Caught in tangled web of vaccine nationalism

Jomo Kwame Sundaram

KUALA LUMPUR: “Oh what a tangled web we weave When first we practice to deceive”. Walter Scott’s lines, already over two centuries old, nicely sum up how pursuit of national advantage and private gain have undermined the public interest and the common good.

As known COVID-19 infections exceed 100 million internationally, with more than two million lives lost, rich countries are now quarrelling publicly over access to limited vaccine supplies. With ‘vaccine nationalism’ widespread, multilateral arrangements have not been able to address current challenges well.

Vaccine nationalism has meant that the rich and powerful come first, not only in societies, but also in the world, making a mockery of the ‘No one left behind’ slogan embraced by the international community.

Many developing countries and most of their people will have to wait for access to vaccines while the powerful and better off secure prior access regardless of need or urgency.

Vaccine nationalism and the prospect of more profits by not scaling up output to induce scarcity may thus cause more losses of both lives and livelihoods, causing economies to slow further.

TRIPS waiver blocked

The 1994 World Trade Organization (WTO) agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) greatly strengthened and extended intellectual property rights (IPRs)transnationally. It is easy to forget that strict cross-border enforcement of IPRs claims are relatively recent.

While many assume that IPRs are needed to promote research and development for technological progress, this is seriously challenged by most serious histories and historians of technology.

Perhaps more importantly, there is considerable evidence that IPRs may well have inadvertently slowed progress. More generally, IPRs have discouraged research cooperation and knowledge sharing, so essential to progress.

By enabling, and thus encouraging ‘patent trolling’ and hoarding, IPRs have effectively denied access to patented products and processes except to the highest bidders.

Public health exception

Following the pushback to the original TRIPS, boosted by Nelson Mandela after he became South African President in 1994, developing countries have secured legal access to ‘essential medicines’.

A 2001 WTO Declaration on TRIPS and Public Health affirmed the right of countries to protect public health, enable access to medicines, and issue a compulsory license (CL), even without a health emergency.

In return for developing countries extending IP protection, developed countries promised to establish manufacturing capabilities for patented processes in developing countries, and incentivise their transnational corporations (TNCs) to enable technology transfer to developing countries, especially the least developed countries (LDCs).

In 2017, the TRIPS Agreement was amended to confirm developing countries unable to domestically produce certain pharmaceuticals, could issue compulsory licenses to import patented drugs produced abroad under compulsory licensing.

But although TRIPS now allows such use of compulsory licensing, developing countries are still constrained by its complex rules, procedures and conditions as well as constant TNC threats and inducements, supported by their governments.

Hence, use of compulsory licensing by developing countries has been largely limited to several more independent middle-income countries, such as India, Thailand, Indonesia and Malaysia, and to HIV/AIDS medicines.

TRIPS waiver

The TRIPS waiver – proposed by South Africa, India and others to the WTO – seeks temporary suspension of several TRIPS provisions on patents, design and protection of undisclosed information.

The proposed waiver seeks to greatly scale up production of and access to COVID-19 vaccines, medicines and equipment, especially in developing countries, to contain the contagion. But the Trump administration, the European Union (EU) and their allies have stubbornly blocked the waiver.

The EU claims “an [intellectual property] system is…also to ensure the publication and dissemination of research results, when otherwise they will remain secret.” It omits to acknowledge that no vaccine developer has shared research results needed to scale up vaccine output by others, including generic producers.

Vaccine nationalism rules

Although the waiver implies treating vaccine production and distribution as public goods, and the European Commission (EC) President Ursula von der Leyen has spoken about “working together” and “solidarity” for the “public good”, the EU continues to block it.

But after AstraZeneca and Pfizer failed to meet their contractual obligations to deliver vaccines to EU countries, the now embattled EC President has criticised the companies for not meeting their contractual obligations. She did not hesitate to emphasise that EU taxpayers and governments had paid much to accelerate vaccine development and production.

Ironically, the most feasible way forward now involves approving the TRIPS waiver at the WTO. The US and EU governments can make the badly needed breakthrough and thus do much to restore international confidence in their intentions.

