Showing posts with label vaccine. Show all posts
Showing posts with label vaccine. Show all posts
Sunday, 3 December 2023
Thursday, 2 November 2023
Friday, 29 September 2023
Saturday, 27 May 2023
Thursday, 17 February 2022
Wednesday, 9 February 2022
Friday, 29 October 2021
Wednesday, 6 October 2021
Thursday, 8 July 2021
Friday, 11 June 2021
Obscurantist India: Mired in the Past, Messing with the Present, Muddled about the Future
Parakala Prabhakar (Telugu: పరకాల ప్రభాకర్; born 2 January 1959) is an Indian political economist, political commentator, economic, and social affairs. He served as Communications Advisor, held a cabinet rank position in Andhra Pradesh Government between July 2014 and June 2018. For several years he presented a current affairs discussion programme on television channels of Andhra Pradesh. His programmes, Pratidhwani on ETV2 and Namaste Andhra Pradesh on NTV.[1] He was also a former spokesman and one of the founding general secretaries of Praja Rajyam Party.[2] In the early 2000s, Parakala was the spokesperson of the Andhra Pradesh unit of the BJP.[3] He is the spouse of the incumbent union Minister of Finance and Corporate Affairs of India, Nirmala Sitharaman.
Source: Wikipedia
Wednesday, 9 June 2021
Wednesday, 12 May 2021
Saturday, 24 April 2021
Friday, 2 April 2021
The Poor and the Covid vaccine
Achal Prabhala and Leena Menghaney in The Guardian
As the UK’s vaccination programme was “knocked off course” due to a delay in receiving five million doses of the AstraZeneca vaccine from India, a far more chilling reality was unfolding: about a third of all humanity, living in the poorest countries, found out that they will get almost no coronavirus vaccines in the near future because of India’s urgent need to vaccinate its own massive population.
It’s somewhat rich for figures in Britain to accuse India of vaccine nationalism. That the UK, which has vaccinated nearly 50% of its adults with at least one dose, should demand vaccines from India, which has only vaccinated 3% of its people so far, is immoral. That the UK has already received several million doses from India, alongside other rich countries such as Saudi Arabia and Canada, is a travesty.
The billions of AstraZeneca doses being produced by the Serum Institute in India are not for rich countries – and, in fact, not even for India alone: they are for all 92 of the poorest countries in the world.
Except they’re now being treated as the sovereign property of the Indian government.
How did we get here? Exactly one year ago, researchers at Oxford University’s Jenner Institute, frontrunners in the race to develop a coronavirus vaccine, stated that they intended to allow any manufacturer, anywhere, the rights to their jab. One of the early licences they signed was with the Serum Institute, the world’s largest vaccine manufacturer. One month later, acting on advice from the Gates Foundation, Oxford changed course and signed over exclusive rights to AstraZeneca, a UK-based multinational pharmaceutical group.
AstraZeneca and Serum signed a new deal. Serum would produce vaccines for all poor countries eligible for assistance by Gavi, the Vaccines Alliance – an organisation backed by rich countries’ governments and the Gates Foundation. These 92 nations together counted for half the world – or nearly four billion people. India’s fair share of these vaccines, by population, should have been 35%. However there was an unwritten arrangement that Serum would earmark 50% of its supply for domestic use and 50% for export.
The deal included a clause that allowed AstraZeneca to approve exports to countries not listed in the agreement. Some countries which asked for emergency vaccine shipments from Serum, including South Africa and Brazil, were justified: they had nothing else. Rich countries like the UK and Canada, however, which had bought up more doses than required to vaccinate their people, to the detriment of everyone else, had no moral right to dip into a pool of vaccines designated for poor countries.
Paradoxically, when South Africa and India asked the World Trade Organization to temporarily waive patents and other pharmaceutical monopolies so that vaccines could be manufactured more widely to prevent shortfalls in supply, among the first countries to object were the UK, Canada and Brazil. They were the very governments that would later be asking India to solve their own shortfalls in supply.
The deal did not include restrictions on what price Serum could charge, despite AstraZeneca’s pledge to sell its vaccine for no profit “during the pandemic”, which led to Uganda, which is among the poorest countries on Earth, paying three times more than Europe for the same vaccine. (An AstraZeneca spokesperson told Politico that the “price of the vaccine will differ due to a number of factors, including the cost of manufacturing – which varies depending on the geographic region – and volumes requested by the countries”.)
As it became clear that the western pharmaceutical industry could barely supply the west, let alone anywhere else, many countries turned to Chinese and Russian vaccines. Meanwhile, the Covax Facility – the Gavi-backed outfit that actually procures vaccines for poor countries – stuck to its guns and made deals exclusively with western vaccine manufacturers. From those deals, the AstraZeneca vaccine is now the only viable candidate it has. The bulk of the supply of this vaccine comes from Serum, and a smaller quantity from SK Bioscience in South Korea. As a result, a third of all humanity is now largely dependent on supplies of one vaccine from one company in India.
Cue the Indian government’s involvement. Unlike western governments, which poured billions into the research and development of vaccines, there is no evidence that the Indian government has provided a cent in research and development funding to the Serum Institute. (This did not stop it turning every overseas vaccine delivery into a photo-op.) The government then commandeered approval of every single Covax shipment sent out from Serum – even, according to one well-placed source within the institute, directing how many doses would be sent and when.
The Indian government has not publicly commented on its involvement in the vaccine shipments and has refused requests for comment.
Last month, faced with a surge in infections, the Indian government announced an expansion of its domestic vaccination programme to include 345 million people, and halted all exports of vaccines. About 60m vaccine doses have already been dispensed, and the government needs another 630m to cover everyone in this phase alone. One other vaccine is approved for use – Bharat Biotech’s Covaxin – but it is being produced and utilised in smaller quantities. As more vaccines are approved, the pressure on Serum might decrease. For now, however, the bulk of India’s vaccination goals will be met by just one supplier, which faces the impossible choice of either letting down the other 91 countries depending on it, or offending its own government.
The consequences are devastating. To date, 28m Covax Facility doses have been produced by Serum for the developing world – 10m of which went to India. The second largest shipment went to Nigeria, which received 4m doses, or enough to cover only 1% of its population. Given the new Indian government order of 100m doses, further supplies to countries like Nigeria may be delayed until July. And given the Indian government’s need of 500m more vaccine doses in the short run, that date could surely be pushed out even further.
This colossal mess was entirely predictable, and could have been avoided at every turn. Rich countries such as the UK, the US, and those of the EU, and rich organisations such as Covax should have used their funding of western pharmaceutical companies to nip vaccine monopolies in the bud. Oxford University should have stuck to its plans of allowing anyone, anywhere, to make its vaccine. AstraZeneca and Covax should have licensed as many manufacturers in as many countries as they could to make enough vaccines for the world. The Indian government should have never been effectively put in charge of the wellbeing of every poor country on the planet.
For years, India has been called “the pharmacy of the developing world”. It’s time to rethink that title. We will need many more pharmacies in many more countries to survive this pandemic.
As the UK’s vaccination programme was “knocked off course” due to a delay in receiving five million doses of the AstraZeneca vaccine from India, a far more chilling reality was unfolding: about a third of all humanity, living in the poorest countries, found out that they will get almost no coronavirus vaccines in the near future because of India’s urgent need to vaccinate its own massive population.
