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Transcript
Rob Johnson:
I’m here today in light of the very distressing developments in India that continue around the world with Arjun Jayadev, who’s a member of the INET family for a very long time and a professor at Premji University in Bengaluru India. And we’re here also with Achal Prabhala, who runs AccessIBSA, which is an activist organization, and a very sophisticated organization about the dissemination of medicines in places like India and South Africa. And has, in my opinion, great insights about what kind of intellectual property rights regime would facilitate the common good, rather than the profitability of narrow segments of production. So thank you both for joining me gentlemen, I think this is a very stressful and critical time.
Arjun Jayadev:
Thanks Rob.
Achal Prabhala:
Thank you.
Rob Johnson:
So Arjun, let’s talk about what might have inspired Joe Biden, the scale of the emergency. I know John Carey was down in Delhi for some time just before, but what inspired this change in the regime of honoring intellectual property rights that was grounded in India?
Arjun Jayadev:
So thanks Rob. I think the Indian case has really shown what can happen if you do not really think about vaccines and medicines for all during a pandemic. When you have something that’s obviously a public good, a global public good, which is global health, when it’s treated as if it’s not a global public good and treated as a private commodity, what kind of hell can break loose for the whole world. Just for context, as many of you and many interviewers will know, India has been having daily new cases of over 300,000 a day for at least two weeks now.
And that’s a vast underestimate of the infection rate, everyone thinks there could be an order of magnitude higher. And on top of that we’ve had recorded deaths of about 4,000 a day at this point, which is again possibly very, very highly under counted. So this is a situation which could happen to any country which doesn’t have vaccination roll out fast enough, and of course there’s also the concern about mutants and mutant strains which can evade the kind of vaccines that are already there.
So in some sense, India is if you will, the canary in the mine of what could happen if you don’t actually treat medicine and vaccines as a global public good. I should say the Biden administration’s decision wasn’t really simply just about Indian cases, it’s been coming after very very long I think public health battle, which really started I would say last year when a lot of activists, people like Achal, but huge number of people across the world who I think quite early and correctly diagnosed the fact that you need to maximize the potential for everyone to get a cure or vaccine and to share that knowledge. So there was a push for common technology access pool that was shot down, and then there was pressure brought to bear through the WDO by India and South Africa to have a regime in which IP was suspended during the pandemic.
And we can talk about why it was necessary, I happen to think it was an extremely necessary step, but not a sufficient step. But I’m sure, to whatever extent the Indian context may have helped precipitate some changes, it was only one of a set of pressures that were brought to bear in the Biden administration. But be that as it may, it’s quite momentous, it’s quite remarkable. And people like Achal or even me who have been working on this for many, many years are quite pleasantly surprised that at least we’ve reached this point. Where we go from here now is the key question.
Rob Johnson:
Achal, at this juncture in India, I gather your awareness of these processes of the basic science, the development, the dissemination structure of intellectual property rights, negotiation across countries, all of these things we can fill in. But what created, in your mind, the distress? What was the failing in the system’s design that was previously implemented that brought this crisis to such, you might call, profound level?
Achal Prabhala:
Rob, one useful thing we could do is go back to last year. And in fact, Arjun, you and I had a conversation last year, it was a little later in the year. But when we talked there was a different atmosphere. And I think in exactly the same time last year or a little earlier actually, March last year when the pandemic was declared, I remember thinking at that time that my job was to try to make sure that whatever exceptions we created for this pandemic would survive the pandemic itself. Meaning that they would apply to epidemics, an epidemic is a massive health problem in a country or in a set of countries and a pandemic is when it’s global.
And so that we’ve had in the past problems with HIV/AIDS epidemics or Hepatitis C epidemics, and they’re never treated in the same way because they happen in poor countries or they happen in a few countries. And so I thought that of course we’d have a whole range of exceptions for the pandemic because this is something that’s affecting the economy catastrophically. At that time last year it was affecting lives in Europe and United States enormously. And it didn’t seem like the same kinds of solutions that had not worked for other life saving medicines would be promoted in this pandemic, because they didn’t seem like a solution.
And then very quickly last year I think I realized that not only would I not be fighting for exceptions to be made permanent, I would be fighting and we would all be struggling to get any kinds of allowances within the space of the pandemic. So this wasn’t going to be treated any differently, but in fact was going to be a little worse. And this became clear towards the end of last year when Pfizer and Moderna rolled out their vaccines. When it became very clear that there was an enormous outpouring of goodwill towards these companies for bringing vaccines so quickly to the market, raising some of the billions of dollars in commitments that they received from you essentially Rob, the US taxpayer, or from the European taxpayer.