With Biden announcing the US re-joining the World Health Organization (WHO), the new administration can not only lift the embargo on exports of vaccines, vital medicines and equipment, but also advocate for the TRIPS waiver, quickly winning appreciation for his commitment to multilateral leadership.

US taxpayers have already spent many billions for Trump’s Operation Warp Speed to accelerate private vaccine development and distribution. Now, both the US and EU are well placed to greatly accelerate vaccine production and distribution for the world at relatively little additional cost.

They can do so by ensuring that relevant information is quickly shared to rapidly scale up vaccine production. For example, mass vaccine production capacity remains limited internationally, but it is the Serum Institute of India, not a developed country facility, which is acknowledged as the world leader by far.

Poor lives matter, but less

Jomo Kwame Sundaram

KUALA LUMPUR: Current development fads fetishize data, ostensibly for ‘evidence-based policy-making’: if not measured, it will not matter. So, forget about getting financial resources for your work, programmes and projects, no matter how beneficial, significant or desperately needed.

Measure for measure

Agencies, funds, programmes and others lobby and fight for attention by showcasing their own policy agendas, ostensible achievements and potential. Many believe that the more indicators they get endorsed by the ‘international community’, the more financial support they can expect to secure.

Collecting enough national data to properly monitor progress on the Sustainable Development Goals is expensive. Data collection costs, typically borne by the countries themselves, have been estimated at minimally over three times total official development assistance (ODA).

Remember aid declined after the US-Soviet Cold War, and again following the 2008-9 global financial crisis. More recently, much more ODA is earmarked to ‘support’ private investments from donor countries.

With data demands growing, more pressure to measure has led to either over- or under-stating both problems and progress, sometimes with no dishonest intent. ‘Errors’ can easily be explained away as statistics from poor countries are notoriously unreliable.

Political, bureaucratic and funding considerations limit the willingness to admit that reported data are suspect for fear this may reflect poorly on those responsible. And once baseline statistics have been established, similar considerations compel subsequent ‘consistency’ or ‘conformity’ in reporting.

And when problems have to be acknowledged, ‘double-speak’ may be the result. Organisations may then start reporting some statistics to the public, with other data used, typically confidentially, for ‘in-house’ operational purposes.

Money, money, money

Economists generally prefer and even demand the use of money-metric measures. The rationale often is that no other meaningful measure is available. Many believe that showing ostensible costs and benefits is more likely to raise needed funding. Using either exchange rates or purchasing power parity (PPP) has been much debated. Some advocate even more convenient measures such as the prices of a standard McDonald’s hamburger in different countries.

Money-metrics imply that estimated economic losses due to, say, smoking or non-communicable diseases (NCDs), including obesity, tend to be far greater in richer countries, owing to the much higher incomes lost or foregone as well as costs incurred.

Development discourse changes

The four UN Development Decades after 1960 sought to accelerate economic progress and improve social wellbeing. Unsurprisingly, for decades, there have been various debates in the development discourse on measuring progress.

The rise of neoliberal economic thinking, claiming to free markets, has instead mainly strengthened and extended private property rights. Rejecting Keynesian and development economics, both associated with state intervention, neoliberalism’s influence peaked around the turn of the century.

The so-called ‘Washington Consensus’ of US federal institutions from the 1980s also involved the Bretton Woods institutions, the International Monetary Fund (IMF) and World Bank, both headquartered in the American capital.

In 2000, the UN Secretariat drafted the Millennium Declaration. This, in turn, became the basis for the Millennium Development Goals which gave primacy to halving the number of poor. After all, who would object to reducing poverty. The poor were defined with reference to a poverty line, somewhat arbitrarily defined by the Bank.

Poverty fetish

Presuming money income to be a universal yardstick of wellbeing, this poverty measure has been challenged on various grounds. Most in poorer developing countries sense that much nuance and variation are lost in such measures, not only for poverty, but also for, say, hunger.

Anyone familiar with the varying significance, over time, of cash incomes and prices in most countries will be uncomfortable with such singular measures. But they are nonetheless much publicised and have implied continued progress until the Covid-19 pandemic.