It’s somewhat rich for figures in Britain to accuse India of vaccine nationalism. That the UK, which has vaccinated nearly 50% of its adults with at least one dose, should demand vaccines from India, which has only vaccinated 3% of its people so far, is immoral. That the UK has already received several million doses from India, alongside other rich countries such as Saudi Arabia and Canada, is a travesty.
The billions of AstraZeneca doses being produced by the Serum Institute in India are not for rich countries – and, in fact, not even for India alone: they are for all 92 of the poorest countries in the world.
Except they’re now being treated as the sovereign property of the Indian government.
How did we get here? Exactly one year ago, researchers at Oxford University’s Jenner Institute, frontrunners in the race to develop a coronavirus vaccine, stated that they intended to allow any manufacturer, anywhere, the rights to their jab. One of the early licences they signed was with the Serum Institute, the world’s largest vaccine manufacturer. One month later, acting on advice from the Gates Foundation, Oxford changed course and signed over exclusive rights to AstraZeneca, a UK-based multinational pharmaceutical group.
AstraZeneca and Serum signed a new deal. Serum would produce vaccines for all poor countries eligible for assistance by Gavi, the Vaccines Alliance – an organisation backed by rich countries’ governments and the Gates Foundation. These 92 nations together counted for half the world – or nearly four billion people. India’s fair share of these vaccines, by population, should have been 35%. However there was an unwritten arrangement that Serum would earmark 50% of its supply for domestic use and 50% for export.
The deal included a clause that allowed AstraZeneca to approve exports to countries not listed in the agreement. Some countries which asked for emergency vaccine shipments from Serum, including South Africa and Brazil, were justified: they had nothing else. Rich countries like the UK and Canada, however, which had bought up more doses than required to vaccinate their people, to the detriment of everyone else, had no moral right to dip into a pool of vaccines designated for poor countries.
Paradoxically, when South Africa and India asked the World Trade Organization to temporarily waive patents and other pharmaceutical monopolies so that vaccines could be manufactured more widely to prevent shortfalls in supply, among the first countries to object were the UK, Canada and Brazil. They were the very governments that would later be asking India to solve their own shortfalls in supply.
The deal did not include restrictions on what price Serum could charge, despite AstraZeneca’s pledge to sell its vaccine for no profit “during the pandemic”, which led to Uganda, which is among the poorest countries on Earth, paying three times more than Europe for the same vaccine. (An AstraZeneca spokesperson told Politico that the “price of the vaccine will differ due to a number of factors, including the cost of manufacturing – which varies depending on the geographic region – and volumes requested by the countries”.)
As it became clear that the western pharmaceutical industry could barely supply the west, let alone anywhere else, many countries turned to Chinese and Russian vaccines. Meanwhile, the Covax Facility – the Gavi-backed outfit that actually procures vaccines for poor countries – stuck to its guns and made deals exclusively with western vaccine manufacturers. From those deals, the AstraZeneca vaccine is now the only viable candidate it has. The bulk of the supply of this vaccine comes from Serum, and a smaller quantity from SK Bioscience in South Korea. As a result, a third of all humanity is now largely dependent on supplies of one vaccine from one company in India.
Cue the Indian government’s involvement. Unlike western governments, which poured billions into the research and development of vaccines, there is no evidence that the Indian government has provided a cent in research and development funding to the Serum Institute. (This did not stop it turning every overseas vaccine delivery into a photo-op.) The government then commandeered approval of every single Covax shipment sent out from Serum – even, according to one well-placed source within the institute, directing how many doses would be sent and when.
The Indian government has not publicly commented on its involvement in the vaccine shipments and has refused requests for comment.
Last month, faced with a surge in infections, the Indian government announced an expansion of its domestic vaccination programme to include 345 million people, and halted all exports of vaccines. About 60m vaccine doses have already been dispensed, and the government needs another 630m to cover everyone in this phase alone. One other vaccine is approved for use – Bharat Biotech’s Covaxin – but it is being produced and utilised in smaller quantities. As more vaccines are approved, the pressure on Serum might decrease. For now, however, the bulk of India’s vaccination goals will be met by just one supplier, which faces the impossible choice of either letting down the other 91 countries depending on it, or offending its own government.
The consequences are devastating. To date, 28m Covax Facility doses have been produced by Serum for the developing world – 10m of which went to India. The second largest shipment went to Nigeria, which received 4m doses, or enough to cover only 1% of its population. Given the new Indian government order of 100m doses, further supplies to countries like Nigeria may be delayed until July. And given the Indian government’s need of 500m more vaccine doses in the short run, that date could surely be pushed out even further.
This colossal mess was entirely predictable, and could have been avoided at every turn. Rich countries such as the UK, the US, and those of the EU, and rich organisations such as Covax should have used their funding of western pharmaceutical companies to nip vaccine monopolies in the bud. Oxford University should have stuck to its plans of allowing anyone, anywhere, to make its vaccine. AstraZeneca and Covax should have licensed as many manufacturers in as many countries as they could to make enough vaccines for the world. The Indian government should have never been effectively put in charge of the wellbeing of every poor country on the planet.
For years, India has been called “the pharmacy of the developing world”. It’s time to rethink that title. We will need many more pharmacies in many more countries to survive this pandemic.
Sunday, 21 March 2021
DECODING DENIALISM
Nadeem F. Paracha in The Dawn
Illustration by Abro
On November 12, 2009, the New York Times (NYT) ran a video report on its website. In it, the NYT reporter Adam B. Ellick interviewed some Pakistani pop stars to gauge how lifestyle liberals were being affected by the spectre of so-called ‘Talibanisation’ in Pakistan. To his surprise, almost every single pop artiste that he managed to engage, refused to believe that there were men willing to blow themselves up in public in the name of faith.
It wasn’t an outright denial, as such, but the interviewed pop acts went to great lengths to ‘prove’ that the attacks were being carried out at the behest of the US, and that those who were being called ‘terrorists’ were simply fighting for their rights. Ellick’s surprise was understandable. Between 2007 and 2009, hundreds of people had already been killed in Pakistan by suicide bombers.
But it wasn’t just these ‘confused’ lifestyle liberals who chose to look elsewhere for answers when the answer was right in front of them. Unregulated talk shows on TV news channels were constantly providing space to men who would spin the most ludicrous narratives that presented the terrorists as ‘misunderstood brothers.’
From 2007 till 2014, terrorist attacks and assassinations were a daily occurrence. Security personnel, politicians, men, women and children were slaughtered. Within hours, the cacophony of inarticulate noises on the electronic media would drown out these tragedies. The bottom-line of almost every such ‘debate’ was always, ‘ye hum mein se nahin’ [these (terrorists) are not from among us]. In fact, there was also a song released with this as its title and ‘message.’
The perpetrators of the attacks were turned into intangible, invisible entities, like characters of urban myths that belong to a different realm. The fact was that they were very much among us, for all to see, even though most Pakistanis chose not to.
Just before the 2013 elections, the website of an English daily ran a poll on the foremost problems facing Pakistan. The poll mentioned unemployment, corruption, inflation and street crimes, but there was no mention of terrorism even though, by 2013, thousands had been killed in terrorist attacks.
So how does one explain this curious refusal to acknowledge a terrifying reality that was operating in plain sight? In an August 3, 2018 essay for The Guardian, Keith Kahn-Harris writes that individual self-deception becomes a problem when it turns into ‘public dogma.’ It then becomes what is called ‘denialism.’
