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Comment by thisistheend123 | Hacker News Reader

I live in India. I am already hearing companies offering planned month long vacation tours to UK/US where you could get yourself vaccinated with vaccines that aren't available in India.

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That seems bizarre — you’re much more likely to be able to get it privately in India or Thailand or any other country that has good healthcare for the rich and few qualms about allowing people to buy in private stock. Much easier to pay $500 to a private clinic in Mumbai than fly to the West and hope that you can convince the state to provide it

The state will not provide it to non-residents. As soon as you arrive in the UK, immigration stamps "no recourse to public funds" in black all-caps into your passport as a friendly reminder.

In this specific instance, you're probably right that there will be paperwork.

However, in general, acute healthcare in free in the UK and does not even require ID. I don't know if that's how it's "meant" to be, but that's how it is; if you're on vacation in the UK and something bad happens, you can just turn up at the nearest hospital and it will get sorted out, no bill no fuss.

How it’s “meant” to be is that you’re asked for where you’re registered, and your NHS records are pulled up, and if you’re not registered at a GP practice or in the NHS system you get a bill

But I think there are some exceptions for communicable diseases, which they will treat without attempting to bill you. I doubt vaccination would fall under that but don't really know.

That's not what happens, though. You can just say "I'm not registered with a GP" (and many people aren't), and you will still be treated - no bill.

If you aren't registered with a GP and have no records at the hospital there are other ways to check, for instance your National Insurance records. It's not easy to get away without paying if you are an ineligible person.

That's not the case. There's no such thing as a single NHS records system. There's 4 separate NHS systems for each constituent country of the UK. If you go to A&E they cannot generally see your GP records - if they can, it's usually limited so for e.g. if you live in the same local NHS trust as the hospital is in.

Foreign nationals without a visa (and non-resident British people, like me now) do receive a bill. I used to work in the department that recovers the money.

The rates are in an excel file linked on this page. Visitors pay 150% of the published rate. https://improvement.nhs.uk/resources/national-tariff/

Out of curiosity, what kind of money we are talking about? For example checking up sprained ankle at A&E? Many of my friends being disappointed with NHS go for example to Mexico for private treatment and it works much better that doing it here, plus you can enjoy the climate and great food.

Not giving medical advice but you probably shouldn't be going to A&E for a sprained ankle unless it's very serious or a suspected break.

For people who are not ordinarily resident in the UK an A&E admission costs £100-£500 plus any tests and treatment. There's a small amount of margin which is used to offset the cost of recovering the money and the fact that sometimes the bills go unpaid.

Yeah most of the NHS hospitals I know have "Minor Injury Units" - I generally think that if you can make your own way there they it probably isn't one for A&E.

Mind you the last time I went for something I thought wasn't very serious (a cat bite) I was told to go to A&E pretty quickly!

I see, so it is not the kind of situation when you need to consider getting mortgage to pay off the medical bill. It was just an example. General advice I heard is that when you can't go to GP and walk-in is either too far away or closed, you can go to A&E or call 111 for instructions.

It's not like the US system where people have to choose whether or not to call an ambulance but it's obviously better for visitors to come with health insurance since a policy covering most emergency healthcare, and various other eventualities that could happen on a trip, is probably around US$10-20 pp.

I think doctors have to ask for ID if they suspect someone is not eligible for free treatment. I know this happened for two of my friends and they had to show ID at A&E, but that was during the heat of Brexit campaign, so this could make doctors feel encouraged to do such checks. I have not heard about it for a long time now though.

There's not even any plans to offer vaccines privately in the UK yet. The NHS isn't going to offer it to travellers.

Not NHS, but what’s stopping private companies from purchasing from pfizer at 10x markup and selling to willing customers?

Doubt Pfizer has much spare stock just sitting around at this point, and also I’m guessing you’d need an import license for it. But I’d imagine once there’s plenty to go around you’ll absolutely start to see private offerings.

They could theoretically try to order it I suppose, but they're going to be at the end of a very long backlog.

Do we actually know all the details of who they’ve contracted with? I wouldn’t be surprised if private healthcare providers in the UK already got their place in line.