And then somehow turning this into a miracle of private capital and private enterprise, ignoring both the fact of the public funding that went into these vaccines as well as the fact that these companies were serving very few people beyond the 20% who live in the richest countries on earth, who they were supplying vaccines to, and they still are by the way six and a half months down the line. So this became an extraordinary problem. So the original sin really goes back to the 1980s, unfortunately.
And it’s that horrible, meaning that that’s really when the events were set in motion for what we see today, which is not just the allowance of a privatization of essential life-saving pharmaceuticals despite public money being used to create them, but in fact an encouragement of it. Meaning almost like a way to provide cover for what happened in the 1980s in the United States, an idea of Reagan-esque small government, which almost means that you have to obscure the public funding that was going in to keep the private pharmaceutical industry running.
Which is exactly what happened, and that intensified and I think what we’ve seen now is a culmination of that. We’re at the peak of that idea, that regardless of what taxpayers have contributed once towards a vaccine, they will contribute again to buy that vaccine and will have absolutely no say in who gets access to that vaccine outside the United States and Europe. So it’s actually being denied, we don’t have of course Pfizer and Moderna vaccines here in India. I’ve been warned, probably for a long time. But the point is they’ve been denied to us on your behalf without your participation. I don’t think you, Rob Johnson, want Arjun and I not to get these vaccines. And yet that is, in effect, what’s happening.
Rob Johnson:
On the contrary, yeah.
Achal Prabhala:
Exactly. Now, I think that there were a couple of things that happened last year which I think went really awry, and we didn’t pay enough attention to them while they were happening. So while a lot of people were screaming and shouting for public solutions and for common technology pools, and for other kinds of cooperative efforts that would create vaccines, what happened was that the enormous sale of investment by the US and EU into the pharmaceutical industry to create these vaccines meant that the Western vaccine manufacturers had an edge over even Russian, Chinese, and Indian manufacturers, not to mention Cuban and Vietnamese and Thai developers of coronavirus vaccines as well.
So what happened last year is that among these eight or nine vaccine candidates that looked like they were the leading ones, only two created any semblance of access outside this 20% of the world. And those two were AstraZeneca and Novavax. And we know what happened after that, AstraZeneca came to market not yet in the United States by the way, but in the US and in Europe. And Novavax is nowhere near coming to market. So essentially what I will call the kind of philanthropy industrial complex did was to set up a means of access for 500 million people, which is a billion doses, spread across, however, 92 countries with four billion people. So it’s the equivalent of flinging one vaccine in a room of eight desperate people, and then kind of wondering why it’s not working on well.
So that’s exactly what’s happened, is that there’s been a mad scramble for those one billion does. Now, with India it’s even more complicated because we’re producing all of them, they’re not for us. They were never for us, 50 to 60% of those vaccine does were contracted to the other 91 countries who were depending on them, who have not got any of them. So despite all of the bolst of essentially the person who runs this philanthropic industrial system, Bill Gates last year, that the COVAX facility, which is this oddly cobbled together mechanism of the World Health Organization, something called Gavi, which is the Vaccines Alliance, an organization that gets founded.
And the genuinely ridiculously named Coalition for Epidemic Preparedness Innovations, which honestly just makes me wonder who thought of it each time I say it, put together this plan where they promised poor countries that they would save them, that they had their backs. The plan then downsized towards the start of 2021 and they decided to say, instead of saving everybody completely, they would provide enough vaccines for 20% of the population of these poor countries in this year. And now we’re in May, we’re almost in the middle of 2021, and the number of vaccine doses that the COVAX facility has actually sent countries like Nigeria or Ghana together is in the region of about 40 million doses. 10 million doses of which actually the Indian government took back.
Since about the March the Indian government has stopped the export of any vaccines, so we’re essentially taking vaccines that don’t necessarily belong to us because we can, they’ve been produced within our borders to serve the needs of the insanely horrendous surge and new cases and deaths that we’re seeing in this country and living through. And an astonishing combination of incredible growth, criminal incompetence on the part of the philanthropic system in conivance with the Western pharmaceutical industry. And on this side at home, the equally criminal incompetence of the Indian government, which had absolutely no right to wait until January of 2021 to seemingly discover what the Indian population was.
