But the reasons and ethics of the system being the way it is are separate from the reality of what it is for the purposes of getting things done in the here and now.
For better or worse, as things stand right now, pharmaceutical companies, like other companies, need to make profits - or at the very least avoid crippling losses - in order to survive and continue doing their work.
That includes covering the formidable costs of the many research studies that go nowhere and yield no revenues.
I'm sure you wouldn't find a single person in a pharmaceutical company who would feel good about withholding treatment from any person with a life threatening illness. But what they also have to care about is remaining in business so they can treat and cure many more people with serious illnesses.
Practically speaking, I suppose a hypothetical scenario could be that the:
- the companies are granted patents
- the vaccine lasts for a limited amount of time
- before each patent expiry they companies make minor modifications (say, storage temperature requirement decreased by half a degree)
- the company make "unfair" profits by extending the oligopoly for a very long amount of time
I'm not stating that this will happen, but on the other hand, I find this plausible.
In addition, the aforementioned patents prevent disruption. Even long after the original patent expires.