The American science journalist and author Michael Specter, in his book Denialism, explains it to mean an entire segment of society, when struggling with trauma, turning away from reality in favour of a more comfortable lie. Psychologists have often explained denial as a coping mechanism that humans use in times of stress. But they also warn that if denial establishes itself as a constant disposition in an individual or society, it starts to inhibit the ability to resolve the source of the stress.
Denialism, as a social condition, is understood by sociologists as an undeclared ‘ism’, adhered to by certain segments of a society whose rhetoric and actions in this context can impact a country’s political, social and even economic fortunes.
In the January 2009 issue of European Journal of Public Health, Pascal Diethelm and Martin McKee write that the denialism process employs five main characteristics. Even though Diethelm and McKee were more focused on the emergence of denialism in the face of evidence in scientific fields of research, I will paraphrase four out of the five stated characteristics to explore denialism in the context of extremist violence in Pakistan from 2007 till 2017.
The deniers have their own interpretation of the same evidence. In early 2013, when a study showed that 1,652 people had been killed in 2012 alone in Pakistan because of terrorism, an ‘analyst’ on a news channel falsely claimed that these figures included those killed during street crimes and ‘revenge murders.’ Another gentleman insisted that the figures were concocted by foreign-funded NGOs ‘to give Pakistan and Islam a bad name.’
This brings us to denialism’s second characteristic: The use of fake experts. These are individuals who purport to be experts in a particular area but whose views are entirely inconsistent with established knowledge. During the peak years of terrorist activity in the country, self-appointed ‘political experts’ and ‘religious scholars’ were a common sight on TV channels. Their ‘expert opinions’ were heavily tilted towards presenting the terrorists as either ‘misunderstood brothers’ or people fighting to impose a truly Islamic system in Pakistan. Many such experts suddenly vanished from TV screens after the intensification of the military operation against militants in 2015. Some were even booked for hate speech.
The third characteristic is about selectivity, drawing on isolated opinions or highlighting flaws in the weakest opinions to discredit entire facts. In October 2012, when extremists attempted to assassinate a teenaged school girl, Malala Yousafzai, a sympathiser of the extremists on TV justified the assassination attempt by mentioning ‘similar incidents’ that he discovered in some obscure books of religious traditions. Within months Malala became the villain, even among some of the most ‘educated’ Pakistanis. When the nuclear physicist and intellectual Dr Pervez Hoodbhoy exhibited his disgust over this, he was not only accused of being ‘anti-Islam’, but his credibility as a scientist too was questioned.
The fourth characteristic is about misrepresenting the opposing argument to make it easier to refute. For example, when terrorists were wreaking havoc in Pakistan, the arguments of those seeking to investigate the issue beyond conspiracy theories and unabashed apologias, were deliberately misconstrued as being criticisms of religious faith.
Today we are seeing all this returning. But this time, ‘experts’ are appearing on TV pointing out conspiracies and twisting facts about the Covid-19 pandemic and vaccines. They are also offering their expert opinions on events such as the Aurat March and, in the process, whipping up a dangerous moral panic.
It seems, not much was learned by society’s collective disposition during the peak years of terrorism and how it delayed a timely response that might have saved hundreds of innocent lives.
On November 12, 2009, the New York Times (NYT) ran a video report on its website. In it, the NYT reporter Adam B. Ellick interviewed some Pakistani pop stars to gauge how lifestyle liberals were being affected by the spectre of so-called ‘Talibanisation’ in Pakistan. To his surprise, almost every single pop artiste that he managed to engage, refused to believe that there were men willing to blow themselves up in public in the name of faith.
It wasn’t an outright denial, as such, but the interviewed pop acts went to great lengths to ‘prove’ that the attacks were being carried out at the behest of the US, and that those who were being called ‘terrorists’ were simply fighting for their rights. Ellick’s surprise was understandable. Between 2007 and 2009, hundreds of people had already been killed in Pakistan by suicide bombers.
But it wasn’t just these ‘confused’ lifestyle liberals who chose to look elsewhere for answers when the answer was right in front of them. Unregulated talk shows on TV news channels were constantly providing space to men who would spin the most ludicrous narratives that presented the terrorists as ‘misunderstood brothers.’
From 2007 till 2014, terrorist attacks and assassinations were a daily occurrence. Security personnel, politicians, men, women and children were slaughtered. Within hours, the cacophony of inarticulate noises on the electronic media would drown out these tragedies. The bottom-line of almost every such ‘debate’ was always, ‘ye hum mein se nahin’ [these (terrorists) are not from among us]. In fact, there was also a song released with this as its title and ‘message.’
The perpetrators of the attacks were turned into intangible, invisible entities, like characters of urban myths that belong to a different realm. The fact was that they were very much among us, for all to see, even though most Pakistanis chose not to.
Just before the 2013 elections, the website of an English daily ran a poll on the foremost problems facing Pakistan. The poll mentioned unemployment, corruption, inflation and street crimes, but there was no mention of terrorism even though, by 2013, thousands had been killed in terrorist attacks.
So how does one explain this curious refusal to acknowledge a terrifying reality that was operating in plain sight? In an August 3, 2018 essay for The Guardian, Keith Kahn-Harris writes that individual self-deception becomes a problem when it turns into ‘public dogma.’ It then becomes what is called ‘denialism.’
The American science journalist and author Michael Specter, in his book Denialism, explains it to mean an entire segment of society, when struggling with trauma, turning away from reality in favour of a more comfortable lie. Psychologists have often explained denial as a coping mechanism that humans use in times of stress. But they also warn that if denial establishes itself as a constant disposition in an individual or society, it starts to inhibit the ability to resolve the source of the stress.
Denialism, as a social condition, is understood by sociologists as an undeclared ‘ism’, adhered to by certain segments of a society whose rhetoric and actions in this context can impact a country’s political, social and even economic fortunes.
In the January 2009 issue of European Journal of Public Health, Pascal Diethelm and Martin McKee write that the denialism process employs five main characteristics. Even though Diethelm and McKee were more focused on the emergence of denialism in the face of evidence in scientific fields of research, I will paraphrase four out of the five stated characteristics to explore denialism in the context of extremist violence in Pakistan from 2007 till 2017.
The deniers have their own interpretation of the same evidence. In early 2013, when a study showed that 1,652 people had been killed in 2012 alone in Pakistan because of terrorism, an ‘analyst’ on a news channel falsely claimed that these figures included those killed during street crimes and ‘revenge murders.’ Another gentleman insisted that the figures were concocted by foreign-funded NGOs ‘to give Pakistan and Islam a bad name.’
This brings us to denialism’s second characteristic: The use of fake experts. These are individuals who purport to be experts in a particular area but whose views are entirely inconsistent with established knowledge. During the peak years of terrorist activity in the country, self-appointed ‘political experts’ and ‘religious scholars’ were a common sight on TV channels. Their ‘expert opinions’ were heavily tilted towards presenting the terrorists as either ‘misunderstood brothers’ or people fighting to impose a truly Islamic system in Pakistan. Many such experts suddenly vanished from TV screens after the intensification of the military operation against militants in 2015. Some were even booked for hate speech.