We now have a situation where not only does India have no vaccines, it took me eight hours two weeks ago when we still had some vaccines to get my parents an appointment for their second dose. Not only do we not have vaccines, but also there’s no other country that was relying on those vaccines having any. And now the estimates are that they won’t get any until the end of this year. So if you’re Nigeria or you’re Ghana you’re stuck with enough vaccines for just 1% of your population until the end of this year. So essentially it was this unbelievably calamitous meeting of mutual incompetences which created the mess that we’re in today.
Rob Johnson:
Well let me try to disentangle things for our audience here just a little bit. People can talk about what is needed in full scope and what are the blockages, one might be not recognizing the needs or they’re late to the game. Another might be intellectual property rights protection, if that was suspended much earlier the breadth and dissemination, both breadth and depth within any region would be much higher. Then there are other things like people’s fear of a new vaccine. In some places people won’t take them. But it seems to me, I guess the last would be the gestation period for production. Is it on the way but late, but will reach scale? So in desegregating where the blockages are, what do you see as central to the failure thus far?
Achal Prabhala:
So Arjun and you just talked about the TRIPS waiver that Biden, the administration signaled its support for. Now, that TRIPS waiver was proposed by a very talented South African diplomat with the support of the Indian delegation to Geneva, to the WTO in October. Arjun and I actually wrote about in the New York Times about a month later. For the Biden administration to signal the support for beginning talks for a narrower scoped TRIPS waiver proposal in May, it’s sort of observed that we are celebrating that. And I was too, but the fact is that it happened six months after the demand was made in a pandemic in which 4,000 people are dying a day in India, and 15,000 people are dying a day worldwide.
And in this pandemic, not only is that TRIPS waiver being narrowed down, much more than it needs to be. And I’ll tell you why this is important, so the Biden administration wants the TRIPS waiver proposal, is supporting it only as far as vaccine patients go. Now the problem is that you have treatments for instance, which are also patented, which seemingly the Biden administration doesn’t want to cover. You have downstream patents on equipment to make vaccines which are patented. Now is that included in a vaccine waiver? We don’t understand. And nobody understands that.
Now the other aspect that is a little perverse about it is that they’re saying that we will have a text to study by the third of December. So what they’re essentially saying is these are extraordinary times which call for extraordinary measures, and given the urgency of the 4,000 deaths a day in India and 15,000 deaths a day worldwide, not only have we taken six months to respond to this extremely reasonable proposal, we’ll take another six months to decide how to move it forward. And you can just imagine what this sounds like when you’re like Arjun or I who are actually living through this insanity.
Achal Prabhala:
So the situation is this Rob, in a nutshell to go back to your original question, is that we simply don’t have enough licenses for good vaccines that we know work in the world. And that’s for a combination of two things, there are good Russian and Chinese vaccines, one of which the Sinopharm Beijing vaccine, which is a vaccine produced by a state-owned Chinese company just received something called WHO Certification. So the WHO runs a scheme by which they evaluate vaccines around the world and then provide a global safety and quality certificate, for lack of a better phrase. And they just did that with one of these Chinese vaccines.
But the Chinese and the Russian vaccines suffered all of last year from geopolitics essentially. And so they were hobbled right from the start by accusations of political meddling and influence and not working, and just a range of other things which personally outraged me. Because I thought that whatever you feel about the incredible injustices that the Chinese government and the Russian government keep upon LGBTQ people in Russia or among others in China, we have to have a rational understanding that vaccine efficacy is a question of science and is somewhat separate from the the state. I feel like I don’t associate the Moderna and Pfizer vaccines with Ivanka Trump. And in the same way I would ask that, I think that this Sputnik V vaccine should not be associated with what Vladimir Putin is doing in Chechnya.
Now, that didn’t happen though so they were hobbled. Yet, what they did was to make in middle income countries, as well as some poor countries. So vast sways of the world, 30% of the world, all of Latin America and North Africa, the Arab states, the reason that they’ve survived this entire year is because of Chinese and Russian vaccines, that is the only reason that they have any semblance of normalcy. And in fact the only thing saving Brazil from almost total apocalypse is Sinovac, which is the other of the Chinese vaccines that’s up for approval at the WHO this week.
