President Donald Trump’s aggressive support for the unproven idea of using the lupus and malaria drug hydroxychloroquine to treat coronavirus has puzzled public health experts, journalists, and others for weeks.
A Monday New York Times report appeared to offer one possible new explanation: financial interest — his own, and that of those close to him.
Per the Times:
If hydroxychloroquine becomes an accepted treatment, several pharmaceutical companies stand to profit, including shareholders and senior executives with connections to the president. Mr. Trump himself has a small personal financial interest in Sanofi, the French drugmaker that makes Plaquenil, the brand-name version of hydroxychloroquine.
However, Trump’s Sanofi stake is indirect and rather small — he owns shares through a fund that includes a diverse array of stocks. As Vox’s Emily Stewart noted, a government official repeatedly promoting a product made by a company they have a minute stake in would be a very inefficient way to be corrupt:
So the issue on the Trump/Sanofi thing is that if I were planning to make money off talking up a stock, I’d … invest directly in the stock, not a small portion through a mutual fund. Like if I’m talking up Apple and am invested in an S&P index, I’m doing it wrong.
— Emily Stewart (@EmilyStewartM) April 7, 2020
The immediate interest in Trump’s financial connections to the pharmaceutical companies is another indicator of how the president’s decision not sell off his assets or put them into a blind trust opens him up to allegations of impropriety. But it was also a sign of how puzzled some experts are by the president continuing to tout the drug in nearly every public appearance, particularly given that it can have some dangerous side effects.
Overall, Trump’s top medical experts have taken a more measured tone, as director of the National Institute of Allergy and Infectious Diseases and White House coronavirus task force member Dr. Anthony Fauci did in speaking with CBS’s Face the Nation Sunday.
“The data are really, just, at best, suggestive,” Fauci said on the program. “There have been cases that show there may be an effect and there are others to show there’s no effect. So, I think in terms of science, I don’t think we could definitively say it works.”
Trump appears to have been convinced of the drug’s effectiveness by its advocates in his inner circle, including trade adviser Peter Navarro and his personal lawyer Rudy Giuliani, as well as by a French study that indicated the drug is effective against the virus — but that, as Vox’s Umair Irfan has explained, came with a number of caveats the president may have missed, and that has been retracted.
And this — combined with the fact that the president, unlike Fauci, has no scientific training — had led a number of observers to believe Trump genuinely thinks hydroxychloroquine is promising and should be further investigated. This view was encapsulated in the Times’s reporting Monday by a medical director at Brooklyn Hospital Center, Dr. Joshua Rosenberg.
“I certainly understand why the president is pushing it,” Rosenberg told the Times. “He has to project hope. And when you are in a situation without hope, things go very badly. So I’m not faulting him for pushing it even if there isn’t a lot of science behind it, because it is, at this point, the best, most available option for use.”
But the report of Trumpworld’s connections to the pharmaceutical industry caused many to believe something more sinister was afoot — namely, that Trump hoped to use the coronavirus pandemic to enrich himself and his allies.
Trump has on numerous occasions been accused of, put under investigation for, and refused to rule out using his position to financially benefit himself. And he was, of course, impeached about four months ago on charges of using his office for his political benefit.
But while there are a number of outstanding questions about Trump’s financial stakes and how his current role influences them, it isn’t clear there is great cause for concern with respect to his pharmaceutical holdings.
For one, the president doesn’t directly own Sanofi stock. His 2019 financial disclosures suggest he holds it in three family trusts through an investment in the mutual fund company Dodge & Cox’s international stock fund. According to Dodge & Cox, that fund includes shares of a number of drug companies — including AstraZeneca, Novartis, Bayer, GlaxoSmithKline, and Sanofi. But it also includes shares of companies in other industries, from online retail to banking to electronics. And of the drug companies it does include, only some, like Novartis and Sanofi, are major manufacturers of hydroxychloroquine.
This would suggest that the president — and anyone else who bought this particular Dodge & Cox product — may not profit very much from increased hydroxychloroquine sales, and that any benefits drug companies in the portfolio see may not be enough to offset the loses of other included companies.
Trump’s financial disclosures don’t show exactly how much each trust has invested in the fund, but they do say it is $15,000 or less. Financial Times reporter Kadhim Shubber wrote this means the president’s stake in Sanofi is likely worth about $450.
It also is not clear how much the stakes in those other pharmaceutical companies will benefit the president. In late March, Novartis donated 30 million doses of hydroxychloroquine to the US federal government, and Bayer donated an additional 1 million doses of its hydroxychloroquine drug. Other pharmaceutical companies, including Mylan and Teva, have pledged to donate millions of doses as well.
This does not mean these companies will make zero sales — particularly given continuing demand among lupus and malaria patients, as well as at hospitals and other medical facilities for Covid-19 care — but that they may not be making money hand over fist thanks to the coronavirus. And as Ami Fadia of SVB Leerink, a health care investment company, told Barron’s, any additional hydroxychloroquine sales aren’t likely to greatly impact drug companies’ bottom lines because, even if they are able to quickly ramp up production, it is a relatively cheap drug in its generic form. Fadia said it can cost as little as 32 cents per pill.
Assuming increased demand over the short term, Fadia said, Mylan could expect to make $15 million in hydroxychloroquine sales. This sounds like a lot, but not when you bear in mind Mylan’s 2019 revenues were $3.19 billion.
Given demand, Mylan Sanofi and other companies could raise prices in order to increase profits. This would likely cause public uproar and be met with pushback from lawmakers. It is true that a number of drug companies have shown themselves able to disregard that sort of criticism in the past, as with drugs to treat diabetes, for instance — but thus far, there has been little sign there will be hydroxychloroquine-related opportunistic pricing.
And the Trump allies with investments in the drug companies that would seem to be helped by Trump’s advocacy for the drug — which include Commerce Secretary Wilbur Ross, investor Ken Fisher, and Amneal Pharmaceuticals co-founder Chirag Patel — also do not seem to be the beneficiaries of any underhanded behavior.
Ross, like Trump, is connected indirectly, through a fund he used to run; Fisher has long been a Sanofi investor through his asset management company; and while Patel’s company does plan to produce hydroxychloroquine, Amneal has said it plans to donate pills as well — and, should the treatment actually prove effective, it may seem wise to empower those able to make it.
Again, there are many reasons some are suspicious of Trump policies and how they affect his pocketbook. He tried to steer millions of dollars of business to his Florida resort by planning to hold a G7 meeting there. He has faced questions over Air Force and White House spending at his resorts worldwide. He was ordered to pay a $2 million fine by New York for “improperly using charitable assets to intervene in the 2016 presidential primaries and further his own political interests.”
This has made many of his critics sensitive to what could appear to be improprieties on his part. It is important those sensitivities do not lead to false alarms, but past behavior means there is an important line for interested parties to walk when assessing Trump’s behavior.