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My long-read on the already appalling—and entirely preventable—challenges to vaccine roll-out dropped just before Christmas. Didn’t get a chance to break it down.
There’s a lot in here on how the first-out-of-the-gate vaccines work, vaccine manufacture and vaccine roll-out supply chains in general, from fridges and thermoses to bioreactors and trained staff and volunteers. https://www.jacobinmag.com/2020/12/socialism-vaccine-capitalism-distribution
But mainly it’s about how the crisis we saw in the spring with PPE, ventilators and testing is happening all over again, Groundhog-Day style. An almost identical crime is in progress once more, but this time with respect to the logistics of vaccine manufacture and distribution.
It will be especially unfair for those in the developing world,and even in many poorer, rural, less populous parts of the developed West—not least Trump country—there will be cruelties for those who live outside the metropolitan core.
The headline for the essay that the copy editor chose sort of hides that it’s actually about vaccine roll-out logistics. Not many people know that journalists often don’t get to choose their own headlines. So lemme walk you through some of its key points:
There’s a lot of crowing about how the speed of vaccine development—months instead of the typical years or decades—is a triumph for private innovation. Nothing could be further from the truth.
Pfizer-BioNTech, along with the second-place finisher, Moderna, and the other front-runners, all depended on years of public-sector funding for their success, and, in many cases, on research actually performed by government or public university labs long before 2020.
And again during this plague year, these private companies relied on state shepherding and bankrolling of the vaccine development process or, in the case of Pfizer, state-guaranteed purchase of millions of doses.
In many cases, national governments arranged purchase agreements and manufacturing support ahead of clinical trial results so that rollout could start as soon as regulatory approval was given, rather than having to wait for approval before manufacture could begin.
Washington promised to purchase some $2 billion worth of the Pfizer vaccine and guaranteed about $2.5 billion to Moderna for the development and manufacture of its option.
In essence, the state de-risked vaccine production. The pharma firms were agents of state planning, not fully independent actors.
The speed of with which the vaccines have been developed is particularly stunning as infectious disease researchers, clinicians, and public health officials have for years complained how pharma giants largely got out of the business of vaccine development several decades ago.
Contrary to anti-vaxx legend, pharmaceutical companies are, in reality, loath to engage in vaccine production because of the financial risk involved and its sheer unprofitability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518734/#!po=23.6842
Now, suddenly, in the face of a nigh-on existential threat, when the state bashes CEO heads together and takes on all financial risk, vaccines of stunning efficacy appear after just months.
It is almost identical to what happened during World War II, when the US government, frustrated with the intransigence of chemical companies and nascent pharmaceutical firms again fearing lack of profitability...
... simply ordered cooperation across enterprises, made investment decisions on behalf of the private sector, and covered the costs of research, development, and manufacturing. https://link.springer.com/article/10.1057%2Fpalgrave.jphp.3200064
The result was the development or improvement of ten vaccines of military significance. The same wartime planning efforts produced the mass rollout of the first antibiotic, penicillin.
This is a reversal of the political-economic paradigm since the 80s that markets know best.
Instead, it represents an implicit or explicit acknowledgement that there are gaps between what is beneficial for society and what is profitable.
Instead, it represents an implicit or explicit acknowledgement that there are gaps between what is beneficial for society and what is profitable.
It recognizes the ability of the state, which is independent of the profit motive, to shepherd innovation, to sculpt production and distribution, and to be the real entrepreneur when private-sector entrepreneurs are, frankly, a bunch of risk-averse pussies.
But this key, shepherding role of, yes, Big Government, with respect to basic research, R&D and trials, is not yet happening sufficiently with the logistics of manufacture and distribution.
So for example, major hospitals in metro areas are running around to get their hands on ultra-cold (and very expensive) freezers ($10–15,000 a pop). And like the hunt for PPE and ventilators in the spring, a disorganized every-man-for-himself approach has returned in the winter.
Rural areas and towns with smaller populations are being trampled in the stampede. The pandemic has bludgeoned the finances of less well-off hospitals, and these are expenditures they often just cannot afford.
Even those hospitals that could afford one or two freezers are being told by manufacturers that delivery will take months; wealthier, larger hospitals that are able to buy in bulk get priority.
This isn’t merely unjust; it’s irrational. The regions & hospitals able to bid the highest aren’t necessarily the ones most in need. Rural areas and small towns have a higher % of older people, as, greater numbers of poor residents, w/ a greater incidence of underlying conditions
This need-versus-supply mismatch then extends the length of the pandemic beyond what it might otherwise be, which endangers those wealthier regions more than necessary.