So those vaccines were hobbled, and yet because they offered their technology including to companies of India and the United Arab Emirates and elsewhere, there are a range of different vaccine manufacturing sites that sprung up around this available technology. The hunger by both governments who suddenly recognized the need to have the security of vaccine production in their country, as well as private capital around the world which recognized a commercial opportunity in these vaccines meant that you now have one of the four Cuban vaccines being developed under production in Iran.
So there’s this range of unprecedented partnerships and a whole new vaccine manufacturing movement. The Western vaccines were completely excluded from participating in these benefits by the people who hold their monopolies. Now, if they were to open up in the same way as the Chinese and Russians have, you would see an even greater interest. Because fairly or unfairly, they’re more desirable, everybody wants a Western vaccine including in non-Western places like where I live, or Russia or China. So the reason that they need to do all of this faster, including the TRIPS waiver, is that that is complicated.
The way I think about it is that they need to share the vaccine recipe, but the vaccine recipe consists of two ingredients. And the first is just the legal rights to make the vaccine. But the second is a manual as to how you make the vaccine, the vaccine technology. There’s a third problem in this pandemic, which is that all raw material suppliers and equipment suppliers have suddenly found that they have to cope with unprecedented demand. First to supply Western companies, and now to supply more and more people who are making these vaccines. So then there’s a third problem which has to be sorted out, which is to work with raw material suppliers and equipment manufacturers in the vaccine supply chain to increase potential supply, to identify alternatives that can work just as well.
So nothing is impossible, but it just has to be worked upon. And all these three things have to be worked upon immediately. If they were however magically solved tomorrow Rob, so just imagine that we could magically create this momentum tomorrow and get technology transferred let’s say between the Biden administration for the Moderna and J&J vaccines, which they funded 100%. Then we would have the billions of doses that we needed in four or five months. Short of that happening however, we’re pushing out this solution and our exit from this pandemic fatally every single day and week that we delay this solution.
Arjun Jayadev:
Archal’s absolutely right. You asked what are the constrains, Rob, and I think this is a complex problem. There are many, many constrains. Now, the obvious solution is to release all of them. I think one of the things that people argue is that it’s not enough to do an IP waiver or it really doesn’t matter, but the point is that all of these are constraints, all of them have to be worked on. What also seems fairly obvious to me is that this is a situation in which the normal expectation that a price mechanism will do it is just false and wrong. It’s a situation similar to a war situation in which you actually need to bring in resources [inaudible 00:23:39] but quantity and not about prices and so on.
It’s interesting that within the Western countries, let’s say the US or the UK, they were able to take on that view that it was a war. There’s lockdown, there’s the Defense Production Act that’s brought into place. But there’s somehow a lack of ability to realize that this is a global problem and it has to be fought on that front. And that I think is really central. So all the constraints have to release simultaneous, to sort of buttress what Achal is saying.
Rob Johnson:
In the question of the manufacturing, the building of plant capacity, what is involved there Achal, what do you have to construct in order to, if you have the manual and the property rights produce things?
Achal Prabhala:
So one of the interesting things that’s going on Rob, which I’ve been trying to battle against is a number of people within the pharmaceutical industry who are saying that these miraculous Pfizer and Moderna vaccines which use the revolutionary mRNA technology is so new that they’re harder to make. So mRNA is this new vaccine technology that’s the basis of the Pfizer and Moderna vaccines, and the interesting thing about it is that it’s not like the older vaccines because it doesn’t have biology. So the squiggly things, the viruses and the proteins that we put into all vaccines that we’ve had so far are absent in this mRNA vaccine, it’s a chemical product.
Now because it’s a chemical product, it’s actually easier to make. It’s faster to make and it’s cheaper to make, unbelievably. So the most advanced vaccine manufacturing that exists in the West is actually the simplest. Now, that’s not the impression you’ll get if you were to listen to the makers of this vaccine or other people in that ecosystem, but it’s still true. Now the people who can make this vaccine and have that capacity, they would need guidance, they’ve never done it before. So they’ll need a little help, they’ll need the manual. Those companies in India, they number over 200 because any pharmaceutical company that makes chemistry, chemical pharmaceutical, but also makes injectable drugs has potentially the capacity to make a mRNA vaccine.