The third characteristic is about selectivity, drawing on isolated opinions or highlighting flaws in the weakest opinions to discredit entire facts. In October 2012, when extremists attempted to assassinate a teenaged school girl, Malala Yousafzai, a sympathiser of the extremists on TV justified the assassination attempt by mentioning ‘similar incidents’ that he discovered in some obscure books of religious traditions. Within months Malala became the villain, even among some of the most ‘educated’ Pakistanis. When the nuclear physicist and intellectual Dr Pervez Hoodbhoy exhibited his disgust over this, he was not only accused of being ‘anti-Islam’, but his credibility as a scientist too was questioned.
The fourth characteristic is about misrepresenting the opposing argument to make it easier to refute. For example, when terrorists were wreaking havoc in Pakistan, the arguments of those seeking to investigate the issue beyond conspiracy theories and unabashed apologias, were deliberately misconstrued as being criticisms of religious faith.
Today we are seeing all this returning. But this time, ‘experts’ are appearing on TV pointing out conspiracies and twisting facts about the Covid-19 pandemic and vaccines. They are also offering their expert opinions on events such as the Aurat March and, in the process, whipping up a dangerous moral panic.
It seems, not much was learned by society’s collective disposition during the peak years of terrorism and how it delayed a timely response that might have saved hundreds of innocent lives.
Friday, 15 January 2021
Conspiracy theorists destroy a rational society: resist them
John Thornhill in The FT
Buzz Aldrin’s reaction to the conspiracy theorist who told him the moon landings never happened was understandable, if not excusable. The astronaut punched him in the face.
Few things in life are more tiresome than engaging with cranks who refuse to accept evidence that disproves their conspiratorial beliefs — even if violence is not the recommended response. It might be easier to dismiss such conspiracy theorists as harmless eccentrics. But while that is tempting, it is in many cases wrong.
As we have seen during the Covid-19 pandemic and in the mob assault on the US Congress last week, conspiracy theories can infect the real world — with lethal effect. Our response to the pandemic will be undermined if the anti-vaxxer movement persuades enough people not to take a vaccine. Democracies will not endure if lots of voters refuse to accept certified election results. We need to rebut unproven conspiracy theories. But how?
The first thing to acknowledge is that scepticism is a virtue and critical scrutiny is essential. Governments and corporations do conspire to do bad things. The powerful must be effectively held to account. The US-led war against Iraq in 2003, to destroy weapons of mass destruction that never existed, is a prime example.
The second is to re-emphasise the importance of experts, while accepting there is sometimes a spectrum of expert opinion. Societies have to base decisions on experts’ views in many fields, such as medicine and climate change, otherwise there is no point in having a debate. Dismissing the views of experts, as Michael Gove famously did during the Brexit referendum campaign, is to erode the foundations of a rational society. No sane passenger would board an aeroplane flown by an unqualified pilot.
In extreme cases, societies may well decide that conspiracy theories are so harmful that they must suppress them. In Germany, for example, Holocaust denial is a crime. Social media platforms that do not delete such content within 24 hours of it being flagged are fined.
In Sweden, the government is even establishing a national psychological defence agency to combat disinformation. A study published this week by the Oxford Internet Institute found “computational propaganda” is now being spread in 81 countries.
Viewing conspiracy theories as political propaganda is the most useful way to understand them, according to Quassim Cassam, a philosophy professor at Warwick university who has written a book on the subject. In his view, many conspiracy theories support an implicit or explicit ideological goal: opposition to gun control, anti-Semitism or hostility to the federal government, for example. What matters to the conspiracy theorists is not whether their theories are true, but whether they are seductive.
So, as with propaganda, conspiracy theories must be as relentlessly opposed as they are propagated.
That poses a particular problem when someone as powerful as the US president is the one shouting the theories. Amid huge controversy, Twitter and Facebook have suspended Donald Trump’s accounts. But Prof Cassam says: “Trump is a mega disinformation factory. You can de-platform him and address the supply side. But you still need to address the demand side.”
On that front, schools and universities should do more to help students discriminate fact from fiction. Behavioural scientists say it is more effective to “pre-bunk” a conspiracy theory — by enabling people to dismiss it immediately — than debunk it later. But debunking serves a purpose, too.
As of 2019, there were 188 fact-checking sites in more than 60 countries. Their ability to inject facts into any debate can help sway those who are curious about conspiracy theories, even if they cannot convince true believers.
Under intense public pressure, social media platforms are also increasingly filtering out harmful content and nudging users towards credible sources of information, such as medical bodies’ advice on Covid.
Some activists have even argued for “cognitive infiltration” of extremist groups, suggesting that government agents should intervene in online chat rooms to puncture conspiracy theories. That may work in China but is only likely to backfire in western democracies, igniting an explosion of new conspiracy theories.
Ultimately, we cannot reason people out of beliefs that they have not reasoned themselves into. But we can, and should, punish those who profit from harmful irrationality. There is a tried-and-tested method of countering politicians who peddle and exploit conspiracy theories: vote them out of office.
Friday, 1 January 2021
What we have learnt about the limits of science
Thiago Carvalho in The FT
Some years ago, on New Year’s Day, my wife and I noticed that our son, not yet two months old, was struggling to breathe — a belaboured, wheezing effort was all he could manage — and we decided to face the holiday emergency room crush. After assessing his blood oxygen levels, the pediatrician said: “Pack a bag, you will be here all week. He will get worse. Then he will get better.”
Our son had contracted something called respiratory syncytial virus, and it was replicating in his lungs. In a scenario similar to Covid-19, most healthy adults infected with RSV will experience a mild cold, or no symptoms at all. However, some unfortunate infants who contract RSV may suffer a devastating pulmonary infection. For those kids, there are no drugs available that can reliably stop, or even slow down RSV’s relentless replication in the lungs.
Instead, according to Mustafa Khokha, a pediatric critical care professor at Yale University, doctors first give oxygen and then if the child does not improve, there follows a series of progressively more aggressive procedures. “That’s all supportive therapy for the body to recover, as opposed to treatment against the virus itself,” says Khokha. Outstanding supportive care was what our son received, and the week unfolded exactly as his pediatrician predicted. (It was still the worst week of my life.)
For all the progress we have seen in 2020, a patient brought to the emergency room with severe Covid-19 will essentially receive the same kind of supportive care our son did — treatment to help the body endure a viral assault, but not effectively targeting the virus itself. The main difference will be the uncertain outcome — there will be no comforting, near-certain “he will get better” from the attending physician.
Contrast that story with a different one. On a Tuesday morning in early December, in the English city of Coventry, Margaret Keenan, just a few days shy of her 91st birthday, became the first person in the world to receive the BioNTech/Pfizer Covid-19 vaccine outside of a clinical trial. The pace of progress was astonishing. It was less than a year since, in the closing moments of 2019, Chinese health authorities alerted the World Health Organization to an outbreak of a pneumonia of unknown cause in Hubei province.
The Covid-19 pandemic has given us an accelerated tutorial on the promise and the limits of science. With vaccines, testing, epidemiological surveillance, we know where we are going, and we have a good idea how to get there. These are essentially challenges of technological development, reliant now on adequate resources and personnel and tweaking of regulatory frameworks. For other scientific challenges, though, there may be no gas pedal to step on — these include the prickly problems of arresting acute viral infection, or understanding how the virus and the host interact to produce disease. Science, as Nobel Prize-winning immunologist Peter Medawar put it, is the art of the soluble.