The hope is that other vaccine candidates using different approaches will be less temperature-sensitive. The Oxford-AstraZeneca, Novavax, and Sanofi-GlaxoSmithKline vaccines can be stored at ordinary refrigerator temperatures.
But under these circumstances, once again, in the developing world, or even in a US territory like Puerto Rico, which suffered from extended blackouts in the wake of Hurricane Maria, a plain old fridge is no use if the electricity cuts out for hours or days on end.
Meanwhile, Pfizer predicts it will be able to produce 1.3 billion doses by the end of 2021. Moderna claims it can produce another billion in the same time frame. But does that work out to be roughly 2 billion? Not necessarily.
A firm will be making these estimates based on what their own suppliers — of bioreactors, filtration devices, vials, nucleotides, enzymes, and other inputs and equipment — estimate they can provide.
The supplier will tell Pfizer they can offer 1 billion widgets, for example, but then Moderna will call the same supplier and get the same hypothetical number. Those 1 billion available widgets are for both of them combined.
Even if everything ran smoothly from manufacture to local distribution, at the point of care — the site of actually injecting the vaccine into people’s arms — there are insufficient workers on the ground in the United States..
... to perform the inoculation, as well as handling the associated advertising to explain where and how to get a shot (and to combat vaccine hesitancy), software programming, and allied tasks.
The Association of State and Territorial Health Officials and the Association of Immunization Managers have requested that Congress deliver just over $8 billion to cover the cost at state level of recruiting and training extra staff.
Some $200 million distributed to them from the CDC is all they have so far received. https://www.astho.org/Press-Room/Public-Health-Leaders-Request-COVID-19-Vaccine-Infrastructure-and-Administration-Funding/10-15-20/
What’s required is for gov’t to step in to a greater degree than experienced under Donald Trump to shepherd with a firm hand parts of the vaccine production and distribution supply chain, as occurred in spring in many countries w/ respect to PPE, ventilators, hospital beds, etc.
Supply chain specialists argue that in the case of COVID-19, demand planning is of such a different magnitude compared to historic distribution of vaccines...
... that it will require governments to normalize (stabilize) and optimize vaccine supply chains, just as was necessary with PPE. https://www.globalsupplychainlawblog.com/legal-analysis/addressing-covid-19-vaccine-supply-chain-challenges/
While Trump invoked the Defense Production Act (DPA) to force firms to make PPE & used emerg use authorizations to permit new suppliers to enter the market, for the most part, private markets were left to their own devices w/ insufficient gov’t shepherding and they largely failed
A suspicious PPE “broker” market cropped up, wherein shady figures claiming to be brokers said they would help locate and acquire such equipment for hospitals, clinics, and other frontline organizations.
While some of these were legitimate, if exploitative of a crisis situation, many were simply fly-by-night operations with no experience in medical supply chains. Either way, legitimate or criminal, the brokers regularly failed to secure what they had promised.
To prevent this from occurring again, Biden could use a more aggressive application of the DPA, which permits the executive to incentivize firms to expand production within existing domestic manufacturing capacity of critical inputs to the vaccine supply chain...
... to incentivize expansion of new manufacturing capacity, and to employ people with the experience necessary to supervise and plan such production.
Under the act, the federal government could commandeer the resources required, including requisitioning supply chain and logistics experts and suppliers to build a centralized procurement and delivery process.
Should there be transport bottlenecks or shortages, the DPA also allows activation of the Civil Reserve Air Fleet — in essence, drafting private airlines like Delta or United.
It is inefficient for each of the states to design and put in place their own distinct vaccine distribution plans. Instead, the federal government is best positioned to organize information gathering across the entirety of the system...
... in assistance with local and state governments and health providers, and then to feed such data back down the chain in order to alter production and distribution plans as consumption of vaccines dynamically changes.
It is precisely because the logistics are so complicated that the state needs to take over from the chaos of the market.
Because none of us is safe until all of us are safe.
Because none of us is safe until all of us are safe.
There’s lots more detail in the essay, including on “vaccinationalism”, which means state decommodification is necessary step but not sufficient.
Long-term, global solutions will also be required, which I also talked about in this other essay w/ respect to broader questions around pandemic preparedness.
/FIN https://www.jacobinmag.com/2020/07/one-world-government-democracy-covid-19
/FIN https://www.jacobinmag.com/2020/07/one-world-government-democracy-covid-19