The older vaccines for instance, any firm in India that makes biologics, which are a category of complex pharmaceuticals that include vaccines can make a vaccine, whether or not they’ve done so before. And in fact that’s what’s happening in India at the moment, there are six firms who are simultaneously making the Sputnik V vaccine from Russia, which is exactly the same platform as the Johnson & Johnson vaccine. Now the Johnson & Johnson vaccine would be much better for us, why? Not because it’s Western and people might want it more, it’s a one dose vaccine. So in poor countries that saves you such an enormous amount of time. Now we would love to have that, we know that there are firms capable of making it because we know who’s making the Sputnik vaccine, and that’s dozens of companies. Kazakhstan is producing the Sputnik V, Rob.
So just to give you an idea, nobody in the world until now thought that they should be getting vaccines from Kazakhstan, but you can. So this idea of capacity as being some kind of static thing unless you have a huge factory that has a neon sign saying we make vaccines, that it doesn’t exist, is really bizarre the way that it’s banded around. There are lots of companies who have the potential to make older and newer vaccines and are doing so. There are 24 registered vaccine manufacturers in this country, sorry there are 21 actually in India at last count. About three of them at the moment are engaged in COVID vaccine production, why? We should have many, many more of those companies making as many vaccines as possible if we are facing a shortage and others are.
The more we can solve this shortage in India, the more we solve shortages elsewhere in the world. We just sort of ease up the supply chain everywhere. But lastly, it’s not just India. So this is true in Turkey, this is true in Brazil, this is true in Indonesia. All of these countries have these private public partnerships making Chinese or Russian vaccines. They’ve been doing this over a year now. So there’s lots and lots of capacity that’s literally been woken up from a slumber around the world, now the US government just needs to give it something to do.
Rob Johnson:
Yeah, there’s a lot of economics here and I want to start with the place that you might call furthest away from the distress in my heart, which is just a simple question. When these pharmaceutical companies try to constrict dissemination when the demand worldwide is so urgent, and it’s spawning more laboratories in different countries around the world, aren’t they shooting themselves in the foot? They’re trying to squeeze everybody in one game and they’re creating a whole world of supply competitors in the medium term. Isn’t that a foolish strategy on their part?
Arjun Jayadev:
So this is interesting thing, so the question is why not just license, why not hold control and for example license your drugs out, is that what you’re saying Rob?
Rob Johnson:
Yeah.
Arjun Jayadev:
So I think there’s a couple of things here Rob. The first is, just from pure economics principles, once the first copy of the drug is made, social welfare is maximized if you then can produce at cost. So prices equal to margin of cost, this is an extremely mainstream argument, I think nobody would argue with that. The whole question is how do you socialize or make up for that first copy cost? And the answer is, it’s already been done. With Moderna we paid for the first, American taxpayers, whoever.
Rob Johnson:
Taxpayers or yeah.
Arjun Jayadev:
Rob, you. So that has been done. So in that sense there’s an obligation from a social welfare perspective to really open it up to competition. There’s absolutely no reason for us to be paying twice in that sense. Similarly with Pfizer and advanced market commitments, there’s a way that the first copy costs have already been handled. So now the question is, how do we maximize production? Clearly there’s a reason to hold onto intellectual property because in some sense, remember the drug companies, and actually you can correct me if I’m wrong on this, but the decision on when the pandemic ends is not something that we really have full control over. And if they decided the pandemic ends in June and they retain the IP, when you need a booster shot and so on, they certainly want to continue to have control over that.
Now the question of why not license? This is an interesting question, from what I understand there have been newspaper articles where people have reached out but there’s been no interest in licensing. And that’s something which I don’t have full knowledge about and maybe Achal can speak to that. But one of the things that the companies say now is the constraint is not at all IP, it’s really our technological expertise and so on. And our common friend Dean Baker has a wonderful retort to this, he says, “Here’s what I do. I’m going to pay the Moderna engineer, chief engineer and the Pfizer chief engineer $1 million a month, just tell us what the technology is.” And do you think that technology won’t be up and coming three months after that?Arjun Jayadev:
So in some sense this is, as Achal said right at the outset and I still believe, we’re still living with the remnants of a system that was really extractive, really nasty, and set for a different world, and we’ve not been able to move quickly enough into this world. So that I think is the problem, Rob, in terms of economics. We’re fighting with the tools for the wrong economic system.
Rob Johnson:
The other question I had that pertains to economics comes is crystallized in an adage that Mohamed El-Erian offered to our global commission, he said essentially, “This is crazy. None of us are safe until we’re all safe.” And I think of things like, what is the lobbying enterprise for the airline industry doing? Because the pharmaceutical constriction, the lack of spread is shutting down the airline industry for even longer and deeper because people can’t travel. It’s that global flow that we had is not going to be present as long as people are terrified. I look at the public good, you said me as the taxpayer. I pay for this thing.