In March, when, incredibly, the first human vaccine trials for Covid-19 were kicking off in Seattle, the WHO launched an ambitious clinical trial to try to identify existing pharmaceuticals that could show some benefit against Sars-Cov-2. In October, the WHO declared that all four arms of its Solidarity trial had essentially failed. The search for effective antiviral drugs has not lacked resources or researchers, but in contrast to the vaccine victories, it has yet to produce a single clear success story. The concentrated efforts of many of the world’s most capable scientists, relying on ample public support and private investment, are sometimes not enough to crack a problem.
Perhaps nothing exemplifies this more clearly than what followed Richard Nixon’s signing of the National Cancer Act on December 23 1971. The act was cautiously phrased, but January’s State of the Union address declared an all-out war on cancer: “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.” The war on cancer would funnel almost $1.6bn to cancer labs over the next three years, and fuel expectations that a cure for the disease would be found before the end of the decade. Curing cancer remains, of course, an elusive target. In 2016, then vice-president Joe Biden presented the report of his own Cancer Moonshot task force.
The success of the Apollo program planted the Moonshot analogy in the science policy lexicon. Some grand challenges in biology could properly be considered “moonshots”. The Human Genome Project was one example. Like the race to the Moon, it had a clear finish line: to produce a draft with the precise sequence of genetic letters in the 23 pairs of human chromosomes. This was, like the propulsion problems solved by Nasa en route to the Moon, a matter of developing and perfecting technology — technology that later would allow us to have a genetic portrait of the cause of Covid-19 in under two weeks.
The cancer context was rather different. In the countdown to the war on cancer, Sol Spiegelman, the director of Columbia University’s Institute of Cancer Research, quipped that “an all-out effort at this time [to find a cure for cancer] would be like trying to land a man on the Moon without knowing Newton’s laws of gravity.” And so it proved.
We now know quite a lot about how the body resists viral infections, certainly much more than we knew about the biology of cancer in 1971. Over 60 years ago, at London’s National Institute for Medical Research, Alick Isaacs and Jean Lindemann exposed fragments of chicken egg membranes to heat-inactivated influenza A virus. In a matter of hours, the liquid from these cultures acquired the capacity to interfere with the growth of not only influenza A, but other, unrelated viruses, as well. Isaacs and Lindemann named their factor interferon. Interferons are fleet-footed messengers produced and released by cells almost immediately upon viral infection. These molecules warn other host cells to ready themselves to resist a viral onslaught.
Viruses rely on hijacking the normal cellular machinery to make more copies of themselves and interferons interfere with almost all stages of the process: from making it more difficult for the virus to enter cells, to slowing down the cellular protein factories required to make the viral capsule, to reducing the export of newly made viral particles. Interferons are now part of our pharmaceutical armoury for diseases as diverse as multiple sclerosis and cancer, as well as hepatitis C and other chronic viral infections.
Multiple interferon-based strategies have been tried in the pandemic, from intravenous administration to nebulising the molecule so that the patient inhales an antiviral mist directly into the lungs. The results have been inconclusive. “A lot of it has to do with the timing,” says Yale immunologist Akiko Iwasaki, “the only stage that recombinant interferon might be effective is pre-exposure or early post-exposure, and it’s really hard to catch it for this virus, because everyone is pretty much asymptomatic at that time.”
This year’s scramble for effective antiviral drugs led to a revival of other failed approaches. In 2016, a team of researchers from the United States Army Medical Research Institute of Infectious Diseases in Frederick, Maryland, and the biotech company Gilead Sciences reported that the molecule GS-5734 protected Rhesus monkeys from being infected with the Ebola virus. GS-5734, or as it is more familiarly known now, remdesivir unfortunately failed in clinical trials. This was a bona fide antiviral, backed up by demonstrations that the drug efficiently blocked an enzyme used by viruses to copy their genome. Ebola was already remdesivir’s third dead-end: Gilead had previously tested GS-5734 against hepatitis C and RSV, and the results were disappointing.
In late April, National Institute of Allergy and Infectious Diseases director Anthony Fauci, a member of the White House coronavirus task force, proclaimed that the US remdesivir trials had established “a new standard of care” for Covid-19 patients. As has happened repeatedly during the Covid-19 crisis, the data backing this claim not been made public, nor had it, at the time, been peer-reviewed.
Fauci explained that the drug had no significant effect on mortality, but claimed that remdesivir reduced hospitalisation times by about 30 per cent. It was the first piece of good news in a spring marked by global lockdowns. Unfortunately, results from a large-scale trial run by the WHO released in the autumn failed to support even the limited claims of the US study (Gilead has challenged the study’s design), and the WHO currently advises against giving remdesivir to Covid-19 patients.
For those who do not naturally control Sars-Cov-2 infection, or who have not been vaccinated, the failure to repurpose or create effective antiviral agents leaves supportive care. We are only beginning to understand the interplay of this new virus and human hosts. It is also a protean affliction, as sex, age, and pre-existing conditions all affect outcomes. The single clearest way to reduce mortality remains the dexamethasone treatment for patients requiring supplemental oxygen initially reported in the UK Recovery trial. It is not a direct attack on the virus, but a way to ameliorate the effects of infection and the immune response to it on the human body. Dexamethasone is, in a very real sense, supportive care.
So what have we learned about the limits of science? First, we were reminded that spectacular successes are built on a foundation of decades of basic research. Even the novel, first-in-class vaccines are at the end of a long road. It was slow-going to get to warp speed. We learned that there are no shortcuts to deciphering how a new virus makes us sick (and kills us) and that there is no ignoring the importance of human diversity for cracking this code. Diabetes, obesity, hypertension — we are still finding our way through a comorbidity labyrinth. Most of all, we have learned an old lesson again: science is the art of the soluble. No amount of resources and personnel, no Manhattan Project, can ensure that science will solve a problem in the absence of a well-stocked toolbox and a solid, painstakingly built theoretical framework.
South Korea recorded its first Covid-19 case on January 20. Eleven days later, Spain confirmed its first infection: a German tourist in the Canary Islands. Spain and South Korea have similar populations of about 50m people. As of publication of this piece, South Korea has had 879 deaths, while Spain reports over 50,000. The west missed its moment. Efficient testing, tracing and containment of Covid-19 was a soluble technological and organisational problem. Here too, we can hear echoes of the war on cancer. The biggest single reduction in cancer mortality did not come from a miracle drug. It was the drop in lung cancer deaths, due to what we could call the war on tobacco. Perhaps Dr Spiegelman might concede that even if we don’t have a law of gravity, we do have a first law of medicine: always start with prevention.
Covid-19 has pushed science to its limits and, in some cases, sharply outlined its borders. This century’s first pandemic finds humanity, with its transport hubs and supply chains, more vulnerable to a new pathogen. But virology, immunology, critical care medicine and epidemiology, to name a few, have progressed immeasurably since 1918. Unfortunately, in a public health emergency, the best science must be used to inform the best policies. In the seasonal spirit of charity, let us say that that has not always been the case in our pandemic year.
Thursday, 30 July 2020
A coronavirus vaccine could split America
In the battle between public science and anti-vaxxer sentiment, science is heavily outgunned writes Edward Luce in The FT
It is late October and Donald Trump has a surprise for you. Unlike the traditional pre-election shock — involving war or imminent terrorist attack — this revelation is about hope rather than fear. The “China virus” has been defeated thanks to the ingenuity of America’s president. The US has developed a vaccine that will be available to all citizens by the end of the year. Get online and book your jab.
