World Covid 19 Vaccination

by
Robert Waldmann
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I am mainly linking to this fairly important article by Dan Diamond in The Washington Post. Diamond quotes many people arguing that the US really should do more to get everyone in the world who is willing to take the vaccine vaccinated. I am going to move on quickly to how this could be done, because I think it is obvious that it should be done. I think I will try to get a few silly things out of the way.

What about other rich countries ? Is it reasonable to act as if the US alone should do this ? Other rich countries aren’t doing enough, so yes it is reasonable to act as if the US should do this. Yes it is equally reasonable to say that Japan, Germany, France and the UK each should do this, but Angry Bear readers are mostly in the USA. Each of the listed countries could manage it, and each won’t.

We have problems of our own, why focus on problems in other countries ? OK that’s a silly straw man. Obviously a convincing case for doing whatever it takes to get the world vaccinated can be made entirely based on not even especially enlightened self interest. The virus doesn’t care about borders.

“It sounds like you have a SMART goal” — Karen Kraco. Huh ? It stands for specific, measurable achievable relevant and timely. OK so I have specific “everyone who is willing to take a vaccine is vaccinated” looking at the “A” revise “everyone” to “95% of those”. This is easy to measure and obviously relevant. I will focus on “achievable” but should specify a time. I’d say achievable by July 4 2022 (which is way too late but, you know the A is big). I must add (so that it is relevant) that I mean vs wild type and omicron (vaccine containing a mixture of RNAs).

OK that written, I find two numbers in the article which seem to me to report a gross idiotic policy error “Altogether, the White House has committed more than $1.6 billion toward global vaccine efforts, including last week’s announcement of a new $315 million initiative overseen by the U.S. Agency for International Development.” Yes the second number is million with an m. In much of the current US policy debate, mere billions are overlooked. The US has spent over 5 trillion ameliorating some of the side effects of the pandemic. An announcement that the only effort which might end the pandemic has an additional $315 million should be a joke, but it isn’t.

I assert that the problem can and should be solved by throwing money at it, provided the amount of money isn’t miniscule compared to the problem. I think it is obvious that the budget for the effort should be, at least, tens of billions. I guess I have to answer a few questions.

First, how can the problem be solved with money ? The amount of vaccine being manufactured is insufficient. The factories producing vaccine can be copied. Building copies quickly costs more than building them at a normal pace. So? The vaccine is not pure mRNA. In particular, the nanoparticle includes a very special lipid which binds RNA when outside of cells and releases it when inside cells. To rapidly vastly increase production of this lipid would cost a lot of money (including maybe building new factories from the ground up). so? These are problems which can be solved, and which can be solved a lot more quickly if one gets over the idea that “a billion here a billion there and soon you’re talking real money”. This is not true if you are writing a budget for the US government, you don’t get to real money soon at all if you are spending a billion here and a billion there.

The mRNA vaccines have to be kept either very cold or very very cold. So I find another absurd number “Biden officials also pointed to targeted initiatives in dozens of nations around the world, such as USAID helping deploy ultracold freezer trucks to safely transport shots in Bangladesh,…”. “dozens”?!? there are 195 countries . Why dozens not 195 ? The freezers require electricity which is not reliably available everywhere. Am I proposing a spare truck carrying a generator in case the freezer truck needs power and it is in a failed state like, say, Texas ? Well yes I am. WHy not ? Is the expence a significant problem for the US Federal Government ?

The next clause in the article “or experts from the Centers for Disease Control and Prevention training workers in Belize to administer shots.” “experts” ?!? “training” ?!? I don’t think it’s that hard. I list 1) must be kept very cold, after opening this package you have n hours before you have to throw it away. 2) ask these questions — don’t inject if an answer is yes. wash skin with antiseptic first. shove it in an upper arm muscle. Wait 15 minutes. If anaphalacctic shock use this epi-pen and get to a hospital if there are any in this country. I don’t see enough of a need for expertise or a training program which lasts more than a day to justify whatever they are doing. Here consider costs and benefits. How many people die if the campaign is delayed a week compared to how many people die if the training is rushed (I think the expected value of the second number is less than 1).

Now I want to discuss something other than throwing money at the problem — intellectual property. “U.S. trade office has held more than 50 public and private meetings since May in an attempt to reach international consensus around waiving intellectual property protections for vaccines, an official said.” OK I guess there is no harm in doing this, provided the US government plans on nothing at all being achieved at these meetings. Yes it would be better if intellectual property protections for vaccines were waived. This is also not likely to happen, and it would be crazy to count on it happening. I think there should be a plan to get a vaccine in everyone who wants it by July 4 2022 assuming no waiving of intellectual property protections at all. It is best to plan for the worst while hoping for the best. It is not a good idea to wait for diplomacy to be completed unless it is necessary to wait.

There are two ways to get the job done without any waiving of intellectual property rights. One is for all of the new factories etc to belong to the current patent (and trade secret) holders. This implies giving billions (or tens of billions) to firms which are doint very well already and a completely un-earned winning lottery ticket to their shareholders. so what ? Is that worse than hundreds of thousands of un-necessary deaths ? Another throwing money at the problem solution is for the US Federal Government to buy the intellectual property. This would not just be patents but also trade secrets as in anything any Moderna employee knows which is useful to the US Federal Government must be told to any of these listed authorized US Federal Government employees. How much would that cost ? Would Moderna, Pfizer & BioNTech (joint owners) say no to $10 billion ? Would coming up with the 20$ billion be a problem for the US Federal Government ? What would be wrong with that ? How wrong compared to hundreds of millions of preventable deaths ?

Now on another topic. I am sure that a 95% vaccination program achieved by the US Federal Government throwing enough dollars at the problem should be done. I am also sure that it won’t be done. Why not ?

1. The US Federal government can’t afford it. Obvious nonsense. The US Federal Government had no problem with $ 5 trillion extra spending over the past 2 years. The amount required is negligible compared to the amount (more extra in addition) that the US Federal Government could borrow with no detectable problems.
2. This is foreign aid which is politically toxic. I think this is a large part of the problem. It is well known that foreign aid is extremely unpopular. I hate that fact, but clearly this is different — fighting a pandemic disease serves narrowly defined US interests. Still I think this is the key issue.
3. It would require a huge shift in the ratio of say the AID budget to other budgets, a huge shift in money appropriated starting with this committee not that committee. I am sure that this makes it difficult, and I am sure that this should not make it difficult.
4. Speeding things up implies costs including extremely furstrating costs such as starting something then abandoning it unfinished, paying huge unit prices for some component in short supply, and paying high salaries to people who one wants to hire for a few months then lay off etc. That sort of cost is called inefficiency when it is not called waste, fraud, and abuse. There is much more distress over a $ billion which, with the benefit of hindsight, could have been saved, vs a $ billion which, with the benefit of hindsight had to be spent. But there shouldn’t be. The cost is the same (and in both cases negligible compared to hundreds of thousands of preventable deaths).
5. It is unfair for one country to bear the whole burden. Here other countries doing what they should would save the US Federal Government tens of billions. Again a cost from someone free riding is infuriating in a way which an unavoidable cost isn’t. Again dollars are dollars.
6. Greedy pharmaceutical executives will get even huger bonuses than otherwise as their firms will get even huger profits because they didn’t do the right thing. Again so what ? Again dollars are dollars. I am sure that this is an important consideration to many people (including many of the extremely admirable people quoted in the article). I am also sure that it shouldn’t be.

I think I have proposed something SMART which should be done and which won’t be done. I think this is interesting also aside from the hundreds of thousands of lives at stake in this particular case.