Well I want to pay for this thing and be protected, not pay for it, get some shots, and then watch the whole world met and watch variants created and come back and get me even though I’ve got it. So there’s a disservice that’s being done by not recognizing that this is a public good. As you’ve said it’s not an epidemic, it’s a pandemic, but it’s not private property like thing. It’s about we, not about me. Why can’t we sell that to the world? Maybe you got to be taught the hard way, but isn’t this relatively obvious?
Arjun Jayadev:
So Rob, this is a time when maybe you can talk about your favorite poem by the other Muhammad. So maybe you can just say that and then… What was it?
Rob Johnson:
Which one?
Arjun Jayadev:
By Muhammad Ali.
Rob Johnson:
Yeah, me we. I said that’s the pendulum in which all social science exist, me we.
Arjun Jayadev:
So yes, I think that’s really profound in that sense. Especially in the sense of clearly something which has positive like a vaccine, we really really want to scale up as much as possible. And clearly, the loss of welfare or just money if you want to talk about that, just crudely is orders of magnitude above anything that we’re talking about in terms of costs. So yes, clearly from an economic sense and even from a welfare and ethical sense, we need to think about this as being we, not me. I think that as I said, the systems that we have in place, takes time for systems to change. And unless there’s pressure, there’s no reason for people to change.
But I have to say, and this is something that we’ve known historically, there is a certain sense of concern that people often have only for their smaller circles. So there’s a belief, and you can see already from the CDC having their mask removal thing that the West is done with it. So we’ll get to the rest of the world when it does. And selfishly for them I hope that’s true, that there are no variants coming back to haunt them. But we can’t be sure about that. Similarly let me just say in India, we often take a look at the cities, of what’s happening in the cities and we say, okay the city’s numbers are going down. But what’s happening in the rural areas is apocalyptic right now. Villages are being wiped out, we know this. So it’s a question both of economics and also expanding our moral sensibilities.
Rob Johnson:
Yeah. Achal, what are your thoughts?
Achal Prabhala:
There’s a funny thing going on, which is about four months ago when the Pfizer and Moderna shots came out, Pfizer actually applied to India for a license to sell its vaccine here on the private market. They were denied that on the grounds of the India government at that time wanting them to run a small trial, and they refused. But I remember having a talk with a very wealthy business man who said, “Look, what’s wrong with getting all the wealthy people vaccinated through the Pfizer vaccine if they’re willing to sell it here?”
And the conversation I had with him I think at that time was to plead the case for the fact that, when you have a health system that works for both rich and poor people and everyone in between, then the rich people because of the pandemic anonimity that they feel in a country like India, at bad service or at a bad system, actually work very hard to make that system better for everybody else. So the moment you create this super highway for wealthy people to be vaccinated in this country, you’re going to have a much worse public health system that is not being in any way monitored by middle class and rich people because they’re not participating in it.
So I think very much the same kind of feeling that is what we feel about in terms of us not getting enough vaccines. So we have about 3% of our population fully vaccinated, as compared to about 30% in the US and the UK, which are now returning to normalcy slowly. But the same kind of injustice that’s been heaped upon India by having the United States vaccinate itself fully before anything else happens is also a feeling that many wealthy class and middle class people would prefer to have within this country in India. So I think it’s quite a natural tendency, this idea that if you can take care of yourself, whoever yourself is and whoever we are first, then it really doesn’t matter when we get to the next lot.
In terms of the boosters and variants, I really wish it were true that there is a grave threat facing the United States or the UK from variants that come out of unvaccinated populations. But I think that the reality might be a little bit more sinister than that, which is that I think there is a mild threat, and that mild threat will actually be met by continued demand for boosters and reformulated vaccines that Pfizer is already in the business of selling in large quantities over the next three to four years to countries like the US and the EU. So in a way weirdly, the fact that we’re unvaccinated in India and elsewhere is actually a very good future profit signal for companies that make vaccines in the West. This is very perverse, but it’s true.
