Vaccinating the global poor is really important

Vaccinating the global poor is really important

By Matthew Yglesias

SlowBoring.com

March 16, 2021. 

(Photo by ORLANDO SIERRA/AFP via Getty Images)

Since I published “Approve the AstraZeneca Vaccine” on February 16, the vaccine supply situation in the United States has improved for the better in fairly dramatic and visible ways.

At the same time, it’s still the case that I and millions of other eager-to-be-vaccinated Americans still can’t get an appointment for the shot (European countries seem to be hastily suspending the use of AZ due to blood clot fears that have no statistical basis that I can see). Tens of thousands of people have died since I wrote that post, and while it’s of course not the case that they all could have been saved with prompt approval of the AZ vaccine, some of them could have been. The Biden administration now believes that by May 1, it will be prudent to let anyone who wants a vaccine just go sign up for one, but that doesn’t mean they think vaccines will be universally available by then. Nonetheless, I’m fairly optimistic that thanks to vaccine prioritization, we have already eliminated the bulk of the death risk. We will be looking at perhaps thousands of deaths per week rather than tens of thousands going forward.

I think the most convincing pushback I got on the AZ issue came from a friend who works on a range of issues in the developing world. He pointed out that poor countries are really counting on this shot — which has minimal storage requirements and is cheap — to inoculate their population, so perhaps it’s not so bad that the U.S. is eschewing it.

But it turns out that the U.S. has a ban on exporting COVID-19 vaccines due to the public health emergency. Consequently, the New York Times reports that “tens of millions of doses of the coronavirus vaccine made by the British-Swedish company AstraZeneca are sitting idly in American manufacturing facilities, awaiting results from its U.S. clinical trial while countries that have authorized its use beg for access.”

Doesn’t seem great!

We should still approve the AstraZeneca vaccine

I talked about this over the weekend with a half dozen different experienced political professionals, and they all think that exporting vaccines while the pandemic is raging is a non-starter. It would be the height of bad-faith dishonesty for Republicans who haven’t lifted a finger to encourage the approval or use of the AstraZeneca vaccine to launch political attacks based on its export. But Democrats are certain that won’t stop them and are worried that it will be effective, and since there’s zero margin of error on Capitol Hill, it’s just not going to happen until the United States achieves vaccine plenitude.

That dynamic suggests to me that the best thing the country can do to get AstraZeneca shots into the arms of poor countries is to authorize its use in the United States and start putting that stockpile to work.

Set it aside for people under 40 or whatever (I’d take one tomorrow), and get willing Americans vaccinated as quickly as possible.

We will still need to address domestic vaccine hesitancy issues, but once we’re in that phase, we can (and should) start shipping vaccines abroad. But I don’t think exports are going to happen until we’re in “everyone who wants a shot gets a shot” territory, and that means we need to get there as quickly as possible, which means putting our AstraZeneca stockpile to use.

But I also think we should be thinking much bigger on the international dimensions of this.

We should spend a ton of money on vaccinating poor countries

Whenever you look at U.S. orders of COVID-19 vaccines, we always seem to be acting weirdly stingy. Back in August, the Trump administration ordered 100 million Johnson & Johnson doses for $1 billion. Then last week, the Biden administration brokered some agreement whereby Merck will manufacturer J&J doses and also had the United States order 100 million more shots, apparently for the same cost.

When all is said and done, current U.S. orders across all three approved vaccines will cover 500 million people — which obviously is more than the existing population of the United States. This is for redundancy and flexibility, apparently, but if we end up with extras, Biden will give them away:

The White House's latest vaccine purchase is aimed at preparing for a range of longer-term scenarios, including the need to give people second "booster" shots to guard against emerging Covid variants. Biden also suggested that additional J&J shots could also be donated down the line to other countries in need, or aid an eventual push to vaccinate children.

"If we have a surplus we’ll share it with this rest of the world," he said at the press conference.

This strikes me as a shortsighted approach. According to The Washington Post, Emergent Biosolutions, a Maryland company that’s working with J&J, “said it has the capacity to make enough raw vaccine substance for up to 1 billion doses of Johnson & Johnson vaccine in 2021.”

I think if they can make 1 billion doses, we should spend the $10 billion and have all of them. All the reasons the White House cited for wanting the extra 100 million still apply, and just guaranteeing that you’ll have extras to give away to poor countries is good. It’s just not that much money! We’ve spent something like $7 trillion in COVID-19 relief, experienced economic losses that are larger than that, and also hundreds of thousands of Americans are dead. If spending $10 billion on Johnson & Johnson doses we don’t need can reduce the odds that some mutant strain of SARS-Cov-2 emerges in the developing world that our existing vaccines don’t work on, that would be well worth it.

As long as supplies are limited, wanting to hoard vaccines for Americans’ use seems like a normal, healthy amount of selfishness. But to the extent that it becomes just a question of money, basic enlightened self-interest says that we should be making it rain.

The patent fight

Unfortunately for the global poor, the enlightened self-interest argument that works for vaccines does not apply to other large classes of pharmaceuticals.

Cancer drugs or treatments for high blood pressure save lives, but they really just save the patient’s life. Because these drugs are valuable, rich countries are willing to pay high prices for them. But in poor countries, they may be unaffordable. And what’s tragic about this is that manufacturing medicine is typically very cheap. The drugs are only expensive because of patent rights. So there is a longstanding idea in the NGO community and among poorer countries — especially India, which has a big generic pharmaceutical manufacturing industry — that these intellectual property rights are bad.

