the antibody or the maternal vaccine. Insurers have a year to commence coverage and many have been dragging their feet because of the high price.)

There are better and more equitable ways to steer the shots into the arms of those who need it, rather than simply administering it to those who have the right insurance or, swayed by advertising, can pay. For example, insurers, including Medicare, could be required to cover only those ages 60 to 75 who have a prescription from a doctor, indicating shared decision-making has occurred.

Finally, during the pandemic emergency, the federal government purchased all covid-19 vaccines in bulk at a negotiated price, initially below $20 a shot, and distributed them nationally. If, to protect public health, we want vaccines to get into the arms of all who benefit, thats a more cohesive strategy than the patchwork one used now.

Vaccines are miraculous, and its great news that they now exist to prevent serious illness and death from RSV. But using such novel vaccines wisely directing them to the people who need them at a price they can afford will be key. Otherwise, the cost to the health system, and to patients, could undermine this big medical win.

Elisabeth Rosenthal: erosenthal@kff.org, @RosenthalHealth Related Topics Aging Health Care Costs Health Industry Pharmaceuticals Public Health CDC Children's Health Drug Costs Vaccines Contact Us Submit a Story Tip

Environment

Tesla (TSLA) down 5% on news it’s stuck with its bad CEO Elon Musk for a decade

Published

2 hours ago

November 7, 2025

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Tesla (TSLA) down 5% on news it's stuck with its bad CEO Elon Musk for a decade

In the morning after Tesla’s shareholder meeting, shares of the company dropped significantly on market open, likely signaling a selloff from reasonable investors who objected to a vote to retain and overpay its CEO, Elon Musk, who has been responsible for a drastic drop in sales and earnings.

Tesla held its shareholder meeting yesterday, and shareholders voted on several high-profile proposals, the most-publicized of which would give CEO Elon Musk hundreds of millions of shares worth up to potentially $1 trillion, contingent upon company growth.

The headline $1 trillion has been widely reported and would be the largest payday ever for any employee of any company by multiple orders of magnitude if the company grows enough for all 12 milestone tranches to be met. The milestone tranches depend on company performance, and span over the next 7.5-10 years, with the goal of retaining Musk as CEO for that time period.

But Musk can still manage to get paid tens of billions of dollars – again, the largest payday ever for any CEO – even if the company grows slower than the S&P average. And another proposal printed 208 million shares, which the board can give to Musk at their discretion, independent of any milestone requirements.

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The vote was framed by Tesla as a necessity to retain Musk, and Musk himself threatened to leave the company if the vote did not go his way. He was probably bluffing, but it was enough to get 75% of shares to vote in favor of the incentive plan.

Many TSLA shareholders felt like they had no option other than to vote for the plan, as Musk’s incessant stock pumping with fantasies of robots and self-driving cars has been responsible for a huge run-up in share price, even as sales and earnings have dropped precipitously under his direction.

Due to Musk’s stock-pumping and the drop in earnings he’s caused at the company, Tesla’s price-to-earnings ratio is currently over 300. P/E ratio is an indication of the difference between market expectations and the company’s actual ability to make money, and lower numbers are healthier and less speculative. Most healthy companies have P/E ratios of around 20, possibly a bit more if they are in a high-growth industry.

But Musk had trapped Tesla shareholders: his lies are what led to TSLA stock being so high, and his threats to leave made shareholders fear a selloff in the event he didn’t get his absurd pay package, regardless of the benefits that might lead to in terms of company performance and stronger corporate governance. Nobody knows what actually would have happened to share price in the event that shareholders saw reason before the vote, but the common wisdom suggested a crash.

On other proposals, shareholders voted mostly lockstep with recommendations from Tesla’s captured board filled with Musk’s friends and family (and drug buddies). This included maintaining a supermajority voting requirement such that 67% of shares must agree to any change – an extremely high bar, now that Musk has been given incentives that could see his ownership share raise to over 25%.

The only significant measure on which shareholders broke with the board was a proposal to elect each company director annually – which would theoretically allow shareholders to respond more swiftly to problems in corporate governance (though they have as of yet shown disinterest in doing so).

Vote results lead to selloff in Tesla stock

Now, the market is responding to what happened yesterday, and it’s not nearly as enthusiastic as Elon Musk’s soldiers (yes, that is how one questioner referred to shareholders – they cheered, just before Musk referred to shareholders as “parasitic” in his response) in the room were.

At market open today, the stock immediately dropped nearly 5%, down 20 points from yesterday’s pre-meeting closing of $445.91 (which was already a down day for the company). The stock has moved up and down during the day, but as of this writing is at $424.

The drop was likely led by a selloff of the few investors who held out hope that shareholders might see reason. Given the news yesterday included a drastic pullback in shareholder voting rights, some shareholders might not want to keep their money in a company where they have effectively no say (this recent exodus of reasonable people probably influenced the vote results in the first place, too, as many people interested in healthy corporate governance sold their shares long ago).

The plan’s dilution may also have spooked shareholders. When new shares are printed, that reduces the value of all current shares, as all it does is cut the “pie” of the company’s market capitalization into smaller pieces. This means each share is worth less.

And the plans voted on involve the printing and granting of hundreds of millions of shares to Musk, which will dilute current shareholders. While this dilution hasn’t happened yet, the market can react ahead of time to the expectation of dilution.