Your point however Rob about the airline industry for instance not getting into the game to fight for global access to vaccines is incredibly strong, I’d really never thought of that. But when you think of the stronger economic interest outside the pharmaceutical industry for global vaccinations, just in terms of having their economy run again. Because okay, let’s take Emirates Airlines, great for them if the US and Europe have a travel bubble over the summer holidays so that people who are equally vaccinated in societies where we have vaccines can then mingle together and fly those airlines. But what about the rest of the world? They’re going to have no business essentially in the parts of the world they probably earn predominant revenue from. That would go for all airlines including Western airlines.
And so that’s an incredibly interesting argument as to why the other industries, because there are lots of really powerful industries, except for maybe Silicon Valley, which doesn’t really care I suppose and in fact probably wants us to have a pandemic a little longer so we all watch a little more Netflix and buy things. Sorry, I’m just being perverse. I don’t mean that they actually do, but I’m just saying that maybe it is in the narrow short term, long term, economic interest of the largest section of the economy, the largest section of the industrial economy for every one of us to get vaccinated. And that’s not honestly something that I thought about from that perspective, but yes I don’t know why they’re not asking for it more, seriously. It’s a good question, it’s a really good question.
Rob Johnson:
Arjun, do you have thoughts in this realm?
Arjun Jayadev:
I think Rob, again I think to whatever extent we think about these things, we underestimate inertia. And just the fact of longstanding networks, we know about the lobbying networks, we know about just how powerful that particular lobby has been in the US forever. So it would be naïve to assume those networks would dissolve overnight. So in that sense, there probably is a sort of strong real politic going on behind there that we don’t have full understanding of. Someone like Tom Ferguson would probably be very clear about something like this. That may be some of it, so combination of inertia, combination of existing networks.
I do think though that the larger pivot that we’re going to have to get to at some point or the other is that if we do want to think of ourselves as a global economy, we really have to start moving into thinking about global public good. Again, we were talking about like cyclone and climate change. There’s going to be so many of these things coming at us in the next 10 years. And hopefully this will be… We talked about hope and diagnosis, hopefully this will be a place where actually people realize that you really can’t go it alone beyond a certain point. So that’s where I would sort of lead it.
Rob Johnson:
It’s almost ironic to say that perhaps the pandemic is unmasking things. It is clearly the case that the inadequacy of what I’ll call our mental habits, which inform our structures and our institutions, and some of that resistance to change are still quite in the way. The idea that, in America I’ve always been quite unsettled by the notion that freedom is to carry a weapon. But there’s no counterbalancing freedom to be unafraid that you can shoot me or protected from that. So that’s this me we dilemma. But the idea that somehow, lawyers are talking now about when people go back to work that you can’t ask people to be vaccined. Well, you can’t ask them not to be higher risk to all their colleagues?
I just don’t understand how habit interferes with the vision of the challenge that’s before us. But I’ll refer to one of my earlier podcasts, a man named Eugene McCarraher, he wrote a book called The Enchantments of Mammon. And how after science and decentralized societies, we might call displaced religion as the focal point, that we kind of sacralized markets as this structure that leads to individual autonomy and just rewards, and all these kinds of things. I guess Arjun, when you write your textbook, you can’t have externalities and public goods being a footnote in chapter 37. This is front and center. And I think climate change, it’s also front and center.
That’s why I said kind of being silly, an unmasking, as we’re all asked to wear a mask, we’re unmasking the flaws in our social concept. And I think the work that you do Achal is such a bright light on the specifics of the failings that are unfolding right now. I think it’s very important to illuminate and it’s very important to go beyond. INET I think is in the world of challenging the resistance of thought to evolving. But there are a lot more pieces to it, related to activism and related to political representation and related to understanding in the depth that you do, what’s happening in this particular case. It’s kind of institutional economics.
Achal Prabhala:
I find that it’s very, very personal now Rob. So for both Archal and I and literally for anybody living in this country, it is impossible for this not to be very, very personal. I counted that there were three days in the last month where I have not received notice of the death of someone I either knew or loved very much. And I mean this sincerely, this is not just us, this is everybody that we know. So there is a kind of collective trauma at the moment of just literally waiting to see what fresh horrors tomorrow’s WhatsApp will bring.
I dread calls from people that I know who I haven’t heard from in a while because I know what it is, always. In the best circumstances it’s someone needing oxygen or a hospital bed in a hurry. And most of the times it’s actually just the news of somebody dying. It’s a culling of the old, the weak, and people who are vulnerable in other ways with lung disorders and with asthma, and conditions like that. It’s cruel, it’s really, really hard to live through.