I'd be somewhat surprised. In Ireland this year the _flu_ vaccine wasn't generally available privately, as the HSE took all available supply. Health authorities should be expected to be even more aggressive with covid vaccines.

I don't think private parties will have any access to vaccine for a while.

Can you imagine the shit storm if some wealth person got vaccinated ahead of the doctors treating dying Covid patients. Ain't gonna happen.

> Can you imagine the shit storm if some wealthy person got vaccinated ahead of the doctors

In an ideal world, I suppose not. But, in the real world, I think I can. Yes.

I've already heard stories about people in both China and Russia using bribes/connections to get themselves or relatives into vaccine trials. In particular, the Chinese military has been vaccinating its own since June.

https://www.cbc.ca/news/health/covid-vaccine-approved-milita...

Not really bribes, just go to the Taihe Hospital in Beijing and pay to be vaccinated. The Chinese are more laid back about regulating stuff. https://time.com/5902646/china-covid-19-vaccine/

It sounds like in some countries, the rich will be able to get the vaccine ahead of official channels - eg. https://www.cyclingweekly.com/news/racing/uae-team-emirates-...

On the contrary, vaccinations started early in November in the UAE. They are using the weaker Chinese vaccine though.

This kind of egregious injustice happens daily.

This will, too.

Well celebrities were tested before frontline workers.

The production so far has been funded through government contracts.

Some time in the future - maybe nothing. Right now - all current and future doses for many months (if not years) are accounted for in existing contracts. Selling the doses to private parties, especially at 10x markup would be a huge PR disaster and invitation to AGs to open investigations.

Pfizer's production is ordered for months out.

I would be gobsmacked if it isn’t available privately. I’m sure someone is planning it.

I’d guess that wide spread availability privately will coincide with when the highest risk groups have been vaccinated and then the government will say it’s “only right and proper” that people who aren’t very much at risk, who “can pay, should pay” rather than “burdening” the NHS and timed that they won’t look too callous.

Why would they do that? If they are providing it free to those at high risk, why not provide it free to those at low risk? Why would they charge for this particular treatment when all other treatments are free? How could they ensure those who are poor and cannot afford to pay still get vaccinated?

The vaccine is not available privately in the UK. If you're not registered with the NHS, you're probably not going to be able to get vaccinated in the UK anytime soon. Even if you are registered, you will probably have to wait til late spring if you're under 50 with no underlying health issues.

This.

The idea that people are planning 'vaccine holidays' is bizarre.

Perhaps it is a scam?

It's absolutely is either an outright scam or just crafty marketing off the back of this.

The comment says 'vaccines that aren't available in India' of which I'm sure there may well be plenty, just not necessarily the COVID one.

I'm sure people are planning one. That doesn't mean they will be successful. Most of the people with enough money to do this are alert for scams (though they might decide it is 80% chance of scam and decide to risk it anyway), so they will be looking to see if they will get the vaccine in the end, and if they don't think you will deliver they won't go. I would expect anyone who gets a "black market" vaccine gets one of the not approved (yet) vaccines. That supply is sitting around and probably not tracked as much. Break into a warehouse (often with insider help, possibly at high levels such that most people in the company help you because your alibi checks out), get a supply, then send it to your black market buddies. Pfizer has a legal market now and will do everything to ship to that market. Moderna is close enough that they won't risk it. The Oxford vaccine has a lot of companies who can make it and an uncertain future (60% effective when there is a 95%?) so it is the most likely candidate, for this. Russia also is making a vaccine that they might be willing to sell like this. China might as well, but I find it unlikely as they have other markets. Of course this whole paragraph is pure speculation: anything is possible.

The Pfizer vaccine won't be available privately in UK, not for a long time. So I think they will be disappointed.

What stops pfizer from selling directly to customers?

Probably the billions that governments have paid for their place in the queue

India alone has 759k millionaires. Assuming each has a family of four, and they’re willing to pay just $500 for a two shot course on an exclusive basis (say). That alone will be make pfizer about 1.58 billion dollars.

There are 13555k millionaires outside of Europe and US. The 1.9 billion paid by the US government for 100million viles pales in front of what pfizer could earn by catering to the rich.

