It contains a brilliant portrait of Maurice Hilleman, the pivotal figure in vaccine development at Merck. It provides clear insight into the choices open to Merck at critical junctures, and shows why certain paths were taken, and alternatives forsworn. The critical centrality of access to networks is clearly demonstrated, as is the personal as opposed to institutional basis of that access. However, when Galambos and Sewell assess the failure or success of a corporate policy, or berate the wisdom of a government regulation, one would have hoped for a broader comparative basis for their assertions. Poor prospects for profit from vaccine research has led many firms including Lilly and Pfizer to abandon the business.
Patents are hard to come by, and the risks from law suits loom large.
Most of the product is purchased by governments and international agencies who exercise monopoly power. Most of the profit comes from the small part of the U.S. market, and the smaller part of the European market in private hands. Huge quantities of vaccine are consumed in less developed countries, but, in a business where price and average cost can be orders of magnitude higher than marginal cost, that external market yields a markedly lower price. Merck stays in the business in part because exiting would produce bad publicity. Measured by sales, and even more by profits, abandonment of the vaccine business would have no perceptible impact on the size of the health care industry or even pharmaceuticals.