Finally, the stock awards mean the company will be stuck with Musk for the foreseeable future. While this was the goal of the vote, to ensure that Musk not follow through on his threat to leave the company, he has also acted recently as the company’s chief saboteur, with most of his influence for more than a year being negative on company performance.

He’s spent $288M of his own money to cost Tesla $1.4B in lost profits and to harm the EV industry as a whole, he’s ruined Tesla’s formerly-shining brand, he’s made it harder for the company to do business overseas, he’s spread climate disinformation (and plenty of other types), he’s cost Tesla a million sales in the US alone with further drops overseas leading to cratering earnings, he pushed through a flop of a vehicle (that he’s had to sell spare inventory of to himself) and cancelled one that would have been successful, he fired the most important team in the company which caused chaos with suppliers, he’s distracted himself at all manner of other companies he owns (and with his social media addiction), he’s diverted Tesla resources to his own private companies while making threats to Tesla, he’s spent company resources to advertise for his own pay (rather than to sell Tesla products), he’s embarrassed and pushed away owners by trying to stoke civil war in other countries and engaging in corrupt government activities that killed hundreds of thousands of people… and then there’s the Nazi stuff.

That’s quite a list of fireable offenses, all within the last year or two, and it’s not an exhaustive list either. And Tesla has ten more years of that to look forward to, if this stock award runs its course.

The shareholders selling off their shares today probably held some vain hope that “Elon Musk’s soldiers” might see some amount of reason, and push back against some of the greater excesses reflected in yesterday’s shareholder votes. But alas, that did not happen.

And so, another straw has been added to the camels’ backs, with some of them finally breaking. Thus today’s selloff, as the “to the moon” enthusiasm seen in the room yesterday meets with a small semblance of reality.

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Environment

Honda wants to sell you an EV for under $30,000, eventually

Published

2 hours ago

November 7, 2025

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Honda wants to sell you an EV for under ,000, eventually

Honda wants in on the growing demand for affordable EVs. With the company’s CEO saying EVs selling for under $30,000 will be the main competition in the US, Honda may offer one of its own.

Honda mulls launching a sub-$30,000 EV in the US

Honda currently sells one fully electric vehicle in the US, the Prologue, which shares the same Ultium platform as the Chevy Equinox EV and all of GM’s electric cars.

The company confirmed that the Acura ZDX will not return for the 2026 model year, as it prepares for a new lineup over the next few years.

During the Japan Mobility Show last week, Honda unveiled the Super-ONE, a prototype of its smallest and most affordable EV set to launch in Japan next year, followed by Europe, the UK, and other global markets. Although the Super-ONE is not expected to arrive in the US, Honda may still offer an EV for under $30,000.

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Honda’s CEO, Toshihiro Mibe, told reporters in Japan last week (via The Drive) that looking ahead, the main competition in the US will be affordable EVs, priced under $30,000.

“So, for the future, we will consider coming up with EVs under $30,000 as well,” Mibe said. However, don’t expect to see it anytime soon.

Thanks to the Trump administration killing off the $7,500 federal tax credit and ending other policies promoting EV adoption, Honda believes it has some time before it needs to launch it.

Honda-Prologue-EV — 2026 Honda Prologue Elite (Source: Honda)

“What’s making it difficult, of course, is with the IRA subsidies now gone, with the Trump administration in place, we have the sense that maybe EV growth has been moved back out, maybe out five years in the further future,” Mibe said.

Due to the changes, Honda is aiming to launch more affordable EVs priced under $30,000 closer to the end of the decade.

“If we think about whether we have to really come up with those affordable EVs right away, we get the feeling not really,” Mibe said, adding it will be around 2030 before we see it.

In the meantime, Honda will focus on hybrids. The company is set to introduce its next-gen mid-size hybrid platform in 2027, promising it will be more efficient, less costly, and free of rare-earth materials.

Although it’s still not under $30,000, Honda is offering over $16,500 off with stackable savings on the 2025 Prologue in most US states.

Want to see the Prologue in person? You can use our link to find the Honda Prologue at a dealership in your area (trusted affiliate link).

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Technology

Affirm CEO says furloughed federal employees are starting to lose interest in shopping

Published

3 hours ago

November 7, 2025

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Affirm CEO says furloughed federal employees are starting to lose interest in shopping

Affirm CEO: We're not seeing a degradation in Affirm's consumer

Affirm CEO Max Levchin said Friday that while the buy now, pay later firm isn’t seeing credit stress among federally employed borrowers due to the government shutdown, there are signs of a change in shopping habits.

“We are seeing a very subtle loss of interest in shopping just for that group, and a couple of basis points,” Levchin told CNBC’s “Squawk on the Street.”

At least 670,000 federal employees have been furloughed in the shutdown, and about 730,000 are working without pay, the Bipartisan Policy Center said this week.

Levchin said he’s closely watching employment data for signs of major disruptions, but the company is “capable” of adjusting credit standards when needed.

“Right now, things are just fine,” he said. “We’re not seeing any major disturbances at all.”

The federal funding lapse, which began Oct. 1, is the longest in U.S. history and has halted work across agencies with an impact beyond those who are government employees. The SNAP food benefit program, which serves 42 million Americans, has also been cut off.