Read on Twitter
I’ve been thinking a lot about vaccines lately (in case my twitter feed wasn’t a major clue). Threads on COVAX and domestic supply are here:
https://twitter.com/ldobsonhughes/status/1357862123691528194
https://twitter.com/ldobsonhughes/status/1356982505044279297
https://twitter.com/ldobsonhughes/status/1357715079903461385 https://twitter.com/ldobsonhughes/status/1357477907292168192
https://twitter.com/ldobsonhughes/status/1357862123691528194
https://twitter.com/ldobsonhughes/status/1356982505044279297
https://twitter.com/ldobsonhughes/status/1357715079903461385 https://twitter.com/ldobsonhughes/status/1357477907292168192
But all our discussions about vaccines sit within a bigger, fundamental point - the way we research, fund and make pharmaceutical products, especially for global health - is completely broken and results in perverse, unethical behaviour
All the weird, unethical, short-termist, trade war behaviours we’re seeing from rich and poor countries is them imperfectly trying to protect their interests and navigate a fundamentally broken system
The pharma system is not fit for purpose. It produces short term, nationalistic, immoral, and downright weird outcomes, as each country tries logically and rationally within their own borders, to navigate it. It prevents collective action that would better us all
That’s not to absolve countries from doing the right thing. But the system makes that very hard. We’ve essentially outsourced moral and ethical questions about who gets lifesaving medication, to multinational for-profit pharmaceutical manufacturers
Rather than coming together with collective solidarity on COVID vaccines, we’ve descended into an ugly, domestic politics above all, who has the most trade levers, who funded what R&D, who can place most pressure on pharma, game
Theoretically, there is enough supply to vaccinate globally in stages; essential workers and congregate settings first, no matter which country they’re in. Ideally, we’d have pooled our funding and all purchased through COVAX. That way, nobody gets played off each other
Ironically, the time when we most needed global solidarity to fund and share Covid vaccines, was the time trust and leadership needed for it was in shortest supply. We can't underestimate the impact of global relations on the situation we find ourselves in now
Knowing total collective action was a pipe dream, Covax tried to manipulate the system for the better, while changing behaviours and incentives in it. Fine, rich countries (HICs) want bilateral deals. In return, they will fund some R&D and infrastructure, so it’s a decent trade
But Covax will bind HICs in with poor (LMICs) with an incentive scheme to prevent HICs doing so many bilateral deals they use all the supply, while harnessing their capital and purchasing power for LMICs. Everyone wins and we avoid a stupid vaccine war where the poor lose
It was in many ways a genius but uncertain calculation. If all HICs agreed to do bilateral deals for just 80% of the population, we’d have been grand. But it was prisoner’s dilemma. Nobody wants to be the idiot who didn’t secure enough supply then gets annihilated domestically
Once one country started making excessive bilateral deals, they all did. Which undermined the collective purchasing power of Covax as well as hoovering the supply, and leaving pharmaceutical companies making the moral decision on who gets lifesaving vaccines
And it’s so futilely short term and domestically focused. The fact is, if the rest of the world doesn’t vaccinate til 2024 cause HICs had a trade war over weekly delivery schedules, we will see further covid mutations where current vaccines aren’t effective
We already have 4+ mutations in a year. Thankfully, current vaccines seem to work for them. There’s a real risk if we don’t vaccinate equitably, of mutations that don’t respond to current vaccines. We’ll have spent hundreds of billions of dollars on vaccines that no longer work