For me, when you were talking about how you see this ending and the kinds of solutions, I’m working entirely this month I think with a colleague in the United States, with an American to try to put ideas to the Biden administration that they can actually work on, that are not merely just the kind of politically expedient signals that supporting the TRIPS waiver in a very narrow form, the kind of bump it gave the Biden administration. But more than that, things that actually get things done to put vaccines on the table for us. And I think that one way this could end is somehow magically the US really reversing the course of 25 years of industrial and diplomatic policy by forcing these companies to finally do the thing that it needs and that the world economy and people need.
But the other way I think it could also work, which is I think not something outside the realm of consciousness is that what happens is the Western pharmaceutical industry doesn’t play ball, that the Biden administration actually doesn’t ever capitulate, whatever this death count leads to. I think what happens then is that the Western pharmaceutical industry is not entirely replaced, but there is an alternative that’s created, which is the combined industries of Russia, China, Cuba, India, Brazil, Vietnam, Thailand, and all of these other places who figure out in desperation, a way to make things work and keep their people alive through this pandemic. And in effect, in that process create an alternative to the Western pharmaceutical system to go to get life-saving products from, seriously.
Rob Johnson:
Well I think they always say hindsight is 20/20, that’s an exaggeration. But when you look back you can see these concerns. I think we talked about before, John le Carré’s novel, The Constant Gardener was all about Africa and intellectual property rights, and the suffering that conforming to that system implied. There’s a great deal of… I’ll just tell you about a personal anecdote. I once went to a birthday party at the House of Lords in England. And I’m sitting at a table and I ask all these people, elder wise men, wise women type, “What do you guys do?” Almost all of them were on the boards of pharmaceutical companies. I said, “Okay, what is it that you do inside that?” Just like a cocktail party birthday celebration.
And they said, “Oh that’s easy.” One guy stood up and said, “That’s easy. What you do is you open a subsidiary in the United States, you go there, and you make things that are so profitable you can cross-subsidize and build market share all around the rest of the world.” And everybody agreed with him, they’re all nodding their heads. And I’m the American sitting there thinking, how would I say, and we’re getting soaked as taxpayers and our healthcare system is ranked 38th in the world, and it costs almost double. And you can throw the insurance industry in for their taste of that too. But it just feels like a madness that was growing, even within the United States.
But let’s talk geopolitics, it’s threatening to discredit American leadership because it can’t respond to the public good. I find that quite daunting. The stakes are quite high for when you challenge the Biden administration, higher than normal. That’s why I started with my question to Arjun on is their reluctance going to lead to a whole system of competition, not only in this sector but in others? I don’t know, we can’t know. But these are very powerful, powerful challenges.
I’m reading a book right now called Somebody Else’s World I think it called by Patrick L. Smith, no it was by Patrick Lawrence, someone I’ve never met. But it’s about how the east west interaction was, I’ll say among other things, a clash of philosophical systems. In the common good, the we of Muhammad Ali had completely been what you might call eradicated from what was considered a legitimate perspective on social organization and design.
I guess I want to encourage the two of you to stay on it, you’re making a huge contribution. By illuminating this, by envisioning possibilities, by sharing the vulnerability and your suffering you’re making a huge contribution. And the New York Times, places like The Guardian, goodhearted people are rising to the things you’re illuminating.
Arjun Jayadev:
Thanks Rob, that’s the hope in any case. And it’s what we have to do.
Achal Prabhala:
That’s certainly the case Rob. Good people everywhere actually recognize good arguments that are as you just said, simple, rational, and logical, and humane.
Rob Johnson:
Well I guess as is my custom, if there are last thoughts I have a song for you to close today’s proceedings. It came to my mind about 20 minutes into this conversation, it’s by a band called Creedence Clearwater Revival. The name of the song is Who’ll Stop the Rain. That’s a tribute to you today Arjun and the cyclone. But I love the first verse, that also I thought was Germane, it says, “Long as I remember the rain been coming down, clouds of mystery pouring confusion on the ground. Good men through the ages trying to find the sun. And I wonder, still I wonder, who’ll stop the rain?” Thank you both.
Achal Prabhala:
Lovely Rob, thank you very much.
Arjun Jayadev:
Thanks very much Rob, it’s lovely.
Rob Johnson:
And check out more from the Institute for New Economic Thinking at INETeconomics.org.
