The True Costs of Pandemic Explained

Summary: The COVID-19 pandemic has posed a monumental challenge for public health experts, governments, and private organizations alike. To date, 20 coronavirus vaccines are available or in development and have been approved for use by at least one regulatory body worldwide. Each vaccine is unique in its composition and development process, offering varied levels of efficacy and safety. Sounds great. Still, the financial burden of coordination with providers and hospitals, particularly the government, has led to a massive increase in healthcare spending even during a downturn in COVID diagnoses and deaths.

COVID-19 Vaccines Explained

Vaccines developed to prevent the spread of COVID-19 have quickly become some of the most sought-after pharmaceutical products in history. This can largely be attributed to the sheer scale of the need created by the pandemic, which spurred a massive effort by drugmakers worldwide to produce safe and effective treatments on an accelerated timeline. The demand for these medicines has received significant support from governments and philanthropic organizations, who have collectively earmarked billions of dollars for vaccine procurement and distribution. 

Pfizer is expected to post $101.3 billion or more in earnings from its COVID vaccines, while Johnson & Johnson could report similar earnings, having grown from 2018 ($53.7 billion) to 2019 ($82.6 billion). Most notable is the oral COVID drug Paxlovid, which likely will post $30 billion or more in 2022, and was found to successfully reduce hospitalization and/or death in patients by up to 89%! Paxlovid is used in combination with the HIV drug Ritonavir.

Why Does this Matter to You as a Payer or Provider?

Pfizer has become a significant influence on U.S. Healthcare Policy in the future. Since they became the #1 producer of COVID-19 vaccines, they have successfully raised their prices to the Biden Administration’s budget for public health. The Biden Administration, in late 2022, bought 105 million doses for $3.2 billion, which equates to an increase from $19.50 per dose to $30.47 per dose. Yes, folks, the cost of the vaccine is going up. But why?

Well, when you have an epidemic and demand is high, the price can be low or medium, depending on the emergency status of both patients and hospital staffing, but COVID-19 infection rates are on the decline. 
The graph below shows the new cases per day in the USA. You can see that the COVID case spikes began with a slow uptick in Q1 2020, then grew dramatically from Q4 2020 to Q2 2021, with the most significant growth in Q1 2022. Now that daily COVID cases have decreased and there are more treatment options for patients, the demand for treatment has decreased, leading Big Pharma to raise the price of the drugs in an attempt to continue its profits.

COVID-19 Statistics vs. Influenza (Flu)

From 2011 to 2019, the USA averaged 20 million to 40 million flu cases, 25,000 - 50,000 deaths per year, 10-18 million medical visits, and over 400,000 hospital visits for the flu. However, since COVID-19 entered our lives, we have had approximately 9 million flu cases in 2021-2022, rather than 20-40 million. We’ve had only 5,000 to 7,500 flu deaths. As providers and payers, we need to be able to question the legitimacy of a COVID diagnosis, which entails far more future costs at this time than a flu diagnosis. 

According to both Johns Hopkins and the Mayo Clinic, over 80% of deaths result from those 65 or older, and those who have the hardest time battling COVID and its possible long-lasting effects are those with pre-existing diseases of the lung, heart, brain, cancer, kidneys, Down syndrome, and diabetes and/or obesity. So wouldn’t it make sense that COVID-19 campaigns be more focused on educating these patient populations? Wouldn’t it make more sense to spend more time with patients who fall under these conditions and see whether COVID-19 treatments and preventive care will help Americans? We don’t know, that’s why we’re asking you as providers, payers, and healthcare professionals…

COVID 19 Death Rates



There has to come a time when we as a general public need to establish COVID-19 as a treatable and not a worldly pandemic mindset. In just a single year, COVID-19 deaths have fallen from 2,179 deaths on Jan 24, 2022; to 270 deaths on Jan 24, 2023. We are better informed and have more treatment options, yet the Federal Government continues to pay more for the vaccines and boosters… PCG is not standing on one side of the vaccination or non-vaccination fence, we are just stating that with death rates declining, shouldn’t the US Healthcare System and the White House be demanding that the Vaccine price decline?

COVID Billing, Fraud, and Lessons

COVID Fraud was a blueprint for future Vaccine Fraud

COVID-19–related fraud represents the largest concentrated period of healthcare fraud enforcement in U.S. history. In April 2022, the U.S. Department of Justice announced charges against 21 defendants across nine federal districts for approximately $149 million in alleged COVID-19–related false billings. Later that year, in September 2022, federal prosecutors charged an additional 47 defendants in connection with schemes that defrauded the healthcare system, patients, and payers of more than $250 million in federal funds originally designated to support pandemic response programs, including nutrition assistance for children. Separate enforcement actions included providers charged with wire fraud, healthcare fraud, and kickback violations related to telemedicine programs that failed to comply with CMS requirements for COVID-era care delivery, exposing participants to significant criminal penalties.

This matters to providers, payers, and taxpayers because COVID-19 services were largely funded through federal emergency programs rather than patient cost-sharing. While patients incurred little or no out-of-pocket expense, the financial burden was absorbed by taxpayers and payer organizations through public funding, administrative fees, and downstream program losses. CMS and the U.S. Treasury have also warned of widespread scams involving the misuse of patient PHI and financial information to improperly access grants, stimulus payments, or healthcare benefits. These enforcement actions underscore why strong oversight, documentation controls, and fraud-prevention infrastructure remain essential long after emergency declarations expire. Suspected COVID-related scams can be reported through the FBI’s Internet Crime Complaint Center (IC3).

Summary

The COVID-19 pandemic created an unprecedented expansion of publicly funded healthcare services, exposing systemic weaknesses in billing controls, utilization oversight, and fraud prevention infrastructure. While emergency policies increased access to care, they also generated significant financial risk through relaxed documentation standards, rapid telehealth expansion, vaccine administration complexity, and large-scale federal funding flows with limited real-time oversight.



This article examines the true costs of COVID-era healthcare spending through the lens of billing behavior, fraud enforcement, and payer accountability. By reviewing vaccine funding structures, testing and telehealth billing practices, and documented fraud patterns, it highlights how emergency conditions translated into long-term financial exposure for taxpayers and health plans. The lessons from COVID are no longer clinical—they are operational. Strong documentation standards, consistent adjudication logic, and proactive fraud controls remain essential to prevent future large-scale program losses.