Rejection of such singular poverty measures has led to multi-dimensional poverty indicators, typically to meet ‘basic needs’. While such ‘dashboard’ statistics offer more nuance, the continued desire for a single metric has led to the development, promotion and popularisation of composite indicators.

Worse, this has been typically accompanied by problematic ranking exercises using such composite indicators. Many have become obsessed with such ranking, instead of the underlying socio-economic processes and actual progress.

Blind neglect

Improving such metrics has thus become an end in itself, with little debate over such one-dimensional means of measuring progress. The consequent ‘tunnel vision’ has meant ignoring other measures and indicators of wellbeing.

In recent decades, instead of subsistence agriculture, cash crops have been promoted. Yet, all too many children of cash-poor subsistence farmers are nutritionally better fed and healthier than the offspring of monetarily better off cash crop or ‘commercial’ farmers.

Meanwhile, as cash incomes rise, those with diet-related NCDs have been growing. While life expectancy has risen in much of the world, healthy life expectancy has progressed less as ill health increasingly haunts the sunset years of longer lives.

Be careful what you wish for

Meanwhile, as poor countries get limited help in their efforts to adjust to global warming, rich countries’ focus on supporting mitigation efforts has included, inter alia, promoting ‘no-till agriculture’. Thus attributing greenhouse gas emissions implies corresponding mitigation efforts via greater herbicide use.

Maximising carbon sequestration in unploughed farm topsoil requires more reliance on typically toxic, if not carcinogenic pesticides, especially herbicides. But addressing global warming should not be at the expense of sustainable agriculture.

Similarly, imposing global carbon taxation will raise the price of, and reduce access to electricity for the ‘energy-poor’, who comprise a fifth of the world’s population. Rich countries subsidising affordable renewable energy for poor countries and people would resolve this dilemma.

Following the 2008-2009 global financial crisis, the UN proposed a Global Green New Deal (GGND) which included such cross-subsidisation by rich countries of sustainable development progress elsewhere.

The 2009 London G20 summit succeeded in raising more than the trillion dollars targeted. But the resources mainly went to strengthening the IMF, rather than for the GGND proposal. Thus, the finance fetish blocked a chance to revive world economic growth, with sustainable development gains for all.

Nothing to Learn from East Asia?

Jomo Kwame Sundaram

KUALA LUMPUR: Covid-19 infection and death rates in the Western world and many developing countries in Asia and Latin America have long overtaken East Asia since the second quarter of 2020. Perhaps unsurprisingly, considering prevailing Western accounts of the Asian financial crises, there have been no serious efforts to draw policy lessons from East Asian contagion containment.

Lockdowns necessary?

Although most East Asian economies have successfully contained the pandemic without nationwide ‘stay in shelter lockdowns’, many governments have seen such measures as necessary. But lockdowns are blunt measures, with inevitable adverse consequences, especially for businesses and employment.

Many countries have thus imposed lockdowns, citing China’s response in Wuhan. But as the first WHO fact-finding mission to China noted, “The majority of the response in China, in 30 provinces, was about case finding, contact tracing, and suspension of public gatherings—all common measures used anywhere in the world to manage [infectious] diseases.

Lockdowns were limited to a few cities where contagion went “out of control in the beginning”. The key lesson from China was “all about…speed. The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be.”

To be sure, lockdowns ‘flatten the curve’ by temporarily preventing further contagion. But unless accompanied by appropriate complementary measures, undetected infectious individuals may cause silent community transmission that becomes evident only too late. Instead of lockdowns, it is far more prudent to find and isolate cases before numbers become unmanageable.

South Korean lessons

The Republic of Korea was the first country to dramatically reduce the number of Covid-19 cases and related deaths without nationwide movement restrictions. It checked the spread of Covid-19 infections without imposing lockdowns, even in Daegu its most infected city.

Mass testing has been key to its response, doing the most by mid-March. By late March, Korea’s newly confirmed cases had fallen from second to eighth place in the world. Meanwhile, Korean authorities urged physical distancing, personal hygiene and remote work while discouraging mass gatherings.