Indeed, as we saw in “Oh, the intellectual property rights you’ll extend,” when the U.S. was a developing country, we did not respect foreigners’ IP, and this was beneficial to U.S. economic development. Today, however, the World Trade Organization has the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which is basically a way for rich countries to use the threat of losing access to their markets to force poor countries to respect foreign IP.

The technical term for that situation is that it’s “pretty fucked up,” so I think it’s fairly understandable that poor countries are taking the opportunity of the pandemic to complain:

South Africa and India renewed their bid to waive rules of the WTO’s Trade-Related Aspects of Intellectual Property (TRIPS) agreement, a move that could allow generic or other manufacturers to make more vaccines.

South Africa argued the current TRIPS system does not work, pointing to the failure to secure life-saving medicines during the HIV/AIDS pandemic that had cost at least 11 million African lives.

Medecins Sans Frontieres in October put together a letter signed by over 375 civil society organisations supporting the waiver.

It’s important to note that MSF is a longstanding TRIPS critic. Bernie Sanders, who is backing the call, obviously loves to hate pharmaceutical companies and says “it is unconscionable that amid a global health crisis, huge multibillion-dollar pharmaceutical companies continue to prioritize profits by protecting their monopolies and driving up prices rather than prioritizing the lives of people everywhere, including in the Global South” (2:44 in the below video).

It seems to me that if you think specifically about the companies who have developed COVID-19 vaccines, it is a little hard to find it particularly unconscionable that they are deriving profits from the situation. Domino’s Pizza has reaped incredible profits from the pandemic, as has Peloton and Zoom. And while all of those companies are making money because their products are useful, they’re obviously not nearly as useful as the COVID-19 vaccines. Conversely, the economic benefits that the vaccines are going to provide to the hotel, airline, and restaurant sectors are much larger than the profits the vaccine-making companies are conceivably going to make.

Many vaccines, little manufacturing capacity

Last but by no means least, we are actually in the happy situation where despite patents, this isn’t a case of monopoly. Pfizer has a vaccine. Moderna has a vaccine. AstraZeneca has a vaccine. Johnson & Johnson has a vaccine. The Novovax vaccine seems to work great. Indeed, as best I can tell, the Chinese and Russian vaccines we don’t like to talk about in the West work too.

So we are not actually dealing with a situation in which a vaccine monopolist can hold the world hostage on unit prices. You would expect this to eventually settle down into an equilibrium where the vaccine is widely available and actually quite cheap.

The problem right now is that global demand for vaccines is incredibly high, and the manufacturing capacity can’t meet the demand. Of course, it’s possible to expand manufacturing capacity. But precisely because demand isn’t going to stay this high for very long, it doesn’t necessarily make sense to create big new manufacturing facilities.

Just days after the U.S. blocked India’s TRIPS efforts, we announced a joint deal with Australia and Japan to finance the creation of more vaccine manufacturing capacity in India, which should lead to the production of a billion doses. It’s not clear from the release which vaccine the Indian company, Biological E, will be making. But they’ve been in talks with Johnson & Johnson, and since Biden already brokered a deal between J&J and Merck, it seems like that’s the most likely candidate.

This makes sense as diplomacy; it makes sense as public health; and it makes sense as basic economics. It seems like the U.S., Australia, and Japan are putting up something like $200 million in this India deal. If we can do more deals like that in South Africa, Argentina, Mexico, and wherever else they have some vaccine manufacturing infrastructure, we absolutely should.

But note that the need for these hard material resources not only outweighs the alleged need for access to patented IP, but to some extent, it undermines the IP-focused narrative. The reason rich countries don’t yet have all the vaccines they want is that making these vaccines — especially the mRNA ones — is evidently a difficult logistical process, and not just something where you can look at a recipe and start cooking. What we need to do is spend the money to actually increase capacity, both at home and abroad.

Relatedly, the South Africans and Indians are not helping their cause on TRIPS by seeming to be mostly interested in the mRNA vaccines that are both the hardest to manufacture and also the most interesting technologically. It’s raising the suspicion of both U.S. and EU officials that this is more of an industrial espionage fishing expedition than a real focus on enhancing vaccine supplies. I basically think we ought to be throwing more money at the problem.

Vaccines are really good

In a big picture sense, I think Western governments are underrating the financial value of vaccinating the world. Biden is talking about a $4 billion contribution to COVAX to help with this. That’s peanuts. If Bill Gates wants to give $4 billion, I’d be impressed.

But the American Rescue Plan includes $8 billion in funds for airports, and not only do I have no idea why airports need $8 billion, but it was also apparently so uncontroversial that I’ve never even heard anyone argue about it. And to be clear, that’s separate from the $15 billion for airlines or the $3 billion for aviation manufacturers. There’s just a lot of money flying around right now because interest rates are really low and the COVID-19 pandemic is really bad.

That logic shouldn’t stop at America’s borders.

Economically, 2021 is going to be a gangbusters year for U.S. growth in which our forward surge pulls the whole world forward. But it’s easier for the U.S. economy to grow if the rest of the world isn’t in the doldrums. And it’s going to be impossible for us to grow if continued uncontrolled spread in poor countries produces variants that evade our vaccines. And in foreign policy terms, there is no better way to do “American leadership” than to just be somewhat broad-minded about this kind of thing. In a world of a $1.9 trillion COVID-19 relief bill and a $700 billion annual military budget, we can spare a lot more than $4 billion for the global vaccine effort.

The anti-TRIPS activists strike me as slightly barking up the wrong tree here, but the general issue they are speaking to — global vaccination — is extremely pressing, and leaders in the rich countries ought to counter their IP push by truly opening up the spigots of funding.