It is possible Mr Trump could sway a critical slice of voters with such a declaration. The bigger danger is that he would deepen America’s mistrust of science. A recent poll found that only half of Americans definitely plan to take a coronavirus vaccine. Other polls said that between a quarter and a third of the nation would never get inoculated.
Whatever the true number, anti-vaccine campaigners are having a great pandemic — as indeed is Covid-19. At least three-quarters of the population would need to be vaccinated to reach herd immunity.
Infectious diseases thrive on mistrust. It is hard to imagine a better Petri dish than today’s America. Some of the country’s “vaccine hesitancy” is well grounded. Regulators are under tremendous pressure to let big pharma shorten clinical trials. That could lead to mistakes.
Vaccine nationalism is not just about rich governments pre-ordering as many vials as they can. It is also about winning unimaginably large bragging rights in the race to save the world. Cutting immunological corners could be dangerous to public health.
Such caution accounts for many of those who would hesitate to be injected. The rest are captured by conspiracy theories. In the battle between public science and anti-vaxxer sentiment, science is heavily outgunned. It faces a rainbow coalition of metastasising folk suspicions on both the left and the right. Public health messages are little match for the memology of social media opponents.
It is that mix of technological savvy and intellectual derangement that drives today’s politics. Mr Trump did not invent postmodern quackery — though he has endorsed some life-threatening remedies. The irony is that he could fall victim to the mistrust he has stoked.
Should an effective vaccine loom into view before the US goes to the polls in 95 days, Mr Trump would not be the ideal person to inform the country. The story is as old as cry wolf. Having endorsed the use of disinfectants and hydroxychloroquine, Mr Trump has forfeited any credibility. Validation should come from Anthony Fauci, America’s top infectious-diseases expert, whose trust ratings are almost double those of the president he serves.
Even then, however, the challenge would only just be starting. There is no cause to doubt the world-beating potential of US scientific research. There are good reasons to suspect the medical establishment’s ability to win over public opinion.
The modern anti-vaxxer movement began on the left. It is still going strong. It follows the “my body is my temple” philosophy. Corporate science cannot be trusted to put healthy things into our bodies. The tendency for modern parents to award themselves overnight Wikipedia degrees in specialist fields is also to blame.
Not all of this mistrust is madcap. African Americans have good reason to distrust public health following the postwar Tuskegee experiments in which hundreds were infected with syphilis and left to fester without penicillin. Polls show that more blacks than whites would refuse a coronavirus vaccine. Given their higher likelihood of exposure, such mistrust has tragic potential.
But rightwing anti-vaxxers have greater momentum. America’s 19th century anti-vaccination movements drew equally from religious paranoia that vaccines were the work of the devil and a more general fear that liberty was under threat. Both strains have resurfaced in QAnon, the virtual cult that believes America is run by a satanic deep state that abuses children.
It would be hard to invent a more unhinged account of how the world works. Yet Mr Trump has retweeted QAnon-friendly accounts more than 90 times since the pandemic began. Among QAnon’s other theories is that Covid-19 is a Dr Fauci-led hoax to sink Mr Trump’s chances of being re-elected. Science cannot emulate such imaginative forms of storytelling.
All of which poses a migraine for the silent majority that would happily take the vaccine shots. Their lives are threatened both by a pandemic and by an infodemic. It is a bizarre feature of our times that the first looks easier to solve than the second.
It is late October and Donald Trump has a surprise for you. Unlike the traditional pre-election shock — involving war or imminent terrorist attack — this revelation is about hope rather than fear. The “China virus” has been defeated thanks to the ingenuity of America’s president. The US has developed a vaccine that will be available to all citizens by the end of the year. Get online and book your jab.
It is possible Mr Trump could sway a critical slice of voters with such a declaration. The bigger danger is that he would deepen America’s mistrust of science. A recent poll found that only half of Americans definitely plan to take a coronavirus vaccine. Other polls said that between a quarter and a third of the nation would never get inoculated.
Whatever the true number, anti-vaccine campaigners are having a great pandemic — as indeed is Covid-19. At least three-quarters of the population would need to be vaccinated to reach herd immunity.
Infectious diseases thrive on mistrust. It is hard to imagine a better Petri dish than today’s America. Some of the country’s “vaccine hesitancy” is well grounded. Regulators are under tremendous pressure to let big pharma shorten clinical trials. That could lead to mistakes.
Vaccine nationalism is not just about rich governments pre-ordering as many vials as they can. It is also about winning unimaginably large bragging rights in the race to save the world. Cutting immunological corners could be dangerous to public health.
Such caution accounts for many of those who would hesitate to be injected. The rest are captured by conspiracy theories. In the battle between public science and anti-vaxxer sentiment, science is heavily outgunned. It faces a rainbow coalition of metastasising folk suspicions on both the left and the right. Public health messages are little match for the memology of social media opponents.
It is that mix of technological savvy and intellectual derangement that drives today’s politics. Mr Trump did not invent postmodern quackery — though he has endorsed some life-threatening remedies. The irony is that he could fall victim to the mistrust he has stoked.
Should an effective vaccine loom into view before the US goes to the polls in 95 days, Mr Trump would not be the ideal person to inform the country. The story is as old as cry wolf. Having endorsed the use of disinfectants and hydroxychloroquine, Mr Trump has forfeited any credibility. Validation should come from Anthony Fauci, America’s top infectious-diseases expert, whose trust ratings are almost double those of the president he serves.
Even then, however, the challenge would only just be starting. There is no cause to doubt the world-beating potential of US scientific research. There are good reasons to suspect the medical establishment’s ability to win over public opinion.
The modern anti-vaxxer movement began on the left. It is still going strong. It follows the “my body is my temple” philosophy. Corporate science cannot be trusted to put healthy things into our bodies. The tendency for modern parents to award themselves overnight Wikipedia degrees in specialist fields is also to blame.
Not all of this mistrust is madcap. African Americans have good reason to distrust public health following the postwar Tuskegee experiments in which hundreds were infected with syphilis and left to fester without penicillin. Polls show that more blacks than whites would refuse a coronavirus vaccine. Given their higher likelihood of exposure, such mistrust has tragic potential.
But rightwing anti-vaxxers have greater momentum. America’s 19th century anti-vaccination movements drew equally from religious paranoia that vaccines were the work of the devil and a more general fear that liberty was under threat. Both strains have resurfaced in QAnon, the virtual cult that believes America is run by a satanic deep state that abuses children.
It would be hard to invent a more unhinged account of how the world works. Yet Mr Trump has retweeted QAnon-friendly accounts more than 90 times since the pandemic began. Among QAnon’s other theories is that Covid-19 is a Dr Fauci-led hoax to sink Mr Trump’s chances of being re-elected. Science cannot emulate such imaginative forms of storytelling.
All of which poses a migraine for the silent majority that would happily take the vaccine shots. Their lives are threatened both by a pandemic and by an infodemic. It is a bizarre feature of our times that the first looks easier to solve than the second.
Tuesday, 2 June 2020
The G20 should be leading the world out of the coronavirus crisis – but it's gone AWOL
In March it promised to support countries in need. Since then, virtual silence. Yet this pandemic requires bold, united leadership writes Gordon Brown in The Guardian
The G20’s video conference meeting in Brasilia on 26 March 26. Photograph: Marcos Correa/Brazilian Presidency/AFP via Getty Images
If coronavirus crosses all boundaries, so too must the war to vanquish it. But the G20, which calls itself the world’s premier international forum for international economic cooperation and should be at the centre of waging that war, has gone awol – absent without lending – with no plan to convene, online or otherwise, at any point in the next six months.