The government also had legal authority to collect phone, credit card and other data to expedite contact tracing, and initially only restricted incoming travellers from Hubei province, where Wuhan is, for precautionary reasons, and from Japan in political retaliation.

Just as China had rapidly identified pathogen characteristics using artificial intelligence and big data access, Korea innovatively deployed new technologies to expedite rapid responses to trace, test, treat and isolate those infected.

Lessons from Vietnam

Three months ago, a Vietnamese official described how “Vietnam is fighting Covid without pitting economic growth against public health”. Besides testing and contact-tracing, “the government has depoliticised the pandemic, treating it purely as a health crisis, allowing for effective governance”.

Hence, there is “no political motive for government officials to hide information, as they don’t face being reprimanded if there are positive cases in their authority area that are not due to their mistakes”.

He noted that “With the head of the Hanoi centre for disease control being arrested for suspected corruption in relation to the purchase of testing kits, and small traders getting fines for price-gouging face-masks, the government has also been clear that public health cannot be entangled with commercial interests”.

After China announced its first infections and deaths in January 2020, “Vietnam tightened its border and airport control of Chinese visitors. This wasn’t an easy decision, given that cross-border trade with China accounts for a significant part of the Vietnamese economy”.

Vietnam also “took precautionary measures above and beyond World Health Organization recommendations”. Preparations started “a week before the outbreak was officially declared a public health emergency of international concern, and more than a month before WHO declared Covid-19 a pandemic”.

The communist-led government also ensured “freedom of information on Covid-related matters”. “Lockdown and isolation are more selective” from the outset, without resorting to nationwide lockdowns, as has happened elsewhere without much benefit.

Vietnam is one of the few countries with “positive GDP growth” in 2020; “the supposed trade-off between the economy and public health… looks to be something of a false choice”.

In their war, Vietnam is believed to have lost over three million people compared to 58,209 US lives. In fighting the virus, Vietnam, with 97 million people, has lost 35 lives so far, while the US, with a 332 million population, has lost almost four hundred thousand.

Mass testing crucial

After a year of living with Covid-19, all governments can learn a great deal from critical evaluation of their own country experiences, other experiences as well as accumulated, especially new knowledge relevant to feasible policy options.

Thus far, appropriate East Asian policy measures for rapid early detection, isolation and contact tracing, while protecting the most vulnerable and treating the infected, have succeeded in flattening the curve.

More reliable, cheaper methods (e.g., ‘lateral-flow’ antigen tests) allow more frequent mass testing. As undetected cases are more likely to spread infection, such tests enable more frequent, faster and easier testing and quicker results, and facilitate faster, more efficacious actions.

This can help check contagion by identifying more of those infected earlier, thus reducing transmission. Even though less accurate than supposed ‘gold standards’, lower costs allow more widespread and frequent testing to identify many more of those infected.

Easier to administer and delivering results more rapidly, such cheaper, simpler and quicker tests more speedily detect the infected, especially among the asymptomatic, in time for appropriate and timely action.

As SARS-CoV-2 transmission peaks several days after infection, together with the viral load, more frequent testing is necessary to check contagion. More frequent mass testing is probably going to detect many more of those infected much earlier, while they are still infectious.

Look East

In the early 20th century, a young Cambridge-trained doctor, Wu Lien Teh returned to practice in the British colony of Penang where he mobilised thousands against the opium trade. The authorities arrested him, forcing him to seek employment outside the British empire.

He eventually found work with China’s Ching emperor in Manchuria where a plague was raging, eventually claiming 60,000 lives. Recognising it as pneumonic, Wu recommended use of multi-layered masks he designed to protect users against airborne infection, now recognised as forerunner of the N95 mask.

His later analysis of the socio-behavioural determinants of zoonotic transmission of the epidemic was also pioneering. Sadly, a famous French doctor Gerald Mesny, who rejected Wu’s mask advice as diagnostically wrong, died of the plague soon after arrival.

Over a century later, and over two decades after the 1997-1998 Asian financial crisis exposed the systemic financial fragility creating conditions for the 2008-2009 global financial crisis, the reluctance to learn from the East continues, ignoring Prophet Muhammad’s advice to ‘seek knowledge, even unto China’.