So, again, my question stands, why wouldn’t pfizer sell directly to customers? What binds them to just deal with governments alone? I ask this as a humble non-millionaire (just to clarify that I wouldn’t benefit from such a scheme in any way) :)

They are already sold out. There’s no spare. And yes they can sell to millionaire but states purchases millions of doses at a Time, not 5.

Do you honestly think Pfizer would come off well (PR wise) if they put millionaires in the front of the queue for cash? At a time when vulnerable people are dying? The $1.58bn wouldn’t be worth sinking their entire brand, not even close.

Pfizer doesn't have to do anything. The vaccines will be sent all over the world, all destined for reputable hospitals where they're intended to be used for elderly transgender orphans with pre-existing conditions working in COVID ICUs. However, some shipments will mysteriously fall off the truck on the way there, and will resurface at private hospitals for the elite who can and will pay large quantities for them.

Lack of supply. They’ve already pre-sold all they could make to governments.

Presumably they pre-sold based on estimates of their production. I would not be very surprised if it turns out they can make 10% more than they committed, and auction this off. And would expect hospitals treating Saudi princelings & the like to win such an auction.

But does anyone actually know what these pre-sale contracts look like? They must have some wiggle room in case production doesn't go as well as planned... are there just penalties for late delivery to specific customers, or explicitly tied to total production, or did they literally sell places in the queue, or what?

Last I'd heard, they overestimated how much they could produce and presold more than they could actually deliver at least at first.

Companies that have a vaccine are aware of image. They know that the world is watching, and this is a big marketing opportunity. They will make a profit, but long term goodwill is more valuable than any profit they could make selling to billionaires, so I doubt anything will go to auction.

The hospitals treating Saudi princes are real hospitals. So they can win auctions if it comes down to that, because they are invited to them while the rest of the black market isn't. I don't think real vaccines will come to auction though.

There is one thing left: vaccines that have approval issues. Any vaccine that is somewhat effective by not enough (The Oxford vaccine at 65% efficiency is questionable). The Russian vaccine. Any of many that haven't started phase 3 trails yet. Any vaccine that has safety issues. All are candidates for someone to "leak" to the underground. You will have to consider the risks, but it might be worth it to get it now and then in a year when the better vaccines come to you get that too.

Yes, an actual open auction would be astonishingly bad PR! But quietly, on the side? Maybe I'm a cynic but I struggle to believe the billionaires won't find a way.

If not from the main production... they had 43538 phase III participants, there must be leftovers, which won't appear in the books as real production... maybe you can route those to important donors of your philanthropic arm, or something? Run some "further trials" in a variety of small clinics, including those catering to visiting Saudis?

Plus actual black market stuff of course, I wonder if any of their refrigerated shipping boxes have gone missing? And, as you say, things like the Russian vaccine are probably already available at a price.

The risk of being caught trying to pull that off as a company are too big. Though there might be some individual who does something against company policy, but it is hard to keep such things secret if they involve more than a couple people.

As someone who works in medical devices, there's huge sections of standards referring to confirming that software and devices reach the intended user untampered and analysing the risk of selling to an untrained customers and things like that.

The long and the short of it always boils down to, it's not worth the risk to sell to individuals. Because if something goes wrong and someone is injured or killed, the regulatory agencies are going to come down on you like a ton of bricks

I would assume similar practices exist for pharmaceuticals.

I'd be up for it, no doubt.

Hong Kong doesn't seem interested to vaccinate people before 2022ish.

https://www.scmp.com/news/hong-kong/health-environment/artic...

Is this not just cynical marketing?

Sure, there are likely to be plenty of vaccines one could get in the UK/US that aren't available easily in India or elsewhere. But you/they didn't say anything about the COVID one...

not surprising. i am shocked people aren’t hawking fakes on the dark net yet.

I am sure my Junk email box is full with offers for private vaccination already

I just checked, and I didn't see any. The closest was an offer for KN95 masks. (Though this is GMail, which I think has started to just auto-delete a lot of the worst stuff. My spam folder now gets spams-per-day rather than kilospams-per-day.)

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