This is not just an abdication of responsibility; it is, potentially, a death sentence for the world’s poorest people, whose healthcare requires international aid and who the richest countries depend on to prevent a second wave of the disease hitting our shores.
On 26 March, just as the full force of the pandemic was becoming clear, the G20 promised “to use all available policy tools” to support countries in need. There would be a “swift implementation” of an emergency response, it said, and its efforts would be “amplified” over the coming weeks. As the International Monetary Fund (IMF) said at the time, emerging markets and developing nations needed at least $2.5tn (£2,000bn) in support. But with new Covid-19 cases round the world running above 100,000 a day and still to peak, the vacuum left by G20 inactivity means that allocations from the IMF and the World Bank to poorer countries will remain a fraction of what is required.
And yet the economic disruption, and the decline in hours worked across the world, is now equivalent to the loss of more than 300 million full-time jobs, according to the International Labour Organization. For the first time this century, global poverty is rising, and three decades of improving living standards are now in reverse. An additional 420 million more people will fall into extreme poverty and, according to the World Food Programme, 265 million face malnutrition. Developing economies and emerging markets have none of the fiscal room for manoeuvre that richer countries enjoy, and not surprisingly more than 100 such countries have applied to the IMF for emergency support.
The G20’s failure to meet is all the more disgraceful because the global response to Covid-19 should this month be moving from its first phase, the rescue operation, to its second, a comprehensive recovery plan – and at its heart there should be a globally coordinated stimulus with an agreed global growth plan.
To make this recovery sustainable the “green new deal” needs to go global; and to help pay for it, a coordinated blitz is required on the estimated $7.4tn hidden untaxed in offshore havens.
As a group of 200 former leaders state in today’s letter to the G20, the poorest countries need international aid within days, not weeks or months. Debt relief is the quickest way of releasing resources. Until now, sub-Saharan Africa has been spending more on debt repayments than on health. The $80bn owed by the 76 poorest nations should be waived until at least December 2021.
But poor countries also need direct cash support. The IMF should dip into its $35bn reserves, and the development banks should announce they are prepared to raise additional money.
A second trillion can be raised by issuing – as we did in the global financial crisis – new international money (known as special drawing rights), which can be converted into dollars or local currency. To their credit, European countries like the UK, France and Germany have already lent some of this money to poorer countries and, if the IMF agreed, $500bn could be issued immediately and $500bn more by 2022.
And we must declare now that any new vaccine and cure will be made freely available to all who need it – and resist US pressure by supporting the World Health Organization in its efforts to ensure the poorest nations do not lose out. This Thursday, at the pledging conference held for the global vaccine alliance in London, donor countries should contribute the $7bn needed to help make immunisation more widely available.
No country can eliminate infectious diseases unless all countries do so. And it is because we cannot deal with the health nor the economic emergency without bringing the whole world together that Donald Trump’s latest counterproposal – to parade a few favoured leaders in Washington in September – is no substitute for a G20 summit.
His event would exclude Africa, the Middle East, Latin America and most of Asia, and would represent only 2 billion of the world’s 7 billion people. Yet the lesson of history is that, at key moments of crisis, we require bold, united leadership, and to resist initiatives that will be seen as “divide and rule”.
So, it is time for the other 19 G20 members to demand an early summit, and avert what would be the greatest global social and economic policy failure of our generation.
If coronavirus crosses all boundaries, so too must the war to vanquish it. But the G20, which calls itself the world’s premier international forum for international economic cooperation and should be at the centre of waging that war, has gone awol – absent without lending – with no plan to convene, online or otherwise, at any point in the next six months.
This is not just an abdication of responsibility; it is, potentially, a death sentence for the world’s poorest people, whose healthcare requires international aid and who the richest countries depend on to prevent a second wave of the disease hitting our shores.
On 26 March, just as the full force of the pandemic was becoming clear, the G20 promised “to use all available policy tools” to support countries in need. There would be a “swift implementation” of an emergency response, it said, and its efforts would be “amplified” over the coming weeks. As the International Monetary Fund (IMF) said at the time, emerging markets and developing nations needed at least $2.5tn (£2,000bn) in support. But with new Covid-19 cases round the world running above 100,000 a day and still to peak, the vacuum left by G20 inactivity means that allocations from the IMF and the World Bank to poorer countries will remain a fraction of what is required.
And yet the economic disruption, and the decline in hours worked across the world, is now equivalent to the loss of more than 300 million full-time jobs, according to the International Labour Organization. For the first time this century, global poverty is rising, and three decades of improving living standards are now in reverse. An additional 420 million more people will fall into extreme poverty and, according to the World Food Programme, 265 million face malnutrition. Developing economies and emerging markets have none of the fiscal room for manoeuvre that richer countries enjoy, and not surprisingly more than 100 such countries have applied to the IMF for emergency support.
The G20’s failure to meet is all the more disgraceful because the global response to Covid-19 should this month be moving from its first phase, the rescue operation, to its second, a comprehensive recovery plan – and at its heart there should be a globally coordinated stimulus with an agreed global growth plan.
To make this recovery sustainable the “green new deal” needs to go global; and to help pay for it, a coordinated blitz is required on the estimated $7.4tn hidden untaxed in offshore havens.
As a group of 200 former leaders state in today’s letter to the G20, the poorest countries need international aid within days, not weeks or months. Debt relief is the quickest way of releasing resources. Until now, sub-Saharan Africa has been spending more on debt repayments than on health. The $80bn owed by the 76 poorest nations should be waived until at least December 2021.
But poor countries also need direct cash support. The IMF should dip into its $35bn reserves, and the development banks should announce they are prepared to raise additional money.
A second trillion can be raised by issuing – as we did in the global financial crisis – new international money (known as special drawing rights), which can be converted into dollars or local currency. To their credit, European countries like the UK, France and Germany have already lent some of this money to poorer countries and, if the IMF agreed, $500bn could be issued immediately and $500bn more by 2022.
And we must declare now that any new vaccine and cure will be made freely available to all who need it – and resist US pressure by supporting the World Health Organization in its efforts to ensure the poorest nations do not lose out. This Thursday, at the pledging conference held for the global vaccine alliance in London, donor countries should contribute the $7bn needed to help make immunisation more widely available.
No country can eliminate infectious diseases unless all countries do so. And it is because we cannot deal with the health nor the economic emergency without bringing the whole world together that Donald Trump’s latest counterproposal – to parade a few favoured leaders in Washington in September – is no substitute for a G20 summit.
His event would exclude Africa, the Middle East, Latin America and most of Asia, and would represent only 2 billion of the world’s 7 billion people. Yet the lesson of history is that, at key moments of crisis, we require bold, united leadership, and to resist initiatives that will be seen as “divide and rule”.
So, it is time for the other 19 G20 members to demand an early summit, and avert what would be the greatest global social and economic policy failure of our generation.
Thursday, 14 May 2020
Any Covid-19 vaccine must be treated as a global public good
David Pilling in The Financial Times
Imagine if, in a year’s time, 300m doses of a safe and effective Covid-19 vaccine have been manufactured in Donald Trump’s America, Xi Jinping’s China or Boris Johnson’s Britain. Who is going to get them? What are the chances that a nurse in India, or a doctor in Brazil, let alone a bus driver in Nigeria or a diabetic in Tanzania, will be given priority? The answer must be virtually nil.
The ugly battle between nations over limited supplies of tests and personal protective equipment will be a sideshow compared to the scramble over a vaccine. Yet if a vaccine is to be anything like the silver bullet that some imagine, it will have to be available to the world’s poor as well as to its rich.
Any vaccine should be deployed to create the maximum possible benefit to public health. That will mean prioritising doctors, nurses and other frontline workers, as well as those most vulnerable to the disease, no matter where they live or how much they can afford.
It will also mean deploying initially limited quantities of vaccine in order to snuff out clusters of infection by encircling them with a “curtain” of immunised people — as was done successfully against Ebola last year in the Democratic Republic of Congo.
With Covid-19, this looks like a pipe dream. Far from bringing the world together, the pandemic has exposed a crisis of international disunity. The World Health Organization is only as good as its member states allow. That it finds itself squeezed between China and the US when humanity is facing its worst pandemic in 100 years, is a sign of the broken international order.
How, under such circumstances, can we possibly conceive of a vaccine policy that is global, ethical and effective?
There are precedents. The principle of access to medicines was established with the HIV-Aids pandemic, in which life-saving medicines were originally priced far above the ability of patients in Africa and other parts of the developing world to pay.
But in 2001, in the so-called Doha declaration on Trade-Related Aspects of Intellectual Property Rights, the World Trade Organization made it clear that governments could override patents in public health emergencies. Largely as a result, a tiered pricing system has developed in which drug companies make profits in richer countries while allowing medicines to be sold more cheaply in poorer ones.
There are also tried-and-tested methods of funding immunisation campaigns that have saved literally millions of lives in Africa, Asia and Latin America. Gavi, the Vaccine Alliance, was founded in 2000 to address market failures. It guarantees the purchase of a set number of vaccine doses so that companies can manufacture existing, or develop new, vaccines knowing there will be a market for their product.
Along similar lines, 40 governments this month pledged $8bn to speed up the development, production and equitable deployment of Covid-19 vaccines, as well as diagnostics and therapeutics. There are already more than 80 candidates for a Covid-19 vaccine, with some of these now in human trials.
Then there is manufacturing. Lack of diagnostics and PPE has exposed the flaws of a just-in-time system that builds in no redundancy. Vaccine capacity must be built up now, even if that means some of it will go to waste. Nor can existing capacity simply be given over to a putative Covid-19 vaccine. That could unwittingly unleash outbreaks of previously controlled diseases, such as mumps or rubella.
Manufacturing will also have to be dispersed geographically to ensure a vaccine can be deployed globally.
Most vaccines are international collaborations. One against Ebola was discovered in Canada, developed in the US and manufactured in Germany. It is unlikely — and certainly undesirable — that any one country will be able to claim a Covid-19 vaccine all to itself.
Even if a successful candidate is developed, not everyone will want to take it.
Heidi Larson, director of the Vaccine Confidence Project, says surveys show that up to 9 per cent of British people, 18 per cent of Austrians and 20 per cent of Swiss would not agree to be immunised. Trust in vaccines is generally higher in the developing world, where the impact of infectious disease is more obvious. But here too there could be resistance, particularly if people suspect they are being used as guinea pigs.
The vaccine against a fictional pandemic in the 2011 film Contagion is distributed through a lottery based on birth date. When a vaccine against a real-life Covid-19 is found, it must be deployed as a global public good.
Health experts estimate it will cost some $20bn to vaccinate everyone on earth, equivalent to roughly two hours of global output. This is the best bargain in the world. Let us hope the world can recognise it.
Imagine if, in a year’s time, 300m doses of a safe and effective Covid-19 vaccine have been manufactured in Donald Trump’s America, Xi Jinping’s China or Boris Johnson’s Britain. Who is going to get them? What are the chances that a nurse in India, or a doctor in Brazil, let alone a bus driver in Nigeria or a diabetic in Tanzania, will be given priority? The answer must be virtually nil.
The ugly battle between nations over limited supplies of tests and personal protective equipment will be a sideshow compared to the scramble over a vaccine. Yet if a vaccine is to be anything like the silver bullet that some imagine, it will have to be available to the world’s poor as well as to its rich.
Any vaccine should be deployed to create the maximum possible benefit to public health. That will mean prioritising doctors, nurses and other frontline workers, as well as those most vulnerable to the disease, no matter where they live or how much they can afford.
It will also mean deploying initially limited quantities of vaccine in order to snuff out clusters of infection by encircling them with a “curtain” of immunised people — as was done successfully against Ebola last year in the Democratic Republic of Congo.
With Covid-19, this looks like a pipe dream. Far from bringing the world together, the pandemic has exposed a crisis of international disunity. The World Health Organization is only as good as its member states allow. That it finds itself squeezed between China and the US when humanity is facing its worst pandemic in 100 years, is a sign of the broken international order.
How, under such circumstances, can we possibly conceive of a vaccine policy that is global, ethical and effective?
There are precedents. The principle of access to medicines was established with the HIV-Aids pandemic, in which life-saving medicines were originally priced far above the ability of patients in Africa and other parts of the developing world to pay.
But in 2001, in the so-called Doha declaration on Trade-Related Aspects of Intellectual Property Rights, the World Trade Organization made it clear that governments could override patents in public health emergencies. Largely as a result, a tiered pricing system has developed in which drug companies make profits in richer countries while allowing medicines to be sold more cheaply in poorer ones.
There are also tried-and-tested methods of funding immunisation campaigns that have saved literally millions of lives in Africa, Asia and Latin America. Gavi, the Vaccine Alliance, was founded in 2000 to address market failures. It guarantees the purchase of a set number of vaccine doses so that companies can manufacture existing, or develop new, vaccines knowing there will be a market for their product.
Along similar lines, 40 governments this month pledged $8bn to speed up the development, production and equitable deployment of Covid-19 vaccines, as well as diagnostics and therapeutics. There are already more than 80 candidates for a Covid-19 vaccine, with some of these now in human trials.
Then there is manufacturing. Lack of diagnostics and PPE has exposed the flaws of a just-in-time system that builds in no redundancy. Vaccine capacity must be built up now, even if that means some of it will go to waste. Nor can existing capacity simply be given over to a putative Covid-19 vaccine. That could unwittingly unleash outbreaks of previously controlled diseases, such as mumps or rubella.
Manufacturing will also have to be dispersed geographically to ensure a vaccine can be deployed globally.
Most vaccines are international collaborations. One against Ebola was discovered in Canada, developed in the US and manufactured in Germany. It is unlikely — and certainly undesirable — that any one country will be able to claim a Covid-19 vaccine all to itself.
Even if a successful candidate is developed, not everyone will want to take it.
Heidi Larson, director of the Vaccine Confidence Project, says surveys show that up to 9 per cent of British people, 18 per cent of Austrians and 20 per cent of Swiss would not agree to be immunised. Trust in vaccines is generally higher in the developing world, where the impact of infectious disease is more obvious. But here too there could be resistance, particularly if people suspect they are being used as guinea pigs.
The vaccine against a fictional pandemic in the 2011 film Contagion is distributed through a lottery based on birth date. When a vaccine against a real-life Covid-19 is found, it must be deployed as a global public good.
Health experts estimate it will cost some $20bn to vaccinate everyone on earth, equivalent to roughly two hours of global output. This is the best bargain in the world. Let us hope the world can recognise it.
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